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Ledda RE, Sabia F, Valsecchi C, Suatoni P, Milanese G, Rolli L, Marchianò AV, Pastorino U. The added value of an AI-based body composition analysis in a lung cancer screening population: preliminary results. Nutr Metab Cardiovasc Dis 2024:S0939-4753(24)00275-8. [PMID: 39278738 DOI: 10.1016/j.numecd.2024.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 07/12/2024] [Accepted: 07/15/2024] [Indexed: 09/18/2024]
Abstract
BACKGROUND AND AIMS Body composition has been linked with clinical and prognostic outcomes in patients with cancer and cardiovascular diseases. Body composition analysis in lung cancer screening (LCS) is very limited. This study aimed at assessing the association of subcutaneous fat volume (SFV) and subcutaneous fat density (SFD), measured on chest ultra-low dose computed tomography (ultra-LDCT) images by a fully automated artificial intelligence (AI)-based software, with clinical and anthropometric characteristics in a LCS population. METHODS AND RESULTS Demographic, clinical, and dietary data were obtained from the written questionnaire completed by each participant at the first visit, when anthropometric measurements, blood sample collection and chest ultra-LDCT were performed. Images were analyzed for automated 3D segmentation of subcutaneous fat and muscle. The analysis included 938 volunteers (372 females); men with a smoking history of ≥40 pack-years had higher SFV (p = 0.0009), while former smokers had lower SFD (p = 0.0019). In female participants, SFV and SFD differed significantly according to age. SFV increased with rising BMI, waist circumference, waist-hip ratio, and CRP levels ≥2 mg/L (p < 0.0001), whereas SFD decreased with rising BMI, waist circumference, waist-hip ratio, and CRP levels ≥2 mg/L (p < 0.001) in both sexes. SFV was associated with glycemia and triglycerides levels (p = 0.0067 and p=<0.0001 in males, p = 0.0074 and p < 0.0001 in females, respectively), while SFD with triglycerides levels (p < 0.0001). CONCLUSION We observed different associations of SFV and SFD with age and smoking history between men and women, whereas the association with anthropometric data, CRP, glycemia and triglycerides levels was similar in the two sexes.
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Affiliation(s)
- Roberta Eufrasia Ledda
- Thoracic Surgery Unit, Fondazione IRCCS Istituto Nazionale Tumori, Via Venezian 1, 20133 Milan, Italy; Department of Medicine and Surgery (DiMeC), University of Parma, Via Gramsci 14, 43126, Parma, Italy.
| | - Federica Sabia
- Thoracic Surgery Unit, Fondazione IRCCS Istituto Nazionale Tumori, Via Venezian 1, 20133 Milan, Italy.
| | - Camilla Valsecchi
- Thoracic Surgery Unit, Fondazione IRCCS Istituto Nazionale Tumori, Via Venezian 1, 20133 Milan, Italy.
| | - Paola Suatoni
- Thoracic Surgery Unit, Fondazione IRCCS Istituto Nazionale Tumori, Via Venezian 1, 20133 Milan, Italy.
| | - Gianluca Milanese
- Department of Medicine and Surgery (DiMeC), University of Parma, Via Gramsci 14, 43126, Parma, Italy.
| | - Luigi Rolli
- Thoracic Surgery Unit, Fondazione IRCCS Istituto Nazionale Tumori, Via Venezian 1, 20133 Milan, Italy.
| | - Alfonso Vittorio Marchianò
- Division of Radiology, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian 1, 20133 Milan, Italy.
| | - Ugo Pastorino
- Thoracic Surgery Unit, Fondazione IRCCS Istituto Nazionale Tumori, Via Venezian 1, 20133 Milan, Italy.
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Kojima M, Mochida Y, Shoko T, Inoue A, Hifumi T, Sakamoto T, Kuroda Y. Association between body mass index and clinical outcomes in patients with out-of-hospital cardiac arrest undergoing extracorporeal cardiopulmonary resuscitation: A multicenter observational study. Resusc Plus 2023; 16:100497. [PMID: 38033346 PMCID: PMC10682674 DOI: 10.1016/j.resplu.2023.100497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 10/20/2023] [Accepted: 10/26/2023] [Indexed: 12/02/2023] Open
Abstract
Background We examined the association between body mass index (BMI) and outcomes in patients with out-of-hospital cardiac arrest (OHCA) undergoing extracorporeal cardiopulmonary resuscitation (ECPR). Methods We retrospectively analyzed the database of an observational multicenter cohort in Japan. Adult patients with OHCA of cardiac etiology who received ECPR between 2013 and 2018 were categorized as follows: underweight, BMI < 18.5; normal weight, BMI = 18.5-24.9; overweight, BMI = 25-29.9; and obese, BMI ≥ 30 kg/m2. The primary outcome was in-hospital mortality; secondary outcomes were unfavorable neurological outcomes at discharge (cerebral performance category ≥ 3) and ECPR-related complications. BMI's association with outcomes was assessed using a logistic regression model adjusted for age, sex, comorbidities, witness/bystander CPR, initial rhythm, prehospital return of spontaneous circulation, and low-flow time. Results In total, 1,044 patients were analyzed. Their median age was 61 (IQR, 49-69) years; the median BMI was 24.2 (21.5-26.9) kg/m2. The overall rates of in-hospital mortality, unfavorable neurological outcome, and ECPR-related complications were 62.2%, 79.9%, and 31.7%, respectively. In multivariate analysis, the overweight and obese groups had higher in-hospital mortality odds than the normal BMI group (odds ratio [95%CI], 1.37 [1.02-1.85], p = 0.035; and 2.09 [1.31-3.39], p < 0.001, respectively). The odds ratio for unfavorable neurological outcomes increased more in the obese than in the normal BMI group (3.17 [1.69-6.49], p < 0.001). ECPR-related complications were not significantly different among groups. Conclusions In OHCA patients undergoing ECPR, a BMI ≥ 25 kg/m2 was associated with increased in-hospital mortality, and a BMI ≥ 30 kg/m2 was also associated with a worse neurological outcome.
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Affiliation(s)
- Mitsuaki Kojima
- Emergency and Critical Care Centre, Tokyo Women’s Medical University Adachi Medical Centre, 4-33-1, Kohoku, Adachi, Tokyo 123-8558, Japan
| | - Yuzuru Mochida
- Emergency and Critical Care Centre, Tokyo Women’s Medical University Adachi Medical Centre, 4-33-1, Kohoku, Adachi, Tokyo 123-8558, Japan
| | - Tomohisa Shoko
- Emergency and Critical Care Centre, Tokyo Women’s Medical University Adachi Medical Centre, 4-33-1, Kohoku, Adachi, Tokyo 123-8558, Japan
| | - Akihiko Inoue
- Department of Emergency and Critical Care Medicine, Hyogo Emergency Medical Centre, 1-3-1 Wakinohamakaigandori, Chuo, Kobe, Hyogo 651-0073, Japan
| | - Toru Hifumi
- Department of Emergency and Critical Care Medicine, St. Luke’s International Hospital, 9-1 Akashi, Chuo, Tokyo 104-8560, Japan
| | - Tetsuya Sakamoto
- Department of Emergency Medicine, Teikyo University School of Medicine, 2-11-2 Kaga, Itabashi, Tokyo 173-8606, Japan
| | - Yasuhiro Kuroda
- Department of Emergency Medicine, Kagawa University School of Medicine, 1750-1 Ikenobe, Miki, Kita, Kagawa 761-0793, Japan
| | - SAVE-J II study group
- Emergency and Critical Care Centre, Tokyo Women’s Medical University Adachi Medical Centre, 4-33-1, Kohoku, Adachi, Tokyo 123-8558, Japan
- Department of Emergency and Critical Care Medicine, Hyogo Emergency Medical Centre, 1-3-1 Wakinohamakaigandori, Chuo, Kobe, Hyogo 651-0073, Japan
- Department of Emergency and Critical Care Medicine, St. Luke’s International Hospital, 9-1 Akashi, Chuo, Tokyo 104-8560, Japan
- Department of Emergency Medicine, Teikyo University School of Medicine, 2-11-2 Kaga, Itabashi, Tokyo 173-8606, Japan
- Department of Emergency Medicine, Kagawa University School of Medicine, 1750-1 Ikenobe, Miki, Kita, Kagawa 761-0793, Japan
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Jones BA, Thornton MA, Heid CA, Burke KL, Scrushy MG, Abdelfattah KR, Wolf SE, Khoury MK. Survival after multiple episodes of cardiac arrest. Heart Lung 2023; 58:98-103. [PMID: 36446264 DOI: 10.1016/j.hrtlng.2022.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 11/18/2022] [Accepted: 11/22/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Cardiopulmonary resuscitation (CPR) is widely used in response to cardiac arrest. However, little is known regarding outcomes for those who undergo multiple episodes of cardiac arrest while in the hospital. OBJECTIVES The purpose of this study was to evaluate the association of multiple cardiac events with in-hospital mortality for patients admitted to our tertiary care hospital who underwent multiple code events. METHODS We performed a retrospective cohort study on all patients who underwent cardiac arrest from 2012 to 2016. Primary outcome was survival to discharge. Secondary outcomes included post-cardiac-arrest neurologic events (PCANE), non-home discharge, and one-year mortality. RESULTS There were 622 patients with an overall mortality rate of 78.0%. Patients undergoing CPR for cardiac arrest once during their admission had lower in-hospital mortality rates compared to those that had multiple (68.9% versus 91.3%, p<.01). Subset analysis of those who had multiple episodes of CPR revealed that more than one event within a 24-hour period led to significantly higher in-hospital mortality rates (94.7% versus 74.4%, p<.01). Other variables associated with in-hospital mortality included body mass index, female sex, malignancy, and increased down time per code. Patients that had a non-home discharge were more likely to have sustained a PCANE than those that were discharged home (31.4% versus 3.9%, p<.01). A non-home discharge was associated with higher one-year mortality rates compared to a home discharge (78.4% versus 54.3%, p=.01). CONCLUSION Multiple codes within a 24-hour period and the average time per code were associated with in-hospital mortality in cardiac arrest patients.
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Affiliation(s)
- Bayley A Jones
- University of Texas, Southwestern Medical Center; Department of Surgery; Division of Trauma and Acute Care Surgery; Dallas, TX
| | - Micah A Thornton
- Southern Methodist University, Department of Statistical Science; Dallas, TX
| | - Christopher A Heid
- University of Texas, Southwestern; Department of Cardiothoracic Surgery; Division of Cardiac Surgery; Dallas, TX
| | - Kristen L Burke
- University of Texas, Southwestern Medical Center; Department of Surgery; Division of Trauma and Acute Care Surgery; Dallas, TX
| | - Marinda G Scrushy
- University of Texas, Southwestern Medical Center; Department of Surgery; Division of Trauma and Acute Care Surgery; Dallas, TX
| | - Kareem R Abdelfattah
- University of Texas, Southwestern Medical Center; Department of Surgery; Division of Trauma and Acute Care Surgery; Dallas, TX
| | - Steven E Wolf
- University of Texas Medical Branch, Galveston; Department of Surgery; Division of Trauma and Acute Care Surgery; Galveston, TX
| | - Mitri K Khoury
- University of Texas, Southwestern Medical Center; Department of Surgery; Division of Trauma and Acute Care Surgery; Dallas, TX; Massachusetts General Hospital; Department of Surgery; Division of Vascular and Endovascular Surgery; Boston, MA.
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Longo JA, Lyman KJ, Hanson TA, Christensen B, Del Rossi G. An Evaluation of the Quality of CPR Chest Compressions Performed on Football-Equipped and Obese Simulation Manikins. PREHOSP EMERG CARE 2023; 28:92-97. [PMID: 36692382 DOI: 10.1080/10903127.2023.2172494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 01/15/2023] [Indexed: 01/25/2023]
Abstract
OBJECTIVE Protective athletic equipment may hamper the delivery of effective chest compressions. Unfortunately, an algorithm for managing cardiac arrest emergencies with equipment-laden athletes has yet to be established by national CPR certifying agencies. Further, athletes classified as being overweight or obese carry adipose in the thoracic region, which has been reported to inhibit the ability of rescuers to provide quality chest compressions. Thus, the purpose of this study was two-fold. The first purpose was to assess the ability of emergency responders to perform CPR chest compressions on an obese manikin. The second purpose was to analyze the effect of American football protective equipment on the performance of chest compressions by emergency responders. METHODS Fifty emergency responders completed four 2-minute bouts of compression-only CPR. The scenarios included performing chest compressions on both traditional and obese CPR manikins, and performing chest compressions over a set of shoulder pads/chest protector that is used in the sport of American football on both traditional and obese manikins. RESULTS The most notable outcomes in this study were related to chest compression depth, which fell well below the minimum recommended depth published by the American Heart Association in all conditions. Mean compression depth was significantly lower when performed on the obese manikin (avg over pads = 32.8, SD = 9.2 mm; avg no pads = 38.2, SD = 9.1 mm) compared to the traditional manikin (avg over pads = 40.0, SD = 10.9 mm; avg no pads = 40.8, SD = 14.8 mm), with statistical analyses revealing a significant effect due to both manikin size (p < 0.001) and the presence of equipment (p = 0.003), and a statistically significant interaction effect (p = 0.035). Chest recoil data revealed a statistically significant effect due to both manikin size (p = 0.017) and the presence of chest/shoulder safety pads (p = 0.003). CONCLUSION Within this sample of emergency responders, chest compressions were adversely affected both by the equipment and obesity. Additionally, the traditional manikin received comparable chest compressions regardless of the presence or absence of football protective equipment, albeit both conditions resulted in poor depth performance.
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Do Body Mass Index and Nutritional Risk Score 2002 Influence the In-Hospital Mortality of Patients Following Cardiac Arrest? Nutrients 2023; 15:nu15020436. [PMID: 36678307 PMCID: PMC9863085 DOI: 10.3390/nu15020436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 01/09/2023] [Accepted: 01/13/2023] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Contemporarily, cardiac arrest (CA) remains one of the leading causes of death. Poor nutritional status can increase the post-CA mortality risk. The aim of this study was to determine the relationship between body mass index (BMI) and Nutritional Risk Score 2002 (NRS 2002) results and in-hospital mortality in patients admitted to the intensive care unit (ICU) after in-hospital and out-of-hospital cardiac arrest. METHODS A retrospective study and analysis of medical records of 161 patients admitted to the ICU of the University Clinical Hospital in Wrocław (Wrocław, Poland) was conducted. RESULTS No significant differences in body mass index (BMI) and nutritional risk score (NRS 2002) values were observed between non-survivors and survivors. Non-survivors had significantly lower albumin concentration (p = 0.017) and total cholesterol (TC) (p = 0.015). In multivariate analysis BMI and NRS 2002 scores were not, per se, associated with the in-hospital mortality defined as the odds of death (Model 1: p: 0.700, 0.430; Model 2: p: 0.576, 0.599). Univariate analysis revealed significant associations between the hazard ratio (HR) and TG (p ≈ 0.017, HR: 0.23) and hsCRP (p ≈ 0.018, HR: 0.34). In multivariate analysis, mortality risk over time was influenced by higher scores in parameters such as BMI (HR = 0.164; p = 0.048) and hsCRP (HR = 1.006, p = 0.002). CONCLUSIONS BMI and NRS 2002, on their own (unconditionally - in the whole study group) did not alter the odds of mortality in patients admitted to the intensive care unit (ICU) after in-hospital and out-of-hospital cardiac arrest. The risk of in-hospital mortality (expressed as hazard ratio - the risk over the time period of the study) increased with an increase in BMI but not with NRS 2002.
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Chavda MP, Bihari S, Woodman RJ, Secombe P, Pilcher D. The impact of obesity on outcomes of patients admitted to intensive care after cardiac arrest. J Crit Care 2022; 69:154025. [PMID: 35339901 DOI: 10.1016/j.jcrc.2022.154025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 03/11/2022] [Accepted: 03/16/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE Studies examining the association between obesity and mortality in cardiac arrest patients have been conflicting which might either be due to residual confounding, or a reliance on estimating the conditional effects rather than the marginal (causal) effects of obesity. We estimated the conditional and causal effects of obesity on mortality in cardiac arrest patients using the Australian and New Zealand Intensive Care Society (ANZICS) Adult Patient Database (APD). MATERIALS AND METHODS This retrospective registry-based cohort study from ICUs of Australia and New Zealand included all ICU patients admitted with cardiac arrest between 2010 and 2020 with height and weight data recorded. The conditional and marginal effects of obesity on mortality was estimated using multivariate binary logistic regression and Targeted Maximum Likelihood Estimation (TMLE) respectively. The primary outcome was in-hospital mortality. RESULTS A total 13,970 patients had complete data and were available for analysis. In multivariate binary logistic regression, there was no difference in the odds of in-hospital mortality for the obese versus non-obese groups; adjusted OR = 0.95, 95% CI = 0.87-1.03; p 0.25. Results were similar using TMLE (Marginal OR= 0.97; 95% CI = 0.91-1.02, p = 0.62). CONCLUSION After adjustment, there was no association between obesity and outcomes in cardiac arrest patients admitted to ICU.
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Affiliation(s)
- Mitul P Chavda
- Intensive Care Unit, Flinders Medical Centre, SA, Australia.
| | - Shailesh Bihari
- Intensive Care Unit, Flinders Medical Centre, SA, Australia; College of Medicine and Public Health, Flinders University, Bedford Park, SA 5042, Australia
| | - Richard J Woodman
- Centre of Epidemiology and Biostatistics, College of Medicine and Public Health, Flinders University, SA, Australia
| | - Paul Secombe
- Intensive Care Unit, Alice Springs Hospital, NT, Australia; School of Medicine, Flinders University, SA, Australia; School of Public Health and Preventive Medicine, Monash University, VIC, Australia
| | - David Pilcher
- School of Public Health and Preventive Medicine, Monash University, VIC, Australia; Intensive Care Unit, The Alfred Hospital, VIC, Australia; Australia and New Zealand Intensive Care Society Centre for Outcome and Resource Evaluation, VIC, Australia
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Ong GYK, Ang AJF, Chen ZJ, Chan YH, Tang PH, Fong ESS, Tan JY, Aurangzeb AS, Pek JH, Maconochie I, Ng KC, Nadkarni V. Should paediatric chest compression depth targets consider body habitus? - A chest computed tomography imaging study. Resusc Plus 2022; 9:100202. [PMID: 35118434 PMCID: PMC8792407 DOI: 10.1016/j.resplu.2022.100202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 12/14/2021] [Accepted: 01/03/2022] [Indexed: 01/03/2023] Open
Abstract
AIM This study explored how body habitus in the paediatric population might potentially affect the use of one-third external anterior-posterior (APD) diameter when compared to age-appropriate absolute chest compression depth targets. It also explored how body habitus could potentially affect the relationship between one-third external and internal APD (compressible space) and if body habitus indices were independent predictors of internal APD at the lower half of the sternum. METHODS This was a secondary analysis of a retrospective study of chest computed tomography (CT) scans of infants and children (>24-hours-of-life to less-than-18-years-old) from 2005 to 2017. Patients' scan images were reviewed for internal and external APDs at the mid-point of the lower half of the sternum. Body habitus and epidemiological data were extracted from the electronic medical records. RESULTS Chest CT scans of 193 infants and 398 children were evaluated. There was poor concordance between one-third external APD measurements and age-specific absolute chest compression depth targets, especially in infants and overweight/obese adolescents. There was a co-dependent relationship between one-third external APD and internal APD measurements. Overweight/obese children's and adolescents' internal and external APDs were significant different from the normal/underweight groups. Body-mass-index (BMI) of children and adolescents (p = 0.009), but not weight-for-length (WFL) of infants (p = 0.511), was an independent predictor of internal APD at the compression landmark. CONCLUSION This study demonstrated correlations between external and internal APDs which were affected by BMI but not WFL (infants). Clinical studies are needed to validate current chest compression guidelines especially for infants and overweight/obese adolescents.(250 words).
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Affiliation(s)
- Gene Yong-Kwang Ong
- Children’s Emergency, KK Women’s and Children’s Hospital, Singapore,Duke-NUS Medical School, Singapore,Corresponding author at: Children’s Emergency, KK Women’s and Children’s Hospital (KKH), Singapore.
| | | | - Zhao Jin Chen
- Biostatistics Unit, National University of Singapore, Singapore
| | - Yiong Huak Chan
- Biostatistics Unit, National University of Singapore, Singapore
| | - Phua Hwee Tang
- Department of Diagnostic Imaging, KK Women’s and Children’s Hospital, Singapore
| | | | - Jun Yuan Tan
- Children’s Emergency, KK Women’s and Children’s Hospital, Singapore
| | | | - Jen Heng Pek
- Department of Emergency Medicine, Sengkang General Hospital, Singapore
| | - Ian Maconochie
- Accident and Emergency Service, St Mary’s Hospital, London, United Kingdom,Department of Medicine, Imperial College, Kensington, London, United Kingdom
| | - Kee Chong Ng
- Children’s Emergency, KK Women’s and Children’s Hospital, Singapore,Duke-NUS Medical School, Singapore
| | - Vinay Nadkarni
- Center for Pediatric Resuscitation, Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, United States of America
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Does the use of BariBoard™ improve adequacy of chest compressions in morbid obesity? A pilot study using a simulation model. Aust Crit Care 2021; 35:688-695. [PMID: 34930648 DOI: 10.1016/j.aucc.2021.09.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 08/18/2021] [Accepted: 09/27/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Obesity is a growing health problem worldwide. Morbid obesity has been associated with significant barriers to effective thoracic cage compression during cardiopulmonary resuscitation. OBJECTIVE The BariBoard™ purports to improve adequacy of chest compressions in morbidly obese patients. This study uses a simulation model to evaluate this. METHODS This was a prospective blinded randomised-controlled crossover pilot trial using a simulation model of obesity. Participants, recruited from hospital departments and prehospital services, performed 2 minutes of continuous compressions on mannequins modified to emulate a morbidly obese patient. Participants were randomised by coin toss to a sequence of either control/intervention or intervention/control, with the BariBoard™ in the intervention arm. Accelerometers measured chest wall movement during compressions. The primary endpoint was a composite measure of compression adequacy (rate, depth, and recoil). Secondary endpoints comprised the individual components of the composite outcome, as both dichotomous outcomes (adequate vs. inadequate) and continuous variables. All endpoints were adjusted for potential confounders. RESULTS Of 205 participants recruited, 201 were analysed. There was a significant difference in the primary outcome between the control and intervention arms (13.4% vs. 4.5%, respectively, p = 0.001) and between the control and intervention arms for the secondary endpoints of adequate compression depth (31.3% vs. 15.9%, p < 0.001) and recoil (63.7% vs. 41.3%, p < 0.001). After adjustment for confounders and interactions, there was no difference in overall efficacy (odds ratio: 0.62, 95% confidence interval: 0.20-1.90, p = 0.40). CONCLUSION This pilot study describes the successful assessment of a device using a simulation model of obesity. Within these constraints and after adjustment for confounders, use of the BariBoard ™ did not improve efficacy of chest compressions.
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Di Giacinto I, Guarnera M, Esposito C, Falcetta S, Cortese G, Pascarella G, Sorbello M, Cataldo R. Emergencies in obese patients: a narrative review. JOURNAL OF ANESTHESIA, ANALGESIA AND CRITICAL CARE 2021. [PMCID: PMC8590435 DOI: 10.1186/s44158-021-00019-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Obesity is associated to an increased risk of morbidity and mortality due to respiratory, cardiovascular, metabolic, and neoplastic diseases. The aim of this narrative review is to assess the physio-pathological characteristics of obese patients and how they influence the clinical approach during different emergency settings, including cardiopulmonary resuscitation. A literature search for published manuscripts regarding emergency and obesity across MEDLINE, EMBASE, and Cochrane Central was performed including records till January 1, 2021. Increasing incidence of obesity causes growth in emergency maneuvers dealing with airway management, vascular accesses, and drug treatment due to both pharmacokinetic and pharmacodynamic alterations. Furthermore, instrumental diagnostics and in/out-hospital transport may represent further pitfalls. Therefore, people with severe obesity may be seriously disadvantaged in emergency health care settings, and this condition is enhanced during the COVID-19 pandemic, when obesity was stated as one of the most frequent comorbidity. Emergency in critical obese patients turns out to be an intellectual, procedural, and technical challenge. Organization and anticipation based on the understanding of the physiopathology related to obesity are very important for the physician to be mentally and physically ready to face the associated issues.
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Lee H, Oh J, Kang H, Lim TH, Ko BS, Choi HJ, Park SM, Jo YH, Lee JS, Park YS, Yoon YH, Kim SJ, Min YG. Association between the body mass index and outcomes of patients resuscitated from out-of-hospital cardiac arrest: a prospective multicentre registry study. Scand J Trauma Resusc Emerg Med 2021; 29:24. [PMID: 33509251 PMCID: PMC7842019 DOI: 10.1186/s13049-021-00837-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 01/14/2021] [Indexed: 12/15/2022] Open
Abstract
Background The effects of the body mass index (BMI) on outcomes of patients resuscitated from cardiac arrest are controversial. Therefore, the current study investigated the association between the BMI and the favourable neurologic outcomes and survival to discharge of patients resuscitated from out-of-hospital cardiac arrest (OHCA). Methods This multicentre, prospective, nationwide OHCA registry-based study was conducted using data from the Korean Cardiac Arrest Resuscitation Consortium (KoCARC). We enrolled hospitals willing to collect patient height and weight and included patients who survived to the hospital between October 2015 and June 2018. The included patients were categorised into the underweight (< 18.5 kg/m2), normal weight (≥18.5 to < 25 kg/m2), overweight (≥25 to < 30 kg/m2), and obese groups (≥30 kg/m2) according to the BMI per the World Health Organization (WHO) criteria. The primary outcome was a favourable neurologic outcome; the secondary outcome was survival to discharge. Univariate and multivariate analyses were performed to investigate the association between BMI and outcomes. Results Nine hospitals were enrolled; finally, 605 patients were included in our analysis and categorised per the WHO BMI classification. Favourable neurologic outcomes were less frequent in the underweight BMI group than in the other groups (p = 0.002); survival to discharge was not significantly different among the BMI groups (p = 0.110). However, the BMI classification was not associated with favourable neurologic outcomes or survival to discharge after adjustment in the multivariate model. Conclusion The BMI was not independently associated with favourable neurologic and survival outcomes of patients surviving from OHCA. Supplementary Information The online version contains supplementary material available at 10.1186/s13049-021-00837-x.
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Affiliation(s)
- Heekyung Lee
- Department of Emergency Medicine, College of Medicine, Hanyang University, 222 Wangsimni-ro, Seongdong-gu, Seoul, 04763, Republic of Korea
| | - Jaehoon Oh
- Department of Emergency Medicine, College of Medicine, Hanyang University, 222 Wangsimni-ro, Seongdong-gu, Seoul, 04763, Republic of Korea.
| | - Hyunggoo Kang
- Department of Emergency Medicine, College of Medicine, Hanyang University, 222 Wangsimni-ro, Seongdong-gu, Seoul, 04763, Republic of Korea
| | - Tae Ho Lim
- Department of Emergency Medicine, College of Medicine, Hanyang University, 222 Wangsimni-ro, Seongdong-gu, Seoul, 04763, Republic of Korea
| | - Byuk Sung Ko
- Department of Emergency Medicine, College of Medicine, Hanyang University, 222 Wangsimni-ro, Seongdong-gu, Seoul, 04763, Republic of Korea
| | - Hyuk Joong Choi
- Department of Emergency Medicine, College of Medicine, Hanyang University, 222 Wangsimni-ro, Seongdong-gu, Seoul, 04763, Republic of Korea
| | - Seung Min Park
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Gyeonggi-do, Republic of Korea
| | - You Hwan Jo
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Gyeonggi-do, Republic of Korea
| | - Jong Suk Lee
- Department of Emergency Medicine, College of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Yoo Seok Park
- Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Young-Hoon Yoon
- Department of Emergency Medicine, College of Medicine, Korea University, Seoul, Republic of Korea
| | - Su Jin Kim
- Department of Emergency Medicine, College of Medicine, Korea University, Seoul, Republic of Korea
| | - Young-Gi Min
- Department of Emergency Medicine, Ajou University School of Medicine, Suwon, Republic of Korea
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11
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Pei-Chuan Huang E, Fu CM, Chang WT, Huang CH, Tsai MS, Chou E, Wolfshohl J, Wang CH, Wu YW, Chen WJ. Associations of thoracic cage size and configuration with outcomes of adult in-hospital cardiac arrest: A retrospective cohort study. J Formos Med Assoc 2020; 120:371-379. [PMID: 32536380 DOI: 10.1016/j.jfma.2020.06.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 05/19/2020] [Accepted: 06/04/2020] [Indexed: 10/24/2022] Open
Abstract
BACKGROUND To analyse the association of thoracic cage size and configuration with outcomes following in-hospital cardiac arrest (IHCA). METHODS A single-centred retrospective study was conducted. Adult patients experiencing IHCA during 2006-2015 were screened. By analysing computed tomography images, we measured thoracic anterior-posterior and transverse diameters, circumference, and both anterior and posterior subcutaneous adipose tissue (SAT) depths at the level of the internipple line (INL). We also recorded the anatomical structure located immediately posterior to the sternum at the INL. RESULTS A total of 649 patients were included. The median thoracic circumference was 88.6 cm. The median anterior and posterior thoracic SAT depths were 0.9 and 1.5 cm, respectively. The ascending aorta was found to be the most common retrosternal structure (57.6%) at the INL. Multivariate logistic regression analyses indicated that anterior thoracic SAT depth of 0.8-1.6 cm (odds ratio [OR]: 2.98, 95% confidence interval [CI]: 1.40-6.35; p-value = 0.005) and thoracic circumference of 83.9-95.0 cm (OR: 2.48, 95% CI: 1.16-5.29; p-value = 0.02) were positively associated with a favourable neurological outcome while left ventricular outflow track or aortic root beneath sternum at the level of INL was inversely associated with a favourable neurological outcome (OR: 0.37, 95% CI: 0.15-0.91; p-value = 0.03). CONCLUSION Thoracic circumference and anatomic configuration might be associated with IHCA outcomes. This proof-of-concept study suggested that a one-size-fits-all resuscitation technique might not be suitable. Further investigation is needed to investigate the method of providing personalized resuscitation tailored to patient needs.
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Affiliation(s)
- Edward Pei-Chuan Huang
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan; Department of Emergency Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan; Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei, Taiwan; Department of Emergency Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu City, Taiwan
| | - Chia-Ming Fu
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan; Department of Emergency Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Wei-Tien Chang
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan; Department of Emergency Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chien-Hua Huang
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan; Department of Emergency Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Min-Shan Tsai
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan; Department of Emergency Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Eric Chou
- Department of Emergency Medicine, Baylor Scott&White All Saints Medical Center, Fort Worth, Texas, USA
| | - Jon Wolfshohl
- Department of Emergency Medicine, Baylor Scott&White All Saints Medical Center, Fort Worth, Texas, USA; Department of Emergency Medicine, John Peter Smith Hospital, Fort Worth, Texas, USA
| | - Chih-Hung Wang
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan; Department of Emergency Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.
| | - Yen-Wen Wu
- Department of Internal Medicine and Nuclear Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan; Department of Nuclear Medicine and Cardiology Division of Cardiovascular Medical Center, Far Eastern Memorial Hospital, New Taipei City, Taiwan; National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Wen-Jone Chen
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan; Department of Emergency Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan; Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
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12
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Wang CH, Chang WT, Huang CH, Tsai MS, Lu TC, Chou E, Wu YW, Chen WJ. Associations between Central Obesity and Outcomes of Adult In-hospital Cardiac Arrest: A Retrospective Cohort Study. Sci Rep 2020; 10:4604. [PMID: 32165678 PMCID: PMC7067829 DOI: 10.1038/s41598-020-61426-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 02/24/2020] [Indexed: 01/15/2023] Open
Abstract
To investigate the association between central obesity and outcomes following in-hospital cardiac arrest (IHCA). A single-centred retrospective study was conducted. Adult patients that experienced IHCA during 2006-2015 were screened. Body mass index (BMI) was calculated at hospital admission. Central obesity-related anthropometric parameters were measured by analysing computed tomography images. A total of 648 patients were included, with mean BMI of 23.0 kg/m2. The proportions of BMI-defined obesity in this cohort were underweight (13.1%), normal weight (41.4%), overweight (31.5%) and obesity (14.0%). The mean waist circumference was 85.9 cm with mean waist-to-height ratio (WHtR) of 0.53. The mean sagittal abdominal diameter was 21.2 cm with mean anterior and posterior abdominal subcutaneous adipose tissue (SAT) depths of 1.6 and 2.0 cm, respectively. Multivariate logistic regression analyses indicated BMI of 11.7-23.3 kg/m2 (odds ratio [OR]: 2.53, 95% confidence interval [CI]: 1.10-5.85; p-value = 0.03), WHtR of 0.49-0.59 (OR: 3.45, 95% CI: 1.56-7.65; p-value = 0.002) and anterior abdominal SAT depth <1.9 cm (OR: 2.84, 95% CI: 1.05-7.74; p-value = 0.04) were positively associated with the favourable neurological outcome. Central obesity was associated with poor IHCA outcomes, after adjusting for the effects of BMI.
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Affiliation(s)
- Chih-Hung Wang
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
- Department of Emergency Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Wei-Tien Chang
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
- Department of Emergency Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chien-Hua Huang
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
- Department of Emergency Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Min-Shan Tsai
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
- Department of Emergency Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Tsung-Chien Lu
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
- Department of Emergency Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Eric Chou
- Department of Emergency Medicine, Baylor Scott & White All Saints Medical Center, Fort Worth, Texas, USA
| | - Yen-Wen Wu
- Departments of Internal Medicine and Nuclear Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
- Department of Nuclear Medicine and Cardiology Division of Cardiovascular Medical Center, Far Eastern Memorial Hospital, New Taipei City, Taiwan
- National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Wen-Jone Chen
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan.
- Department of Emergency Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
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13
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Brainin P, Claggett B, Lewis EF, Dwyer KH, Merz AA, Silverman MB, Swamy V, Biering-Sørensen T, Rivero J, Cheng S, McMurray JJV, Solomon SD, Platz E. Body mass index and B-lines on lung ultrasonography in chronic and acute heart failure. ESC Heart Fail 2020; 7:1201-1209. [PMID: 32077268 PMCID: PMC7261588 DOI: 10.1002/ehf2.12640] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 01/22/2020] [Indexed: 02/07/2023] Open
Abstract
AIMS Increased body mass index (BMI) is common in heart failure (HF) patients and is associated with lower levels of N-terminal pro-brain natriuretic peptide (NT-proBNP). We evaluated the influence of BMI on lung ultrasonography (LUS) findings indicative of pulmonary congestion (i.e. B-lines) in patients with chronic and acute HF (AHF). METHODS AND RESULTS We analysed ambulatory chronic HF (n = 118) and hospitalized AHF (n = 177) patients (mean age 70 years, 64% men, mean BMI 29 kg/m2 , mean ejection fraction 42%) undergoing echocardiography and LUS in eight chest zones. B-lines and chest wall thickness (skin to pleura) on ultrasound were quantified offline and blinded to clinical findings. NT-proBNP was available in AHF patients (n = 167). In chronic HF, B-line number decreased by 18% per 5 unit increase in BMI [95% confidence interval (CI) -35% to +5%, P = 0.11]. In AHF, the number of B-lines decreased by 12% per 5 unit increase in BMI (95% CI -19% to -5%, P = 0.001), whereas NT-proBNP concentration decreased by 28% per 5 unit increase in BMI (95% CI -40% to -16%, P < 0.001). For AHF, B-line number declined to a lesser degree than NT-proBNP concentration with increasing BMI (P = 0.020), and >6 B-lines were observed in half of AHF patients with severe obesity. There was an inverse relationship between B-line number and chest wall thickness, and this association varied by chest region. CONCLUSIONS Despite an inverse relationship between B-lines and BMI, B-lines declined to a lesser degree than NT-proBNP with increasing BMI. These data suggest that LUS may be useful in patients with HF despite obesity.
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Affiliation(s)
- Philip Brainin
- Department of Cardiology, Herlev and Gentofte University Hospital, Herlev, Denmark.,Department of Emergency Medicine, Brigham and Women's Hospital, 75 Francis Street, Neville House, Boston, MA, 02115, USA
| | - Brian Claggett
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Eldrin F Lewis
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Kristin H Dwyer
- Department of Emergency Medicine, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | | | - Montane B Silverman
- Department of Emergency Medicine, Brigham and Women's Hospital, 75 Francis Street, Neville House, Boston, MA, 02115, USA
| | - Varsha Swamy
- Department of Emergency Medicine, Brigham and Women's Hospital, 75 Francis Street, Neville House, Boston, MA, 02115, USA
| | - Tor Biering-Sørensen
- Department of Cardiology, Herlev and Gentofte University Hospital, Herlev, Denmark.,Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Jose Rivero
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Susan Cheng
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, USA.,Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California.,Framingham Heart Study, Framingham, Massachusetts
| | - John J V McMurray
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Scott D Solomon
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Elke Platz
- Department of Emergency Medicine, Brigham and Women's Hospital, 75 Francis Street, Neville House, Boston, MA, 02115, USA
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14
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Lee H, Oh J, Lee J, Kang H, Lim TH, Ko BS, Cho Y, Song SY. Retrospective Study Using Computed Tomography to Compare Sufficient Chest Compression Depth for Cardiopulmonary Resuscitation in Obese Patients. J Am Heart Assoc 2019; 8:e013948. [PMID: 31766971 PMCID: PMC6912977 DOI: 10.1161/jaha.119.013948] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 10/23/2019] [Indexed: 12/12/2022]
Abstract
Background This study aimed to investigate the relationship between body mass index (BMI) and sufficient chest compression depth (CCD) in obese patients by a mathematical model. Methods and Results This retrospective analysis was performed with chest computed tomography images conducted between 2006 and 2018. We classified the selected individuals into underweight (<18.5), normal weight (≥18.5, <25), overweight (≥25, <30), and obese (≥30) groups according to BMI (kg/m2). We defined heart compression fraction (HCF) as [Formula: see text] and estimated under-HCF (the value of HCF <20%), and over-HCF (the residual depth <2 cm after simulation with chest compression depth 5 and 6 cm). We compared these outcomes between BMI groups. Of 30 342 individuals, 8856 were selected and classified into 4 BMI groups from a database. We randomly selected 100 individuals in each group and analyzed a total of 400 individuals' cases. Higher BMI groups had a significantly decreased HCF with both 5 and 6 cm depth (P<0.001). The proportion of under-HCF with both depths increased according to BMI group, whereas the proportion of over-HCF decreased except for the 5 cm depth (P<0.001). The adjusted odds ratio of under-HCF, according to BMI group after adjustment of age and sex, was 7.325 (95% CI, 3.412-15.726; P<0.001), with 5 cm and 10.517 (95% CI, 2.353-47.001; P=0.002) with 6 cm depth, respectively. Conclusions The recommended chest compression depth of 5 to 6 cm in the current international guideline is unlikely to provide sufficient ejection fraction during cardiopulmonary resuscitation in obese patients.
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Affiliation(s)
- Heekyung Lee
- Department of Emergency MedicineCollege of MedicineHanyang UniversitySeoulRepublic of Korea
| | - Jaehoon Oh
- Department of Emergency MedicineCollege of MedicineHanyang UniversitySeoulRepublic of Korea
- Machine Learning Research Center for Medical DataHanyang UniversitySeoulRepublic of Korea
| | - Juncheol Lee
- Department of Emergency MedicineCollege of MedicineHanyang UniversitySeoulRepublic of Korea
- Department of Emergency MedicineArmed Forces Capital HospitalSeongnamRepublic of Korea
| | - Hyunggoo Kang
- Department of Emergency MedicineCollege of MedicineHanyang UniversitySeoulRepublic of Korea
| | - Tae Ho Lim
- Department of Emergency MedicineCollege of MedicineHanyang UniversitySeoulRepublic of Korea
| | - Byuk Sung Ko
- Department of Emergency MedicineCollege of MedicineHanyang UniversitySeoulRepublic of Korea
| | - Yongil Cho
- Department of Emergency MedicineCollege of MedicineHanyang UniversitySeoulRepublic of Korea
| | - Soon Young Song
- Department of RadiologyCollege of MedicineHanyang UniversitySeoulRepublic of Korea
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15
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Liu JZ, Ye S, Cheng T, Han TY, Li Q, Li RX, Zhang Z, Li TY, He YR, Zeng Z, Cao Y. The effects of thoracic cage dimension and chest subcutaneous adipose tissue on outcomes of adults with in-hospital cardiac arrest: A retrospective study. Resuscitation 2019; 141:151-157. [PMID: 31238036 DOI: 10.1016/j.resuscitation.2019.06.278] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 06/11/2019] [Accepted: 06/16/2019] [Indexed: 02/05/2023]
Abstract
BACKGROUND The associations between thoracic cage dimension, chest subcutaneous adipose tissue (SAT) depth and outcomes of adults with in-hospital cardiac arrest (IHCA) remain unknown. METHODS We retrospectively evaluated IHCA patients between January 2016 and October 2017. The thoracic cage transverse diameter, internal AP diameter, cross-sectional area, anterior and posterior SAT depths were measured in computed-tomography (CT) images. Using logistic regression models, we determined the adjusted associations between thoracic cage dimension, SAT depths and the prognosis for IHCA. The primary outcome was sustained return of spontaneous circulation (ROSC) and the secondary outcome was survival to hospital discharge. RESULTS Among 423 IHCA patients, 258 patients achieved ROSC and 70 survived to discharge. Smaller cross-sectional area and posterior SAT depth were significantly related to ROSC. Smaller posterior SAT depth was associated with ROSC. After multivariate adjustment, the smaller cross-sectional area was independently associated with ROSC (Odds ratio [OR] 0.99, 95% confidence interval [95%CI] 0.99-1.00; p = 0.008) and survival to discharge (OR 0.99, 95%CI 0.98-1.00; p = 0.024), and the smaller posterior SAT depth was independently related to ROSC (OR 0.65, 95%CI 0.44-0.96; p = 0.030), whereas no relation to survival to discharge was found. CONCLUSIONS In adults with IHCA, the smaller thoracic cage dimension and posterior SAT depth are associated with better survival. An adjustable compression depth based on the thoracic cage dimension might be better than the "one-size-fits-all" compression depth for resuscitating CA patients. In addition, physicians should pay extra attention to compression efficacy when resuscitating obese patients.
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Affiliation(s)
- Jun-Zhao Liu
- Emergency Department, West China Hospital, Sichuan University, 37 Guoxue Road, Chengdu, Sichuan, China
| | - Sheng Ye
- Emergency Department, West China Hospital, Sichuan University, 37 Guoxue Road, Chengdu, Sichuan, China
| | - Tao Cheng
- Emergency Department, West China Hospital, Sichuan University, 37 Guoxue Road, Chengdu, Sichuan, China
| | - Tian-Yong Han
- Emergency Department, West China Hospital, Sichuan University, 37 Guoxue Road, Chengdu, Sichuan, China
| | - Qin Li
- Emergency Department, West China Hospital, Sichuan University, 37 Guoxue Road, Chengdu, Sichuan, China
| | - Rui-Xin Li
- Emergency Department, West China Hospital, Sichuan University, 37 Guoxue Road, Chengdu, Sichuan, China
| | - Zhuo Zhang
- Emergency Department, West China Hospital, Sichuan University, 37 Guoxue Road, Chengdu, Sichuan, China
| | - Tong-Yao Li
- Emergency Department, West China Hospital, Sichuan University, 37 Guoxue Road, Chengdu, Sichuan, China
| | - Ya-Rong He
- Emergency Department, West China Hospital, Sichuan University, 37 Guoxue Road, Chengdu, Sichuan, China
| | - Zhi Zeng
- Emergency Department, West China Hospital, Sichuan University, 37 Guoxue Road, Chengdu, Sichuan, China.
| | - Yu Cao
- Emergency Department, West China Hospital, Sichuan University, 37 Guoxue Road, Chengdu, Sichuan, China; Disaster Medicine Center, Sichuan University, China.
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16
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Wang CH, Huang CH, Chang WT, Fu CM, Wang HC, Tsai MS, Yu PH, Wu YW, Ma MHM, Chen WJ. Associations between body size and outcomes of adult in-hospital cardiac arrest: A retrospective cohort study. Resuscitation 2018; 130:67-72. [PMID: 29990579 DOI: 10.1016/j.resuscitation.2018.07.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 06/19/2018] [Accepted: 07/06/2018] [Indexed: 11/30/2022]
Abstract
AIM Animal studies have demonstrated that hemodynamic-directed cardiopulmonary resuscitation (CPR) improves outcomes following cardiac arrest compared with the "one-size-fits-all" algorithm. We investigated whether body size of patients is correlated with outcomes of in-hospital cardiac arrest (IHCA). METHODS A retrospective study in a single centre was conducted. Adult patients experiencing IHCA between 2006 and 2015 were screened. Body mass index (BMI) was calculated using body weight and height measured at hospital admission. Thoracic anteroposterior diameter (APD) was measured by analysing computed tomography images. Multivariate logistic regression analysis was used to study the associations between independent variables and outcomes. Generalised additive models were used to identify cut-off points for continuous variables. RESULTS A total of 766 patients were included, and 60.4% were male. Their mean age was 62.8 years. Mean BMI was 22.9 kg/m2, and the mean thoracic APD was 21.4 cm. BMI > 23.2 kg/m2 was inversely associated with a favourable neurological outcome (odds ratio [OR]: 0.30, 95% confidence interval [CI]: 0.13-0.68; p-value = 0.004), while thoracic APD was not. When the interaction term was analysed, BMI > 23.2 (kg/m2) × thoracic APD > 18.5 (cm) was inversely associated with both a favourable neurological outcome (OR: 0.33, 95% CI: 0.16-0.69; p-value = 0.003) and survival to hospital discharge (OR: 0.46, 95% CI: 0.26-0.81; p-value = 0.007). CONCLUSION Higher BMI and thoracic APD was correlated with worse outcomes following IHCA. For those patients, it might be better to perform CPR under guidance of physiological parameters rather than a "one-size-fits-all" resuscitation algorithm to improve outcomes.
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Affiliation(s)
- Chih-Hung Wang
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan; Department of Emergency Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chien-Hua Huang
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan; Department of Emergency Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Wei-Tien Chang
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan; Department of Emergency Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chia-Ming Fu
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Hui-Chih Wang
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Min-Shan Tsai
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan; Department of Emergency Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Ping-Hsun Yu
- Department of Emergency Medicine, Taipei Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan
| | - Yen-Wen Wu
- Departments of Internal Medicine and Nuclear Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan; Department of Nuclear Medicine and Cardiology Division of Cardiovascular Medical Center, Far Eastern Memorial Hospital, New Taipei City, Taiwan; National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Matthew Huei-Ming Ma
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan; Department of Emergency Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Emergency Medicine, National Taiwan University Hospital, Yunlin Branch, Taiwan
| | - Wen-Jone Chen
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan; Department of Emergency Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan; Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
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17
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Secombe PJ, Sutherland R, Johnson R. Morbid obesity impairs adequacy of thoracic compressions in a simulation-based model. Anaesth Intensive Care 2018; 46:171-177. [PMID: 29519219 DOI: 10.1177/0310057x1804600205] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Adequate cardiopulmonary resuscitation is an important predictor of survival, however, obesity provides a significant physical barrier to thoracic compressions. This study explores the effect of morbid obesity on compression adequacy. We performed a prospective randomised controlled crossover study, assessing the adequacy of thoracic compressions on a manikin modified to emulate a morbidly obese patient. Participants recruited from critical care departments were randomised to perform continuous compressions for two minutes on each manikin. Accelerometers were used to measure thoracic wall movement. The primary endpoint was a composite measure of compression adequacy (rate, depth and recoil). Secondary endpoints were the individual components of the composite outcome and measures of perceived effectiveness, fatigue, and pain. One hundred and one participants were recruited. There was a significant difference between the obese and control groups in the composite endpoint (4% versus 30%, <i>P</i> <0.001), as well as the individual components of adequacy (<i>P</i> <0.01 for all). Quartile data showed significant deterioration in adequacy of depth and recoil in both groups, and this occurred significantly earlier in the obese group (<i>P</i> ≤0.001). Participants' perception of effectiveness was significantly lower (<i>P</i> ≤0.001) in the obese group, and levels of fatigue (<i>P</i> ≤0.001) and pain (<i>P</i> ≤0.001) significantly higher. Morbid obesity impairs the adequacy of thoracic compressions for trained rescuers in a simulation-based model. Participants were not fully aware of how ineffective compressions were. There is evidence of earlier fatigue further reducing effectiveness. These findings have significant implications for the training of rescuers in a clinically relevant population and the planning of future research.
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Affiliation(s)
- P J Secombe
- Intensive Care Consultant, Alice Springs Hospital; Clinical Lecturer, School of Medicine, Flinders University; Alice Springs, Northern Territory
| | - R Sutherland
- Advanced Trainee in Emergency Medicine, Member of the Australasian College for Emergency Medicine; Flinders Medical Centre, Adelaide, South Australia
| | - R Johnson
- Emergency and Retrieval Medicine Consultant, Alice Springs Hospital; Honorary Academic Fellow, Baker Research Institute; Alice Springs, Northern Territory
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