Key result
Normal BMI is linked to ~25% lower survival after shockable cardiac arrest versus overweight.
Why the study?
The relationship between body mass index and survival after in-hospital cardiac arrest had not been previously studied.
Does body mass index affect survival to hospital discharge in adult patients with in-hospital cardiac arrest?
Cohort (n=21,237)
Yes
Does body mass index affect survival to hospital discharge in adult patients with in-hospital cardiac arrest?
Odds Ratio: 0.75 (95% CI 0.63–0.89)
p-value: p=<0.001
In patients with in-hospital cardiac arrest from shockable rhythms, both extremes of BMI (underweight, normal weight, and very obese) are associated with lower survival to discharge compared to overweight patients, suggesting an 'obesity paradox' in this population.
BMI category was associated with post-arrest survival, especially in shockable rhythms; leaves open whether BMI should guide resuscitation or trial design.
BACKGROUND: The quality and effectiveness of resuscitation processes may be influenced by the patient's body mass index (BMI); however, the relationship between BMI and survival after in-hospital cardiac arrest has not been previously studied. METHODS AND RESULTS: We evaluated 21 237 adult patients with an in-hospital cardiac arrest within the National Registry for Cardiopulmonary Resuscitation (NRCPR). We examined the association between BMI (classified as underweight [<18.5 kg/m(2)], normal [18.5 to 24.9 kg/m(2)], overweight [25.0 to 29.9 kg/m(2)], obese [30.0 to 34.9 kg/m(2)], and very obese [≥35.0 kg/m(2)]) and survival to hospital discharge using multivariable logistic regression, after stratifying arrests by rhythm type and adjusting for patient characteristics. Of 4499 patients with ventricular fibrillation or pulseless ventricular tachycardia as initial rhythm, 1825 (40.6%) survived to discharge. After multivariable adjustment, compared with overweight patients, underweight (odds ratio [OR], 0.59; 95% confidence interval [CI], 0.41 to 0.84; P=0.003), normal weight (OR, 0.75; 95% CI, 0.63 to 0.89; P<0.001), and very obese (OR, 0.78; 95% CI, 0.63 to 0.96; P=0.02) had lower rates of survival, whereas obese patients had similar rates of survival (OR, 0.87; 95% CI, 0.72 to 1.06; P=0.17). In contrast, of 16 738 patients with arrests caused by asystole or pulseless electric activity, only 2501 (14.9%) survived. After multivariable adjustment, all BMI groups had similar rates of survival except underweight patients (OR, 0.67; 95% CI, 0.54 to 0.82; P<0.001). CONCLUSIONS: For cardiac arrest caused by shockable rhythms, underweight, normal weight, and very obese patients had lower rates of survival to discharge. In contrast, for cardiac arrest caused by nonshockable rhythms, survival to discharge was similar across BMI groups except for underweight patients. Future studies are needed to clarify the extent to which BMI affects the quality and effectiveness of resuscitation measures.
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Jain et al. (2010) conducted a cohort in In-hospital cardiac arrest (n=21,237). Body mass index vs. Overweight patients (BMI 25.0 to 29.9 kg/m2) was evaluated on Survival to hospital discharge (OR 0.75, 95% CI 0.63-0.89, p=<0.001). Normal body mass index (OR 0.75; 95% CI 0.63-0.89) and underweight/very obese status were associated with lower survival to discharge after cardiac arrest with shockable rhythms versus overweight.
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