Body mass index and outcomes of in-hospital ventricular tachycardia and ventricular fibrillation arrest.
Due to higher transthoracic impedance, obese patients may be less likely to be successfully defibrillated from ventricular tachycardia or ventricular fibrillation (VT/VF) arrest. However, the association between patient body mass index (BMI), defibrillation success, and survival outcomes of VT/VF arrest are poorly understood.



We evaluated 7110 patients with in-hospital VT/VF arrest at 286 hospitals within the Get With The Guidelines(®)-Resuscitation (GWTG-R) Multicenter Observational Registry between 2006 and 2012. Patients were categorized as underweight (BMI<18.5kg/m(2)), normal weight (BMI 18.5-24.9kg/m(2)), over-weight (BMI 25.0-29.9kg/m(2)), obese (BMI 30.0-34.9kg/m(2)), and extremely obese (BMI≥35.0kg/m(2)). Using generalized linear mixed regression, we determined the risk-adjusted relationship between BMI and patient outcomes while accounting for clustering by hospitals. The primary outcome was successful first shock defibrillation (a post-shock rhythm other than VT/VF) with secondary outcomes of return of spontaneous circulation, survival to 24h, and survival to discharge.



Among adult patients suffering VT/VF arrest, 304 (4.3%) were underweight, 2061 (29.0%) were normal weight, 2139 (30.1%) were overweight, and 2606 (36.6%) were obese or extremely obese. In a risk-adjusted analysis, we observed no interaction between BMI and energy level for the successful termination of VT/VF with first shock. Furthermore, the risk-adjusted likelihood of successful first shock termination of VT/VF did not differ significantly across BMI categories. Finally, when compared to overweight patients, obese patients had similar risk-adjusted likelihood of survival to hospital discharge (odds ratio 0.786, 95% confidence interval 0.593-1.043).



There was no significant difference in the likelihood of successful defibrillation with the first shock attempt among different BMI categories.
University of Texas Southwestern Medical Center, Dallas, TX, United States. Electronic address: Babatunde.Ogunnaike@utsouthwestern.edu.
Babatunde O
BO
Ogunnaike
University of Texas Southwestern Medical Center, Dallas, TX, United States.
Charles W
CW
Whitten
University of Texas Southwestern Medical Center, Dallas, TX, United States.
Abu
A
Minhajuddin
University of Texas Southwestern Medical Center, Dallas, TX, United States.
Emily
E
Melikman
University of Texas Southwestern Medical Center, Dallas, TX, United States.
Girish P
GP
Joshi
University of Texas Southwestern Medical Center, Dallas, TX, United States.
Tiffany S
TS
Moon
VA Eastern Colorado Health Care System and University of Colorado, Denver, CO, United States.
Preston M
PM
Schneider
VA Eastern Colorado Health Care System and University of Colorado, Denver, CO, United States.
Steven M
SM
Bradley
D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D015992:Body Mass Index; D016887:Cardiopulmonary Resuscitation / Q000379:methods* / Q000401:mortality; D047548:Defibrillators; D004554:Electric Countershock / Q000379:methods / Q000401:mortality; D005260:Female; D006323:Heart Arrest / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012042:Registries; D012307:Risk Factors; D016019:Survival Analysis; D017180:Tachycardia, Ventricular / Q000150:complications / Q000401:mortality / Q000628:therapy*; D061665:Time-to-Treatment; D014693:Ventricular Fibrillation / Q000150:complications / Q000401:mortality / Q000628:therapy*
Cardiac arrest; First shock success; Index event; Obesity; Resuscitation; Shockable rhythm