Outcomes of in-hospital cardiopulmonary resuscitation in morbidly obese patients

Authors

Muhammad Shahreyar
Geetanjali DangFollow
Mohammad Waqas BashirFollow
Gagan Kumar
Jawad Hussain
Shahryar Ahmad
Beneet Pandey, Advocate Aurora Health
Atul Thakur
Sanjay BhandariFollow
Krishna Thandra
Jasbir Sra, Advocate Aurora HealthFollow
A. Jamil Tajik, Advocate Aurora HealthFollow
Arshad Jahangir, Advocate Aurora HealthFollow

Recommended Citation

Shahreyar M, Dang G, Bashir MW, et al. Outcomes of In-Hospital Cardiopulmonary Resuscitation in Morbidly Obese Patients. JACC: Clinical Electrophysiology. 2017;3(2):174-183. doi:10.1016/j.jacep.2016.08.011.

Affiliations

Aurora Cardiovascular Services

Aurora Sinai/Aurora St. Luke’s Medical Centers

Sheikh Khalifa bin Hamad Al Thani Center for Integrative Research on Cardiovascular Aging

Aurora Research Institute

Abstract

OBJECTIVES: This study sought to assess the impact of morbid obesity on outcomes in patients with in-hospital cardiac arrest (IHCA).

BACKGROUND: Obesity is associated with increased risk of out-of-hospital cardiac arrest; however, little is known about survival of morbidly obese patients with IHCA.

METHODS: Using the Nationwide Inpatient Sample database from 2001 to 2008, we identified adult patients undergoing resuscitation for IHCA, including those with morbid obesity (body mass index ≥40 kg/m 2 ) by using International Classification of Diseases 9th edition codes and clinical outcomes. Outcomes including in-hospital mortality, length of stay, and discharge dispositions were identified. Logistic regression model was used to examine the independent association of morbid obesity with mortality.

RESULTS: Of 1,293,071 IHCA cases, 27,469 cases (2.1%) were morbidly obese. The overall mortality was significantly higher for the morbidly obese group than for the nonobese group experiencing in-hospital non-ventricular fibrillation (non-VF) (77% vs. 73%, respectively; p = 0.006) or VF (65% vs. 58%, respectively; p = 0.01) arrest particularly if cardiac arrest happened late (>7 days) after hospitalization. Discharge to home was significantly lower in the morbidly obese group (21% vs. 31%, respectively; p = 0.04). After we adjusted for baseline variables, morbid obesity remained an independent predictor of increased mortality. Other independent predictors of mortality were age and severe sepsis for non-VF and VF group and venous thromboembolism, cirrhosis, stroke, malignancy, and rheumatologic conditions for non-VF group.

CONCLUSIONS: The overall mortality of morbidly obese patients after IHCA is worse than that for nonobese patients, especially if IHCA occurs after 7 days of hospitalization and survivors are more likely to be transferred to a skilled nursing facility.

Document Type

Article