Although RRTs have broad appeal, robust evidence to support their effectiveness in reducing hospital mortality is lacking.

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Background The quality and effectiveness of resuscitation processes may be influenced by patients' 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/m2], normal [18.5-24.9], overweight [25.0-29.9], obese [30.0-34.9], and very obese [≥35.0]) and survival to hospital discharge using multivariable logistic regression, after stratifying arrests by rhythm type and adjusting for patient characteristics. Of 4,499 patients with ventricular fibrillation or pulseless ventricular tachycardia as initial rhythm, 1,825 (40.6%) survived to discharge. After multivariable adjustment, compared with overweight patients, underweight (Odds Ratio [OR], 0.59 [95% CI: 0.41-0.84]; p=0.003), normal weight (OR, 0.75; [0.63-0.89]; p<.001), and very obese (OR, 0.78 [0.63-0.96]; p=0.02) had lower rates of survival, while obese patients had similar rates of survival (OR, 0.87; 95% CI, 0.72-1.06; p=0.17). In contrast, of 16,738 patients with arrests due to asystole or pulse less electrical activity, only 2,501 (14.9%) survived. After multivariable adjustment, all BMI groups had similar rates of survival except underweight patients (OR, 0.67 [0.54-0.82]; p<.001). Conclusions For cardiac arrests due to shockable rhythms, underweight, normal weight, and very obese patients had lower rates of survival to discharge. In contrast, for cardiac arrests due to non-shockable 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.

Aims Myocardial work is a novel echocardiographic algorithm that corrects speckle-tracking-derived global longitudinal strain (GLS) for afterload using non-invasive systolic blood pressure as a surrogate for left ventricular systolic pressure (LVSP). Yet, in patients with severe aortic stenosis, non-invasive systolic blood pressure does not equal LVSP. Methods and results We evaluated 35 patients with severe aortic stenosis who underwent transcatheter aortic valve replacement (TAVR). Transthoracic echocardiography, including myocardial mechanics, was performed pre- and post-TAVR. We performed simultaneous echocardiographic and cardiac catheterization measurements in 23 of the 35 patients at the time of TAVR. Peak and mean aortic gradients were calculated from echocardiographic and cardiac catheterization data. Peak-to-peak LV-aortic gradient correlated highly with mean LV-aortic gradient (r = 0.96); measured LVSP correlated highly with our novel method of non-invasively estimated LVSP (non-invasive systolic blood pressure cuff + Doppler-derived mean aortic gradient, r = 0.92). GLS improved from pre- to post-TAVR (−14.2% ± 4.3 vs. −15.1% ± 3.2), and myocardial work reduced from corrected pre-TAVR to post-TAVR (global work index: 1856.2 mmHg% ± 704.6 vs. 1534.8 ± 385.0). Conclusion We propose that non-invasive assessment of myocardial work can be reliably performed in aortic stenosis by the addition of mean aortic gradient to non-invasive systolic blood pressure. From this analysis, we note the novel and unique finding that GLS can improve as myocardial work reduces post-TAVR in patients with severe aortic stenosis. Both GLS and myocardial work post-TAVR remain below normal values, requiring further studies.