Relation of Obesity to Survival After In-Hospital Cardiac Arrest

Gupta, Tanush; Kolte, Dhaval; Mohananey, Divyanshu; Khera, Sahil; Goel, Kashish; Mondal, Pratik; Aronow, Wilbert S.; Jain, Diwakar; Cooper, Howard A.; Iwai, Sei; Frishman, William H.; Bhatt, Deepak L.; Fonarow, Gregg C.; Panza, Julio A.

doi:10.1016/j.amjcard.2016.06.019

Cited by 37 publications

(37 citation statements)

References 27 publications

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“…Second, we used a limited number of patients which limited our conclusions. Recent published study demonstrated that obese group has higher incidences of diabetes, hypertension, dyslipidemia, and prior history of cardiac or cerebral problems [22]. However, in our study, there are no statistical differences of diabetes, hypertension, and VT/VF.…”

Section: Discussioncontrasting

confidence: 80%

Association of body mass index with clinical outcomes for in-hospital cardiac arrest adult patients following extracorporeal cardiopulmonary resuscitation

Gil

Ryu

et al. 2017

PLoS ONE

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BackgroundObesity might be associated with disturbance of cannulation in situation of extracorporeal cardiopulmonary resuscitation (ECPR). However, limited data are available on obesity in the setting of ECPR. Therefore, we investigated the association between body mass index (BMI) and clinical outcome in patients underwent ECPR.MethodsFrom January 2004 to December 2013, in-hospital cardiac arrest patients who had ECPR were enrolled from a single-center registry. We divided patients into four group according to BMI defined with the WHO classification (underweight, BMI < 18.5, n = 14; normal weight, BMI = 18.5–24.9, n = 118; overweight, BMI = 25.0–29.9, n = 53; obese, BMI ≥ 30, n = 15). The primary outcome was survival to hospital discharge.ResultsAnalysis was carried out for a total of 200 adult patients (39.5% females). Their median BMI was 23.20 (interquartile range, 20.93–25.80). The rate of survival to hospital discharge was 31.0%. There was no significant difference in survival to hospital discharge among the four groups (underweight, 35.7%; normal, 31.4%; overweight, 30.2%; obese, 26.7%, p = 0.958). Neurologic outcomes (p = 0.85) and procedural complications (p = 0.40) were not significantly different among the four groups either. SOFA score, initial arrest rhythm, and CPR to extracorporeal membrane oxygenation (ECMO) pump on time were significant predictors for survival to discharge, but not BMI.ConclusionBMI was not associated with in-hospital mortality who underwent ECPR. Neurologic outcomes at discharge or procedural complications following ECPR were not related with BMI either.

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Section: Discussioncontrasting

confidence: 80%

Association of body mass index with clinical outcomes for in-hospital cardiac arrest adult patients following extracorporeal cardiopulmonary resuscitation

Gil

Ryu

et al. 2017

PLoS ONE

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“…Several studies on OSA in the elderly and in other conditions, such as pneumonia, and those hospitalized for bariatric procedures have shown a survival benefit associated with OSA . In fact, the presence of OSA has been used to explain the “obesity paradox” wherein obese patients with established cardiovascular disease have better outcomes than their leaner counterparts . We used the nation‐wide inpatient database to compare in‐hospital outcomes of patients with and without recognized OSA with a primary discharge diagnosis of ST‐elevation MI (STEMI).…”

Section: Introductionmentioning

confidence: 99%

Recognized Obstructive Sleep Apnea is Associated With Improved In‐Hospital Outcomes After ST Elevation Myocardial Infarction

Mohananey

Villablanca

Gupta

et al. 2017

JAHA

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BackgroundObstructive sleep apnea (OSA) is an independent risk factor for many cardiovascular conditions such as coronary artery disease, myocardial infarction, systemic hypertension, pulmonary hypertension, and stroke. However, the association of OSA with outcomes in patients hospitalized for ST‐elevation myocardial infarction remains controversial.Methods and ResultsWe used the nation‐wide inpatient sample between 2003 and 2011 to identify patients with a primary discharge diagnosis of ST‐elevation myocardial infarction and then used the International Classification of Diseases, Clinical Modification code 327.23 to identify a group of patients with OSA. The primary outcome of interest was in‐hospital mortality, and secondary outcomes were in‐hospital cardiac arrest, length of stay and hospital charges. Our cohort included 1 850 625 patients with ST‐elevation myocardial infarction, of which 1.3% (24 623) had documented OSA. OSA patients were younger and more likely to be male, smokers, and have chronic pulmonary disease, depression, hypertension, known history of coronary artery disease, dyslipidemia, obesity, and renal failure (P<0.001 for all). Patients with OSA had significantly decreased in‐hospital mortality (adjusted odds ratio, 0.78 [95% CI, 0.73–0.84]), longer hospital stay (5.00±4.68 versus 4.85±5.96 days), and incurred greater hospital charges ($79 460.12±70 621.91 versus $62 889.91±69 124.15). There was no difference in incidence of in‐hospital cardiac arrest (adjusted odds ratio, 0.93 [95% CI, 0.84–1.03]) between these 2 groups.Conclusion ST‐elevation myocardial infarction patients with recognized OSA had significantly decreased mortality compared with patients without OSA. Although patients with OSA had longer hospital stays and incurred greater hospital charges, there was no difference in incidence of in‐hospital cardiac arrest.

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“…A discharge record was classified as in‐hospital cardiac arrest if the International Classification of Diseases‐Ninth edition, Clinical Modification (ICD‐9CM) procedure code 99.60 and 99.63 was present in any of the procedural fields. This methodology was utilized in prior studies . We included only hospitalizations with IHCA secondary to VT/VF.…”

Section: Methodsmentioning

confidence: 99%

“…This methodology was utilized in prior studies. 15,16 We included only hospitalizations with IHCA secondary to VT/VF. We excluded hospitalizations other than VT/VF (n = 602,040) and those less than 18 years of age (n = 1,531) ( Figure 1).…”

Section: Study Populationmentioning

confidence: 99%

“…We excluded hospitalizations other than VT/VF (n = 602,040) and those less than 18 years of age (n = 1,531) ( Figure 1). We further excluded: do not resuscitate (DNR) orders (n = 16,326), and records with missing data on age, sex, survival, and/or discharge disposition, type of admission and length of stay (n = 563). This resulted in a cohort of 151,628 hospitalizations which comprise our study sample.…”

Section: Study Populationmentioning

confidence: 99%

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Temporal trends of survival and utilization of mechanical circulatory support devices in patients with in‐hospital cardiac arrest secondary to ventricular tachycardia/ventricular fibrillation

Patel

Atti

Kumar

et al. 2019

Cathet Cardio Intervent

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Background Pulseless ventricular tachycardia/ventricular fibrillation (VT/VF) is the initial rhythm in a third of in‐hospital cardiac arrest patients. Mechanical circulatory support (MCS) device use remains poorly understood in this population. Methods We conducted an observational analysis of temporal trends in the utilization of MCS in VT/VF IHCA between January 2008 and December 2014 utilizing the Nationwide Inpatient Sample (NIS) database. Using multivariable analysis, we assessed factors associated with MCS use and survival to discharge. Results Among 151,628 hospitalizations with VT/VF IHCA, 14,981 (9.9%) received MCS. Intra‐aortic balloon pump (IABP) was the most commonly used MCS (9.1%). From 2008 to 2014, there was significant increase in the utilization of MCS (8.7–11%; ptrend < 0.0001). On multivariable analysis, there was 12‐fold increase and three‐fold increase in the utilization of PVAD and ECMO respectively; however, there was no significant change in the use of IABP. Over the seven‐year sample period, there was significant increase in the overall survival to hospital discharge (35.4–43.5%; ptrend < 0.0001). Survival to hospital discharge increased in both MCS and non‐MCS groups. Conclusion There was significant increase in utilization of MCS after VT/VF IHCA during the study period. IABP was the most commonly utilized MCS. The survival to hospital discharge increased in the overall study population including both MCS and non‐MCS groups. Future studies are needed to identify patient population most likely to benefit from the use of MCS after VT/VF IHCA.

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Relation of Obesity to Survival After In-Hospital Cardiac Arrest

Cited by 37 publications

References 27 publications

Association of body mass index with clinical outcomes for in-hospital cardiac arrest adult patients following extracorporeal cardiopulmonary resuscitation

Association of body mass index with clinical outcomes for in-hospital cardiac arrest adult patients following extracorporeal cardiopulmonary resuscitation

Recognized Obstructive Sleep Apnea is Associated With Improved In‐Hospital Outcomes After ST Elevation Myocardial Infarction

Temporal trends of survival and utilization of mechanical circulatory support devices in patients with in‐hospital cardiac arrest secondary to ventricular tachycardia/ventricular fibrillation

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