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. 2023 Jul:188:109842.
doi: 10.1016/j.resuscitation.2023.109842. Epub 2023 May 15.

The impact of BMI on arrest characteristics and survival of patients with out-of-hospital cardiac arrest treated with extracorporeal cardiopulmonary resuscitation

Marinos Kosmopoulos  1 , Rajat Kalra  1 , Tamas Alexy  1 , Christopher Gaisendrees  2 , Deborah Jaeger  3 , Johnny Chahine  1 , Sebastian Voicu  4 , Adamantios Tsangaris  1 , Alejandra B Gutierrez  1 , Andrea Elliott  1 , Jason A Bartos  1 , Demetris Yannopoulos  5
Affiliations

The impact of BMI on arrest characteristics and survival of patients with out-of-hospital cardiac arrest treated with extracorporeal cardiopulmonary resuscitation

Marinos Kosmopoulos et al. Resuscitation. 2023 Jul.

Abstract

Aim: To assess the impact of body mass index (BMI) on survival to hospital discharge of patients presenting with refractory ventricular fibrillation treated with extracorporeal cardiopulmonary resuscitation. We hypothesize that due to limitations in pre-hospital care delivery, people with high BMI have worse survival after prolonged resuscitation and ECPR.

Methods: This study is a retrospective single-centre study that included patients suffering refractory VT/VF OHCA from December 2015 to October 2021 and had a BMI calculated at hospital admission. We compared the baseline characteristics and survival between patients with obesity (>30 kg/m2) and those without (≤30 kg/m2).

Results: Two-hundred eighty-three patients were included in this study, and two-hundred twenty-four required mechanical support with veno-arterial extracorporeal cardiopulmonary membrane oxygenation (VA ECMO). Patients with BMI > 30 (n = 133) had significantly prolonged CPR duration compared to their peers with BMI ≤ 30 kg/m2 (n = 150) and were significantly more likely to require support with VA ECMO (85.7% vs 73.3%, p = 0.015). Survival to hospital discharge was significantly higher in patients with BMI ≤ 30 kg/m2 (48% vs. 29.3%, p < 0.001). BMI was an independent predictor of mortality in a multivariable logistic regression analysis. The four-year mortality rate was low and not significantly different between the two groups (p = 0.32).

Conclusion: ECPR yields clinically meaningful long-term survival in patients with BMI > 30 kg/m2. However, the resuscitation time is significantly prolonged, and the overall survival significantly lower compared to patients with BMI ≤ 30 kg/m2. ECPR should, therefore, not be withheld for this population, but faster transport to an ECMO capable centre is mandated to improve survival to hospital discharge.

Keywords: BMI; Cardiogenic shock; ECMO; Mechanical circulatory support; OHCA; eCPR.

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Conflict of interest statement

Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: ‘Demetri Yannopoulos reports a relationship with Leona M and Harry B Helmsley Charitable Trust that includes: funding grants’.

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