Department of Emergency Medicine College of Medicine Hanyang University Seoul Republic of Korea.
Machine Learning Research Center for Medical Data Hanyang University Seoul Republic of Korea.
J Am Heart Assoc. 2019 Dec 3;8(23):e013948. doi: 10.1161/JAHA.119.013948. Epub 2019 Nov 26.
Background This study aimed to investigate the relationship between body mass index (BMI) and sufficient chest compression depth (CCD) in obese patients by a mathematical model. Methods and Results This retrospective analysis was performed with chest computed tomography images conducted between 2006 and 2018. We classified the selected individuals into underweight (<18.5), normal weight (≥18.5, <25), overweight (≥25, <30), and obese (≥30) groups according to BMI (kg/m). We defined heart compression fraction (HCF) as [Formula: see text] and estimated under-HCF (the value of HCF <20%), and over-HCF (the residual depth <2 cm after simulation with chest compression depth 5 and 6 cm). We compared these outcomes between BMI groups. Of 30 342 individuals, 8856 were selected and classified into 4 BMI groups from a database. We randomly selected 100 individuals in each group and analyzed a total of 400 individuals' cases. Higher BMI groups had a significantly decreased HCF with both 5 and 6 cm depth (<0.001). The proportion of under-HCF with both depths increased according to BMI group, whereas the proportion of over-HCF decreased except for the 5 cm depth (<0.001). The adjusted odds ratio of under-HCF, according to BMI group after adjustment of age and sex, was 7.325 (95% CI, 3.412-15.726; <0.001), with 5 cm and 10.517 (95% CI, 2.353-47.001; =0.002) with 6 cm depth, respectively. Conclusions The recommended chest compression depth of 5 to 6 cm in the current international guideline is unlikely to provide sufficient ejection fraction during cardiopulmonary resuscitation in obese patients.
背景 本研究旨在通过数学模型探讨肥胖患者体重指数（BMI）与充分胸外按压深度（CCD）之间的关系。
方法和结果 本回顾性分析纳入了 2006 年至 2018 年间进行的胸部计算机断层扫描图像。我们根据 BMI（kg/m²）将选定的个体分为体重不足组（<18.5）、正常体重组（≥18.5，<25）、超重组（≥25，<30）和肥胖组（≥30）。我们将心脏压缩分数（HCF）定义为[公式：见文本]，并估计 HCF 不足（HCF 值<20%）和 HCF 过度（模拟胸外按压深度为 5 和 6 cm 后剩余深度<2 cm）。我们比较了这些结果在 BMI 组之间的差异。在 30342 个人中，我们从数据库中选择了 8856 人并将其分为 4 个 BMI 组。我们在每个组中随机选择 100 人，总共分析了 400 人的病例。随着 BMI 组的增加，5 cm 和 6 cm 深度的 HCF 显著降低（<0.001）。随着 BMI 组的增加，HCF 不足的比例增加，而 HCF 过度的比例除 5 cm 深度外均降低（<0.001）。调整年龄和性别后，BMI 组的 HCF 不足的调整比值比为 7.325（95%CI，3.412-15.726；<0.001），5 cm 深度和 10.517（95%CI，2.353-47.001；=0.002），6 cm 深度。
结论 目前国际指南中推荐的 5 至 6 cm 胸外按压深度在肥胖患者心肺复苏期间可能无法提供足够的心输出量。
