• Heekyung Lee, Jaehoon Oh, Juncheol Lee, Hyunggoo Kang, Tae Ho Lim, Byuk Sung Ko, Yongil Cho, and Soon Young Song.
• Department of Emergency Medicine College of Medicine Hanyang University Seoul Republic of Korea.
• J Am Heart Assoc. 2019 Dec 3; 8 (23): e013948.

AbstractBackground 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/m2). 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 (P<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 (P<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; P<0.001), with 5 cm and 10.517 (95% CI, 2.353-47.001; P=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.

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