Correlation of Body Mass Index and The Ability to Perform High Quality Cardiopulmonary Resuscitation: Manikin Study

Abstract


INTRODUCTION
Out-of-hospital cardiac arrest (OHCA), one of the top causes of death in developed nations each year, has claimed about one life per 1000 individuals [1]- [4]. Enhancing the standard of cardiopulmonary resuscitation (CPR) is the most crucial strategy for lowering this fatality rate [5]- [9]. It is well established that making small adjustments to CPR techniques, such as using an adequate compression rate, performing adequate compression depth, allowing the chest to recoil, limiting compression interruptions, and avoiding excessive breathing, will improve survival rates [5]- [9].
The outcomes of CPR are majorly depended on its quality. It was broadly documented that High-quality CPR (HQ-CPR) was the cornerstone to achieving Return of Spontaneous Circulation (ROSC) in the resuscitation procedure [5], [6], [8]. In many cases, rescuers (compressors) can deliver HQ-CPR only in the initial cycles. As the cycles continue, the quality of CPR commonly declined [10], [11]. Whereas HQ-CPR is the basis of the cardiac arrest treatment algorithm, the provision of HQ-CPR will increase the survival rate of patients twice or even three times [5], [12]. A survey conducted in 2009 demonstrated that the majority of health professionals (75%) perceived themselves owned adequate HQ-CPR skills, but in reality, only 26% were able to maintain HQ-CPR. Even worse, 55% of them did not fully aware of their perfunctory CPR [8].
It has been emphasized elsewhere that anthropometric variables impacted the quality of CPR [13]- [16]. Several studies discussed the effect of anthropometric parameters on CPR quality, including weight, height, physical fitness, and muscle strength [17] [18]. Anthropometric variables may affect the depth of chest compressions [14][17] [19] The crosstabulation analysis in Table 2 signified that an individual with a normal or slightly thin BMI category managed to perform HQ-CPR better compared to an individual with a mildly obese, severely obese, and severely thin BMI category. Table 3 revealed findings from the Kolmogorov-Smoirnov test that found a p-value of 0.000.
This finding signified a correlation between BMI and ability to perform HQ-CPR.    [15]. There were common disadvantages in manual compression (by humans), such as inconsistent speed and depth. These drawbacks may occur due to physical fatigue factors considering that HQ-CPR requires much energy [5].
This finding was parallel to previous studies [15]- [19] that demonstrated a significant correlation between BMI and the attainment of recommended compression depth in CPR procedures [17]. Compression depth during CPR could be influenced by the strength generated from both arms and the rescuers' fitness factor [11]. The healthy BMI is ranged within the normal limits. Rescuers with a normal or ideal BMI are more likely to deliver adequate compression power and depth in line with the predetermined standard of > 5 cm [18]. In addition, the healthy physiological status would also influence fitness and fatigue levels [10]. A person with an ideal BMI tends to be able to show better physical endurance due to healthier organ functions, especially the heart and lungs [19]. Thus, the healthier an individual generally is, the higher chance they get to achieve proper compression depth [17].
In would also like to extend our gratitude to all enumerators and participants involved in this study.

CONFLICT OF INTEREST
The authors have no conflict of interest to declare.