Although medical emergencies requiring cardiopulmonary resuscitation (CPR) can happen to
anyone, the risk can vary from person to person. For instance, a previous post on ‘Heart Attack Prevention on Game Day‘ explains how, on top of the heightened risk for heart attacks and arrhythmias during sporting events, chronic conditions such as obesity can serve as preexisting risk factors. People with obesity must hence take necessary precautions to lower the risk of heart attacks.
Furthermore, healthcare professionals and emergency responders must be prepared to perform
CPR on obese patients, as there are specific nuances and considerations related to their body
weight and overall condition. So, here’s a guide on ensuring patient safety and maximizing
health outcomes regarding CPR for people with obesity.
Positioning and hand placement
Across all cases, proper positioning and hand placement play a pivotal role in effective CPR.
However, they’re especially crucial when working with obese patients to adapt your technique to
the individual’s unique body shape. For example, the standard CPR stance, which involves
positioning yourself above the person’s chest using your body weight, helps accommodate the
person’s body mass while minimizing exhaustion. Meanwhile, altering the hand position on the
caudal part of the lower half of the sternum instead of its midpoint allows the rescuer to ensure
adequate pressure and reduce the risk of injury.
Chest compressions are a key determinant of survival in CPR, facilitating the restoration of
blood circulation and oxygenation during medical emergencies like cardiac arrest. A narrative
review by Di Giacinto et al. published in the Journal of Anesthesia, Analgesia, and Critical Care
notes that in terms of sequence and frequency, CPR on an obese adult is not that different from
an adult with a normal BMI. However, in some cases, it is recommended to use the heel of the
hand instead of the palm when performing compressions to better penetrate through the layers of
adipose tissue on the person’s chest. Since achieving the advised compression depth of
5–6 centimeters can also be more challenging among obese adults, rescuers may consider using
more force and switching to a different operator at shorter intervals to make it less tiring.
Lifestyle changes in diet and exercise can manage obesity, but some individuals address the
biological factors in their condition through weight loss medications. Both FDA-approved
liraglutide (Saxenda) and semaglutide (Wegovy) work as GLP-1 agonists that contribute to
clinically significant weight loss by signaling fullness and reducing insulin resistance. The only
difference between Saxenda vs Wegovy is the dosage and frequency through which they are
administered. Nonetheless, rescuers performing CPR on patients who may be using these drugs
must still be careful not to choose emergency medications that may reduce their effectiveness on
appetite and blood sugar levels. Fortunately, a guide from the National Library of Medicine notes
that epinephrine, the primary drug used to increase myocardial and cerebral blood flow during
CPR, has no absolute contraindications. However, additional assessment may be needed if the
obese patient is pregnant, breastfeeding, or an older adult.
Assistive tools for CPR
Rescuers may also consider using assistive tools that allow them to perform high-quality
compressions despite the special considerations among obese patients. For example, mechanical
or portable handheld CPR devices are ergonomically designed to reduce fatigue and avoid the
deteriorating quality of chest compressions over time. Starting from training, emergency
responders can also use CPR manikins with unique features that are more comparable to obese
adults, such as a larger body type with an extra fat layer and slightly altered anatomical
landmarks for the sternum and ribcage.
Overall, health professionals must be equipped to take on the nuances of performing CPR on an
individual with obesity. By adjusting their technique, taking into account medications, and
having their training accommodate diverse body types among patients, they can contribute to
higher success rates and better health outcomes during emergency situations.
‘This post was written by Anthony M. Moser’ as an affiliate post