Things you might not realise...

We all know there are risks associated with obesity which will seriously impact on your health and quality of life, but something not many people realise is that the problem goes beyond your life and into your death - and our attempts to return life.

I've had a few cardiac arrests now where the patient was morbidly obese and the outcome each time has been a non successful resuscitation. In addition to all of the associated health conditions of morbid obesity leading to an arrest, there are a few points you might wish to ponder...

Many morbidly obese patients are confined to chairs or beds, which is where we usually find them and are forced to try to move them to the ground before effective resuscitation attempts may begin. This can sometimes be an impossible task - anyone who has had to carry a slumped body will know just how heavy and awkward it can be, but when the patient is at an estimated 190-200kg the task becomes almost impossible. While at least 2 ambulances are always dispatched to arrests, it is usually the first ambulance with usually 2 officers who are forced to try to make this move, and while occasionally family, friends or bystanders can assist the danger of injury placed on the officers is sometimes so high that they are forced to wait for more help before the move can be made. Sometimes the patient will already be on the ground, but if the patient is on their side in a confined space or simply has too much mass to effectively roll, the result will be the same - decreased effectiveness of chest compressions which will further reducing the viability of the patient.

Of course, even once the body has been placed in an optimal position a morbidly obese patient may not receive effective chest compressions due to the additional adipose around the chest. With some obese patients chest compressions, although placed correctly with the correct amount of pressure, result in the heart being moved 'side to side' rather than compressed and effectively pumping blood to resume circulation. Sometimes it is simply not possible to achieve the correct amount of chest compression with the chest being significantly thicker.

Airway access is also significantly more difficult and ventilation harder with the bulk of the body decreasing lung inflation. Cannulation becomes more difficult which can delay IV drug administration, and one of the greatest tools of resuscitation - defibrillation - can be less effective with decreased conductivity to the heart due to the additional impedance. While many defibrillators will detect impedance and attempt to adjust the current delivered with each shock, there is only so high the machine can go before the risk of burns and electrocution to other organs becomes too dangerous.

Should resuscitation be effective, or the patient is producing enough of a viable rhythm to be deemed by the paramedics transportable, there are then issues of moving the patient to an ambulance stretcher capable of bearing their weight. In NSW we have stretchers rated to 160kg and 180kg, with patients higher than that requiring the use of a custom built vehicle for bariatric patients. As there are very few of these custom built ambulances, there can be considerable delays from when the initial ambulance arrives to confirm the arrest and to call for the vehicle to when it can arrive on scene with the required equipment. These stretchers also require a large amount of room, and specialised lifting equipment with up to 10 ambulance officers sometimes being required to lift the patient can delay loading times. Once the patient is at hospital there will be issues in transferring the patient to the hospital bed, with resuscitation sometimes continuing on the ambulance stretcher due to necessity. Of course, all of the other issues listed above still continue, with potentially decreased effectiveness of CPR, manual ventilation and defibrillation.


None of this is to say that the efforts made by paramedics, nurses and doctors are any less than for any other patient - regardless of the age, race, gender or size of the patient our efforts are always to the best of our abilities to provide the patient with the best chance of a viable outcome. Every patient deserves compassion, respect and care - every patient and their family will have fear, feel grief and loss. But sometimes we know what the outcome will most likely be, and that the factors involved will decrease the chances of that outcome being positive and we will attempt to prepare the family for this fact.

When people see us arrive at an arrest they gain hope that their loved one might be brought back - that they have another chance of taking another breath.

Sometimes they don't.