Table 1 Key issues and optimal strategies for CPR in obese patients

Vascular access

The veins on the dorsum of the hand and the deep brachial vein may be neither visible nor palpable.

The veins of the antecubital fossa of the arm and the external jugular vein are easier to cannulate.

If available, use ultrasound.

Consider CVC placement or intraosseous route with a 45-mm needle.

Airway management

Manual ventilation with bag-mask should be difficult due to anatomical alterations.

Use a two-person technique for bag-mask ventilation.

An experienced clinician should intubate the trachea early.

Consider supraglottic devices if tracheal intubation fails or in case of difficult facial mask ventilation.

Chest compressions

Thoracic adipose tissue may reduce the effectiveness of the chest compressions.

Provide chest compressions greater than 5 cm in depth.

Change rescuer performing chest compression more frequently.

If applicable, consider the use of mechanical chest compression.

Cardiovascular drugs

Patients with obesity may receive an inadequate dose of emergency drugs during CPR.

Adrenaline—1 mg.

Amiodarone—300 mg first time, 0.5–0.75 mg/kg second time.

Lidocaine—1–1.5 mg/kg according to IBW.

Magnesium sulfate—2 g, repeat after 10–15 min.

Calcium chloride 10%—1 g.

Atropine—0.5 mg, repeat to a maximum dose of 3 mg.

Isoprenaline—5 μg/min.

Adrenaline (c.i.)—2–10 μg/min

Defibrillation

Higher transthoracic impedance caused by thoracic fat.

Start with an energy level of 200 J