Increased abdominal fat accumulation is associated with decreased survival to hospital admission in out-of-hospital cardiac arrest: a single center retrospective study.

Objective: The impact of obesity on outcomes after out-of-hospital cardiac arrest (OHCA) remains controversial. This study aimed to evaluate the association between abdominal fat accumulation, quantified by computed tomography (CT), and outcomes in patients with OHCA. Methods: We retrospectively analyzed adult patients with medical OHCA transported to our institution between June 2014 and May 2025. Patients with available abdominal CT scans were included regardless of return of spontaneous circulation (ROSC). The abdominal fat area (AFA) at the level of the third lumbar vertebra was measured on CT. Patients were divided into quartiles based on AFA, and their characteristics and outcomes were compared. The primary outcome was survival to hospital admission. Adjusted odds ratios (ORs) were calculated using multivariable logistic regression analyses. Results: Among 788 adult patients with medical OHCA, 252 (32.0%) survived to hospital admission. Patients with lower AFA values were older and had smaller skeletal muscle areas. The group with the smallest AFA was less frequently classified as shockable or cardiogenic. Although this group achieved ROSC more often and earlier, survival to hospital admission did not differ significantly among the groups. However, logistic regression analysis showed that increased AFA was independently associated with lower odds of survival to hospital admission (adjusted OR 0.68 per 100 cm Conclusions: Greater abdominal fat accumulation was associated with reduced survival to hospital admission after OHCA.