Aims Previous studies on sex differences in out-of-hospital cardiac arrest (OHCA) had limited scope and yielded conflicting results. We aimed to provide a comprehensive overall view on sex differences in care utilization, and outcome of OHCA. Methods and results We performed a population-based cohort-study, analysing all emergency medical service (EMS) treated resuscitation attempts in one province of the Netherlands (2006–2012). We calculated odds ratios (ORs) for the association of sex and chance of a resuscitation attempt by EMS, shockable initial rhythm (SIR), and in-hospital treatment using logistic regression analysis. Additionally, we provided an overview of sex differences in overall survival and survival at successive stages of care, in the entire study population and in patients with SIR. We identified 5717 EMS-treated OHCAs (28.0% female). Women with OHCA were less likely than men to receive a resuscitation attempt by a bystander (67.9% vs. 72.7%; P < 0.001), even when OHCA was witnessed (69.2% vs. 73.9%; P < 0.001). Women who were resuscitated had lower odds than men for overall survival to hospital discharge [OR 0.57; 95% confidence interval (CI) 0.48–0.67; 12.5% vs. 20.1%; P < 0.001], survival from OHCA to hospital admission (OR 0.88; 95% CI 0.78–0.99; 33.6% vs. 36.6%; P = 0.033), and survival from hospital admission to discharge (OR 0.49, 95% CI 0.40–0.60; 33.1% vs. 51.7%). This was explained by a lower rate of SIR in women (33.7% vs. 52.7%; P < 0.001). After adjustment for resuscitation parameters, female sex remained independently associated with lower SIR rate. Conclusion In case of OHCA, women are less often resuscitated by bystanders than men. When resuscitation is attempted, women have lower survival rates at each successive stage of care. These sex gaps are likely explained by lower rate of SIR in women, which can only partly be explained by resuscitation characteristics.
Background-Over the last decades, a gradual decrease in ventricular fibrillation (VF) as initial recorded rhythm during resuscitation for out-of-hospital cardiac arrest (OHCA) has been noted. We sought to establish the contribution of implantable cardioverter-defibrillator (ICD) therapy to this decline. Methods and Results-Using a prospective database of all OHCA resuscitation in the province North Holland in the Netherlands (Amsterdam Resuscitation Studies [ARREST]), we collected data on all patients in whom resuscitation for OHCA was attempted in [2005][2006][2007][2008]. VF OHCA incidence (per 100 000 inhabitants per year) was compared with VF OHCA incidence data during 1995-1997, collected in a similar way. We also collected ICD interrogations of all ICD patients from North Holland and identified all appropriate ICD shocks in 2005-2008; we calculated the number of prevented VF OHCA episodes, considering that only part of the appropriate shocks would result in avoided resuscitation. VF OHCA incidence decreased from 21.1/100 000 in 1995-1997 to 17.4/100 000 in 2005. Non-VF OHCA increased from 12.2/100 000 to 19.4/100 000 (PϽ0.001). VF as presenting rhythm declined from 63% to 47%. In 200547%. In -200847%. In , 1972 ICD patients received 977 shocks. Of these shocks, 339 were caused by a life-threatening arrhythmia. We estimate that these 339 shocks have prevented 81 (minimum, 39; maximum, 152) cases of VF OHCA, corresponding with 33% (minimum, 16%; maximum, 63%) of the observed decline in VF OHCA incidence. Conclusions-The incidence of VF OHCA decreased over the last 10 years in North Holland. ICD therapy explained a decrease of 1.2/100 000 inhabitants per year, corresponding with 33% of the observed decline in VF OHCA. (Circulation. 2012;126: 815-821.)Key Words: cardiopulmonary resuscitation Ⅲ heart arrest Ⅲ implantable cardioverter-defibrillator Ⅲ incidence Ⅲ ventricular fibrillation M ultiple studies from Europe and the United States noted a gradual decrease in the incidence of ventricular fibrillation (VF) during resuscitation for out-of-hospital cardiac arrest (OHCA) over the last decades. These studies showed that the proportion of OHCA with VF as initial rhythm during a resuscitation attempt (VF OHCA) declined on average from 54% to 38% over a 15-year period. [1][2][3][4][5] There is no clear 1-dimensional explanation for this widely observed decline in VF incidence. The introduction of the implantable cardioverter-defibrillator (ICD) has been linked to the decline in VF OHCA incidence. 1 Editorial see p 793 Clinical Perspective on p 821The purpose of this investigation was to confirm whether the incidence of VF OHCA in the Netherlands has declined over the years and to calculate the extent to which this decline could be explained by ICD usage. We used a prospective database of all resuscitation efforts in the province of North Holland in the Netherlands. This Amsterdam Resuscitation Studies (ARREST) registry covers the period [1995][1996][1997] Importantly, although the first ICD implantation in the...
Somatomedin bioactivity (SMA) in maternal serum, as measured by hypophysectomized rat cartilage assays, was low during early and late pregnancy but was similar to normal nonpregnant control levels near 28 weeks and at term pregnancy. At term, the mean level of SMA in cord serum was significantly less than in maternal serum, and greater than in amniotic fluid. The mean level of SMA in amniotic fluid was higher at term than in early pregnancy. No significant correlation was noted between SMA levels in amniotic fluid, maternal serum or cord serum, or between the SMA levels in these samples and the usual amniotic fluid parameters used as indices of fetal maturity.
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