Differential Survival for Men and Women from Out-of-hospital Cardiac Arrest Varies by Age: Results from the OPALS Study

Safdar, Basmah; Stolz, Uwe; Stiell, Ian G.; Cone, David C.; Bobrow, Bentley J.; deBoehr, Melanie; Dreyer, Jonathan; Maloney, Justin; Spaite, Daniel W.

doi:10.1111/acem.12540

Cited by 87 publications

(95 citation statements)

References 50 publications

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“…The proportion of incidents that occurred in urban areas reflects the proportion of the Irish population that resides in urban areas. The age and gender profile of patients was very similar to other large studies of OHCA, as was the difference in median male and female ages 4 14. The proportion of patients presumed to have suffered an arrest of cardiac aetiology is similar to North American data, but high compared with other population-based studies of EMS-treated OHCA 11 14.…”

Section: Discussionsupporting

confidence: 79%

Out-of-hospital cardiac arrest attended by ambulance services in Ireland: first 2 years’ results from a nationwide registry

et al. 2016

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Competing InterestsNone to declare. Dr. McNally reports grants from American Red Cross, the American Heart Association, Medtronic Philanthropy and Zoll Corporation, outside the submitted work.2 Abstract Background: National data collection provides information on out-of-hospital cardiac arrest (OHCA) incidence, management and outcomes that may not be generalisable from smaller studies. This retrospective cohort study describes the first two years' results from the Irish National Out-of-Hospital Cardiac Arrest Register (OHCAR). Methods: Data on OHCAs attended by Emergency Medical Services where resuscitation was attempted (EMS-treated) was collected from ambulance services and entered onto OHCAR. Descriptive analysis of the study population was performed, and regression analysis was performed on the subgroup of adult patients with a bystander-witnessed event of presumed cardiac aetiology and an initial shockable rhythm (Utstein Group). Results: 3,701 EMS-treated OHCAs were recorded for the study period (01/01/2012 -31/12/2013). Incidence was 39/100,000 population per year. In the Utstein Group (n=577), compared to the overall group, there was a higher proportion of male patients, public event location, bystander cardiopulmonary resuscitation and early defibrillation. Median EMS call-response interval was similar in both groups. A higher proportion of patients in the Utstein Group achieved return of spontaneous circulation (ROSC) (35% vs. 17%) and survival to hospital discharge (22% vs. 6%). After multivariate adjustment for the Utstein Group, the following variables were found to be independent predictors of the outcome survival to hospital discharge: public event location (OR 3.1 (95%CI 1.9-5.0)); Bystander CPR (2.4 (95% CI 1.2-4.9)); EMS response of eight minutes or less (2.2 (95%CI 1.3-3.6)). Conclusion:This study highlights the role of nationwide registries in quantifying, monitoring and benchmarking OHCA incidence and outcome, providing baseline data upon which service improvement effects can be measured.

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Section: Discussionsupporting

confidence: 79%

Out-of-hospital cardiac arrest attended by ambulance services in Ireland: first 2 years’ results from a nationwide registry

et al. 2016

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“…This is consistent with other epidemiological data showing a greater proportion of males receive resuscitation from ambulance staff. [22] The OPALS study found that women were older than men (median age 74 versus 69 years, p < 0.01), had fewer witnessed arrests (43% vs. 49%; p < 0.01), were less likely to have shockable rhythms (24% vs. 42%; p < 0.01), and had lower rates of bystander CPR (12% vs. 17%; p < 0.01). Further research may help to explain the apparent inequality in resuscitation rates between the sexes.…”

Section: Discussionmentioning

confidence: 99%

Characteristics of patients who are not resuscitated in out of hospital cardiac arrests and opportunities to improve community response to cardiac arrest

et al. 2016

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NoDerivatives 4.0 International http://creativecommons.org/about/downloadsCharacteristics of patients who are not resuscitated in out of hospital cardiac arrests and opportunities to improve community response to cardiac arrest Rajagopal S [a,b] Methods: This a secondary analysis of unselected patients who sustained an out of hospital cardiac arrest attended by ambulance vehicles participating in a randomized controlled trial of a mechanical chest compression device (PARAMEDIC trial). Patients were categorized as 'non-resuscitation' patients if there was a do-not-attempt-cardiopulmonary-resuscitation (DNACPR) order, signs unequivocally associated with death or resuscitation was deemed futile (15 minutes had elapsed since collapse with no bystander-CPR and asystole recorded on EMS arrival).Results:Emergency Medical Services attended 11,451 cardiac arrests. Resuscitation was attempted or continued by Emergency Medical Service staff in 4,805 (42%) of cases. Resuscitation was withheld in 6,646 cases (58%). Of these, 711 (6.2%) had a do not attempt resuscitation decision, 4439 (38.8%) had signs unequivocally associated with death and in 1496 cases (13.1%) CPR was considered futile. Those where resuscitation was withheld due to futility were characterised by low bystander CPR rates (7.2 %) and by being female. Conclusions:Resuscitation was withheld by ambulance staff in over one in ten (13.1%) victims of out of hospital cardiac arrest on the basis of futility. These cases were associated with a very low rate of bystander CPR. Future studies should explore strengthening the 'Chain of Survival' to increase the community bystander CPR response and evaluate the effect on the number of survivors from out of hospital cardiac arrest.

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“…Concerning the associated factors, we found that male gender, having asystole, a longer time from the cardiac arrest until the arrival of the EMS and the cardiac arrest occurring in the patient's home were significantly associated with increased mortality. There is controversy regarding gender, and it seems that this association may vary by age groups [18]. …”

Section: Discussionmentioning

confidence: 99%

Mortality after out-of-hospital cardiac arrest in a Spanish Region

et al. 2017

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AimsTo determine out-of-hospital cardiac arrest mortality in the province of Alicante (Spain) and its associated factors.MethodsCross-sectional observational study of all patients who received cardiopulmonary resuscitation (CPR) by the Emergency Medical Services (EMS) (n = 422) in the province of Alicante in 2013. To determine associated factors, a binary logistic regression model was constructed. Primary outcome: death before arriving at the hospital. Predictive variables: gender, age, artificial respiration, prior functional status, asystole, cardiogenic aetiology, bystander CPR, time from the cardiac arrest to the arrival of the EMS and location of cardiac arrest.ResultsThere were 337 deaths (79.9%; 95% CI: 76.0–83.7%). Factors independently associated (p<0.05) with death were: male gender (OR = 2.11; 95% CI: 1.20–3.72; p = 0.010), asystole (OR = 1.99, 95% CI: 1.17–3.39; p = 0.012), cardiac arrest at home (OR = 2.44; 95% CI: 1.42–4.18; p = 0.001) and an increased time between arrest and EMS arrival (OR = 1.05, 95% CI: 1.01–1.09, p = 0.009). Having a worse prior functional status had a tendency towards significance (OR = 0.56, 95% CI: 0.31–1.02, p = 0.059).ConclusionsMortality was high. The associated factors were: male gender, asystole, worse prior functional status, longer time from the cardiac arrest to the arrival of the EMS and having the cardiac arrest at home. The clearly negative impact of experiencing a cardiac arrest at home necessitates modifying training policies in Spain. These policies should be focused on providing information about CPR in schools in order to decrease the mortality of these events.

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Differential Survival for Men and Women from Out-of-hospital Cardiac Arrest Varies by Age: Results from the OPALS Study

Cited by 87 publications

References 50 publications

Out-of-hospital cardiac arrest attended by ambulance services in Ireland: first 2 years’ results from a nationwide registry

Out-of-hospital cardiac arrest attended by ambulance services in Ireland: first 2 years’ results from a nationwide registry

Characteristics of patients who are not resuscitated in out of hospital cardiac arrests and opportunities to improve community response to cardiac arrest

Mortality after out-of-hospital cardiac arrest in a Spanish Region

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