Sex Differences in Survival From Out‐of‐Hospital Cardiac Arrest in the Era of Regionalized Systems and Advanced Post‐Resuscitation Care

Bosson, Nichole; Kaji, Amy H.; Fang, Andrea; Jue, Thomas; French, William J.; Shavelle, David M.; Niemann, James T.

doi:10.1161/jaha.116.004131

Cited by 72 publications

(63 citation statements)

References 22 publications

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“…Male sex was also significantly negatively associated with ROSC within this model. While the literature is heterogenous and the determinants unclear, several studies have found a survival advantage in females with shockable and/or non‐shockable rhythms …”

Section: Discussionmentioning

confidence: 99%

Prehospital extracorporeal cardiopulmonary resuscitation for out‐of‐hospital cardiac arrest: A retrospective eligibility study

Kilner

Stanton

Mazur

2019

Emerg Medicine Australasia

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Objective:We sought to identify out-of-hospital cardiac arrest (OOHCA) patients who might benefit from a future prehospital extracorporeal cardiopulmonary resuscitation (ECPR) programme in a moderately sized city. We described the 2014 OOHCA data and identified those who fulfilled hypothetical prehospital ECPR eligibility criteria. Methods: We identified patients aged 18-65 years in cardiac arrest, where CPR was commenced by paramedics on arrival. Traumatic cardiac arrest and end-of-life needs were patient exclusions. Patients were then included in one of three hypothetical 'ECPR eligible' groups. Patients were included in an 'ECPR eligible' group if they met author agreed criteria. Select patients in refractory VT/VF; pulseless electrical activity (PEA); and non-refractory VT/VF, or asystole with subsequent VT/VF or transient return of spontaneous circulation (ROSC), were assigned to three separate groups. Descriptive statistics were applied to each group. Outcomes of ECPR eligible patients who developed sustained ROSC after 20 min of conventional CPR were characterised. Results: A total of 206 patients were included. A significant positive association between initial shockable rhythm (odds ratio [OR] 15.32, confidence interval [CI] 5.4-43.2) and sustained ROSC, and PEA (OR 6.93, CI 2.4-19.8) and sustained ROSC, versus asystole was identified (P < 0.001). Sixty-eight (33%) patients were eligible for one of the hypothetical ECPR groups. Twelve (17.6%) of the 68 ECPR eligible patients developed sustained ROSC after 20 min of conventional CPR, with only two surviving neurologically intact to hospital discharge. Conclusion: Sixty-three (30.6%) patients could have derived benefit from a prehospital ECPR programme. Further analyses of prehospital ECPR logistics and economics are necessary to ensure that any future prehospital ECPR programme is effective and efficient.

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Section: Discussionmentioning

confidence: 99%

Prehospital extracorporeal cardiopulmonary resuscitation for out‐of‐hospital cardiac arrest: A retrospective eligibility study

Kilner

Stanton

Mazur

2019

Emerg Medicine Australasia

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“…For example, women with out‐of‐hospital cardiac arrest are more likely to have advanced age, chronic health comorbidities, noncardiac etiology, unwitnessed cardiac arrest, and initial nonshockable heart rhythm, and to live alone, all of which have been associated with worse outcomes 2, 5, 8, 9, 10, 11. While these characteristics are important to understand differences in outcomes, they are unlikely to be modifiable.…”

Section: Introductionmentioning

confidence: 99%

Association of Bystander and First‐Responder Efforts and Outcomes According to Sex: Results From the North Carolina HeartRescue Statewide Quality Improvement Initiative

Hansen

Kragholm

Dupre

et al. 2018

JAHA

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BackgroundThe Institute of Medicine has called for actions to understand and target sex‐related differences in care and outcomes for out‐of‐hospital cardiac arrest patients. We assessed changes in bystander and first‐responder interventions and outcomes for males versus females after statewide efforts to improve cardiac arrest care.Methods and ResultsWe identified out‐of‐hospital cardiac arrests from North Carolina (2010–2014) through the CARES (Cardiac Arrest Registry to Enhance Survival) registry. Outcomes for men versus women were examined through multivariable logistic regression analyses adjusted for (1) nonmodifiable factors (age, witnessed status, and initial heart rhythm) and (2) nonmodifiable plus modifiable factors (bystander cardiopulmonary resuscitation and defibrillation before emergency medical services), including interactions between sex and time (ie, year and year2). Of 8100 patients, 38.1% were women. From 2010 to 2014, there was an increase in bystander cardiopulmonary resuscitation (men, 40.5%–50.6%; women, 35.3%–51.8%; P for each <0.0001) and in the combination of bystander cardiopulmonary resuscitation and first‐responder defibrillation (men, 15.8%–23.0%, P=0.007; women, 8.5%–23.7%, P=0.004). From 2010 to 2014, the unadjusted predicted probability of favorable neurologic outcome was higher and increased more for men (men, from 6.5% [95% confidence interval (CI), 5.1–8.0] to 9.7% [95% CI, 8.1–11.3]; women, from 6.3% [95% CI, 4.4–8.3] to 7.4% [95% CI, 5.5–9.3%]); while adjusted for nonmodifiable factors, it was slightly higher but with a nonsignificant increase for women (from 9.2% [95% CI, 6.8–11.8] to 10.2% [95% CI, 8.0–12.5]; men, from 5.8% [95% CI, 4.6–7.0] to 8.4% [95% CI, 7.1–9.7]). Adding bystander cardiopulmonary resuscitation and defibrillation before EMS (modifiable factors) did not substantially change the results.ConclusionsBystander and first‐responder interventions increased for men and women, but outcomes improved significantly only for men. Additional strategies may be necessary to improve survival among female cardiac arrest patients.

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“…Analizom epidemioloških podataka (uporedna tabela 2. VBSZ kod muškaraca i žena na teritoriji Vojvodine za 2016. godinu) ustanovili smo da se VBSZ ređe javlja kod žena (33,6%), što potvrđuju i druga istraživanja sprovedena u različitim zemljama (6,7,8). Žene doživljavaju VBSZ u starijoj životnoj dobi (7, 1) , prema našem istraživanju u proseku su starije za 4,6 godina.…”

Section: Diskusijaunclassified

Out of hospital cardiac arrest in women in Vojvodina: Epidemiological data analysis

Jakšić-Horvat¹,

Budimski²,

Holcer-Vukelić³

2018

J Resuscitatio Balcan

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Analiza epidemioloških podataka vanbolničkog srčanog zastoja kod žena zastupljenog na teritoriji Vojvodine uz uporednu analizu ranije objavljenih studija. Metod: Za metodologiju rada su korišteni podaci registra srčanog zastoja sa teritorije Vojvodine u vremenskom periodu od 1.10.2014. do 1.08.2017. godine. Podaci su prikupljeni u jedinstvenoj bazi Resuscitacionog Saveta Srbije i unešeni od strane glavnih istraživača iz 13 centara. Za analizu postojećih podataka iz baze, korišten je statistički program statistika SPSS. Rezultati: U posmatranom periodu na teritoriji Vojvodine potvrđeno je ukup-no1240 iznenadnih srčanih zastoja od strane lekarskih ekipa hitnih medicinskih pomoći. Mere kardiopulmonalne resuscitacije su započete kod 706 pacijenata, od kojih je 237 (33,56%) osoba ženskog pola. Prosečna starost žena je bila 68,2 godine. Najmlađa pacijentkinja je imala manje od 1 godine a najstarija 94. Prema etiologiji, kardiovaskularni uzrok je najučestaliji 197 (83%), dok se respiratorni etiološki uzrok javlja u 15 (6,4%) i nekardiološki uzroci u 23 (9,8%) .Traumatski srčani zastoj kao etiološki faktor u našoj analizi kod žena nije registrovan. Prema mestu nastanka srčanog zastoja kod osoba ženskog pola dominira prebivalište 187 (88,6%), zatim ulica 12 (5%), dom za stare 7 (3%), javna ustanova 3 (1,2%) dok ni jedan vanbolnički srčani zastoj kod osoba nije registrovan na sportskim terenima. Svedok-očevidac je započeo KPR pre dolaska ekipa hitne medicinske pomoći kod 44 žene (18,6%). Šokabilni inicijalni ritam je zabeležen kod 61 osobe ženskog pola (25,7%) dok je uspostavljena spontana cirkulacija (ROSC) kod 74 žene (31,2%). Do otpusta iz bolnice je preživelo 12 pacijentkinja (5%) a nakon 3o dana 11 (4,6%).

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Sex Differences in Survival From Out‐of‐Hospital Cardiac Arrest in the Era of Regionalized Systems and Advanced Post‐Resuscitation Care

Abstract: Background--The purpose of this study was to evaluate sex differences in out-of-hospital cardiac arrest (OHCA) characteristics, interventions, and outcomes.

Cited by 72 publications

References 22 publications

Prehospital extracorporeal cardiopulmonary resuscitation for out‐of‐hospital cardiac arrest: A retrospective eligibility study

Prehospital extracorporeal cardiopulmonary resuscitation for out‐of‐hospital cardiac arrest: A retrospective eligibility study

Association of Bystander and First‐Responder Efforts and Outcomes According to Sex: Results From the North Carolina HeartRescue Statewide Quality Improvement Initiative

Out of hospital cardiac arrest in women in Vojvodina: Epidemiological data analysis

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