Sex-related disparities in the in-hospital management of patients with out-of-hospital cardiac arrest

Song, Jae-Ju; Ahn, Sungyoon; Kim, Jooyeong; Cho, Hanjin; Moon, Sungwoo; Choi, Sung Hyuk; Park, Jong Hak

doi:10.1016/j.resuscitation.2022.02.003

Cited by 8 publications

(6 citation statements)

References 40 publications

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“…Of note, few previous studies have examined sex differences in the provision of ECMO. These had small case cohorts; a shortcoming which also applied to our ECMO cohort ( 6 , 19 ).…”

Section: Discussionmentioning

confidence: 99%

Sex Differences in Vital Organ Support Provided to ICU Patients*

Modra,

Higgins,

Pilcher

et al. 2023

Critical Care Medicine

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Objectives: Critically ill women may receive less vital organ support than men but the mortality impact of this differential treatment remains unclear. We aimed to quantify sex differences in vital organ support provided to adult ICU patients and describe the relationship between sex, vital organ support, and mortality. Design: In this retrospective observational study, we examined the provision of invasive ventilation (primary outcome), noninvasive ventilation, vasoactive medication, renal replacement therapy, extracorporeal membrane oxygenation (ECMO), or any one of these five vital organ supports in women compared with men. We performed logistic regression investigating the association of sex with each vital organ support, adjusted for illness severity, diagnosis, preexisting treatment limitation, year, and hospital. We performed logistic regression for hospital mortality adjusted for the same variables, stratified by vital organ support (secondary outcome). Setting and Patients: ICU admissions in the Australia and New Zealand Intensive Care Society Adult Patient Database 2018–2021. This registry records admissions from 90% of ICUs in the two nations. Interventions: None. Measurements and Main Results: We examined 699,535 ICU admissions (43.7% women) to 199 ICUs. After adjustment, women were less likely than men to receive invasive ventilation (odds ratio [OR], 0.64; 99% CI, 0.63–0.65) and each other organ support except ECMO. Women had lower adjusted hospital mortality overall (OR, 0.94; 99% CI, 0.91–0.97). Among patients who did not receive any organ support, women had significantly lower adjusted hospital mortality (OR, 0.82; 99% CI, 0.76–0.88); among patients who received any organ support women and men were equally likely to die (OR, 1.01; 99% CI, 0.97–1.04). Conclusions: Women received significantly less vital organ support than men in ICUs in Australia and New Zealand. However, our findings suggest that women may not be harmed by this conservative approach to treatment.

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“…Of note, few previous studies have examined sex differences in the provision of ECMO. These had small case cohorts; a shortcoming which also applied to our ECMO cohort ( 6 , 19 ).…”

Section: Discussionmentioning

confidence: 99%

Sex Differences in Vital Organ Support Provided to ICU Patients*

Modra,

Higgins,

Pilcher

et al. 2023

Critical Care Medicine

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“…The Korean EMS, which has regional headquarters in the National Fire Agency, employs a partially dual dispatch response system; it uses basic life support fire engines and advanced cardiovascular life support ambulances for suspected cases of OHCA. 27 Prehospital EMS providers within this system are trained emergency medical technicians and nurses affiliated with the fire department. All patients receive CPR following the EMS protocol and are transported to the nearest emergency department.…”

Section: Methodsmentioning

confidence: 99%

Spatiotemporal Analysis of Out-of-Hospital Cardiac Arrest Incidence and Survival Outcomes in Korea (2009–2021)

Lee,

Jung,

et al. 2024

J Korean Med Sci

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Background Out-of-hospital cardiac arrest is a major public health concern in Korea. Identifying spatiotemporal patterns of out-of-hospital cardiac arrest incidence and survival outcomes is crucial for effective resource allocation and targeted interventions. Thus, this study aimed to investigate the spatiotemporal epidemiology of out-of-hospital cardiac arrest in Korea, with a focus on identifying high-risk areas and populations and examining factors associated with prehospital outcomes. Methods We conducted this population-based observational study using data from the Korean out-of-hospital cardiac arrest registry from January 2009 to December 2021. Using a Bayesian spatiotemporal model based on the Integrated Nested Laplace Approximation, we calculated the standardized incidence ratio and assessed the relative risk to compare the spatial and temporal distributions over time. The primary outcome was out-of-hospital cardiac arrest incidence, and the secondary outcomes included prehospital return of spontaneous circulation, survival to hospital admission and discharge, and good neurological outcomes. Results Although the number of cases increased over time, the spatiotemporal analysis exhibited a discernible temporal pattern in the standardized incidence ratio of out-of-hospital cardiac arrest with a gradual decline over time (1.07; 95% credible interval [CrI], 1.04–1.09 in 2009 vs. 1.00; 95% CrI, 0.98–1.03 in 2021). The district-specific risk ratios of survival outcomes were more favorable in the metropolitan and major metropolitan areas. In particular, the neurological outcomes were significantly improved from relative risk 0.35 (0.31–0.39) in 2009 to 1.75 (1.65–1.86) in 2021. Conclusion This study emphasized the significance of small-area analyses in identifying high-risk regions and populations using spatiotemporal analyses. These findings have implications for public health planning efforts to alleviate the burden of out-of-hospital cardiac arrest in Korea.

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“…This declaration is only to be carried out under direct medical control by an EMS physician on duty at a dispatch centre. Therefore, most patients with OHCA are transported to an eligible hospital for continuing CPR 12 , 13 .…”

Section: Methodsmentioning

confidence: 99%

The interaction effect of bystander cardiopulmonary resuscitation (CPR) and dispatcher CPR on outcomes after out-of-hospital cardiac arrest

Sohn

Cho

2022

Sci Rep

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This study aimed to evaluate the effects of bystander cardiopulmonary resuscitation (CPR) and dispatcher-assisted CPR (DA-CPR) on outcomes after out-of-hospital cardiac arrest (OHCA). We conducted a prospective observational study using the Korean Cardiac Arrest Research Consortium registry database and enrolled adults aged > 20 years who sustained OHCA. The study population comprised 13,864 patients from October 1, 2015, to June 30, 2021. All enrolled patients were transported to the emergency room and resuscitated by the emergency medical personnel. Patients with terminal illnesses, pregnancy, “do not resuscitate” cards, and insufficient recorded information were excluded. Good neurologic outcomes were noted in 6.5%, 9.9%, and 9.6% of patients in the “no bystander”, “standard bystander”, and “compression-only bystander” CPR groups, respectively, and differed significantly (p < 0.001). Survival to discharge differed significantly (p < 0.001) between groups at 10.8%, 13.1%, and 13.2%, respectively. In a multivariable model, the interaction between “compression-only” and DA-CPR showed a positive effect on good neurological outcomes and survival to discharge with an odds ratio of 1.93 (Confidence interval, CI 1.28–2.91, p = 0.002) and 1.74 (CI 1.24–2.44, p = 0.001), respectively. In conclusion, the interaction between compression-only CPR and DA-CPR is significantly associated with good neurological and survival outcomes after OHCA. Education for bystanders and dispatchers should adhere to the current guidelines to improve outcomes among OHCA victims.

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Sex-related disparities in the in-hospital management of patients with out-of-hospital cardiac arrest

Cited by 8 publications

References 40 publications

Sex Differences in Vital Organ Support Provided to ICU Patients*

Sex Differences in Vital Organ Support Provided to ICU Patients*

Spatiotemporal Analysis of Out-of-Hospital Cardiac Arrest Incidence and Survival Outcomes in Korea (2009–2021)

The interaction effect of bystander cardiopulmonary resuscitation (CPR) and dispatcher CPR on outcomes after out-of-hospital cardiac arrest

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