Sex-specific differences in survival after out-of-hospital cardiac arrest: a nationwide, population-based observational study

Goto, Yoshikazu; Funada, Akira; Maeda, Takeshi; Okada, Hirofumi; Goto, Yumiko

doi:10.1186/s13054-019-2547-x

Cited by 32 publications

(30 citation statements)

References 48 publications

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“…However, it is not clear whether sex differences in heart-related diseases affect the prognosis of OHCA. Multiple studies have addressed possible sex differences associated with OHCA prognosis, but the findings are inconsistent: some studies report no difference between males and females in survival after OHCA [ 7 , 11 ]; others have reported better survival for males or better survival for females [ 12 , 13 ]. A meta-analysis published in 2015 showed that the discharge survival rate of female OHCA patients was 10% higher than that of male, but the results of the latest large clinical studies show conflicting trends [ 14 ].…”

Section: Introductionmentioning

confidence: 99%

Sex differences in survival after out-of-hospital cardiac arrest: a meta-analysis

Lei

Liu

et al. 2020

Crit Care

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Background Out-of-hospital cardiac arrest (OHCA) is a leading cause of sudden cardiac death worldwide. Researchers have found significant pathophysiological differences between females and males and clinically significant sex differences related to medical services. However, conflicting results exist and there is no uniform agreement regarding sex differences in survival and prognosis after OHCA. Therefore, we investigated the relationship between the prognosis of OHCA and sex factors. Methods We comprehensively searched the PubMed, Embase, and Cochrane databases and obtained a total of 1042 articles, from which 33 studies were selected for inclusion. The pooled odds ratios (ORs) and 95% confidence intervals (CIs) were estimated using a random-effects model. Results The meta-analysis included 1,268,664 patients. Compared with males, females were older (69.7 years vs. 65.4 years, p < 0.05) and more frequently suffered OHCA without witnesses (58.39% vs 62.70%, p < 0.05). Females were less likely to receive in-hospital interventions than males. There was no significant difference between females and males in the survival from OHCA to hospital admission (OR 0.99, 95% CI 0.89–1.1). However, females had lower chances for survival from hospital admission to discharge (OR 0.59, 95% CI 0.48–0.73), overall survival to hospital discharge (OR 0.73, 95% CI 0.62–0.86), and favorable neurological outcomes (OR 0.62, 95% CI 0.47–0.83) compared with males. Conclusions Our results indicate that the overall discharge survival rate of females is lower than that of males, and females face a poor prognosis of the nervous system. This is likely related to the pathophysiological characteristics of females, more conservative treatment measures compared with males, and different post-resuscitation care. However, these findings should be interpreted with caution due to the presence of several confounding factors.

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Section: Introductionmentioning

confidence: 99%

Sex differences in survival after out-of-hospital cardiac arrest: a meta-analysis

Lei

Liu

et al. 2020

Crit Care

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“…The baseline characteristics of each group are comparable. There is a slight increase in the proportion of women in the PLR group, but this was not associated with worse outcomes (22).…”

Section: Discussionmentioning

confidence: 82%

Clinical Outcomes and Safety of Passive Leg Raising in Out-of-Hospital Cardiac Arrest. A Randomized Clinical Trial.

Azeli

Bardajı́

Barbería³

et al. 2021

Preprint

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Background: There are data suggesting that passive leg raising (PLR) improves hemodynamics during cardiopulmonary resuscitation (CPR). This trial aimed to determine the effectiveness and safety of PLR during CPR in out-of-hospital cardiac arrest (OHCA).Methods: We conducted a randomized clinical trial with blinded assessment of the outcomes that assigned adults OHCA to be treated with PLR or in the flat position. The trial was conducted in the Camp de Tarragona region. The main end point was survival to hospital discharge with good neurological outcome defined as Cerebral Performance Category (CPC 1-2). To study possible adverse effects, we assessed the presence of pulmonary complications on the first chest X-rays in survivors and lungs weight from autopsies in non-survivors. Results: In total, 445 randomized CPR attempts were included, 234 were treated with PLR and 211 were controls. Overall, 71.5% were men and the median age was 69 IQR (58-78) years old. At hospital discharge, 4.3% in the PLR group and 4.7% in the control group were alive with CPC 1-2 (OR 0.9; 95% CI 0.4-2.2, p=0.81). A higher survival at hospital admission was found among patients with a shockable rhythm, but there were no significant differences (OR 1.6; 95% CI 0.8-3.4, p=0.18). There were no differences in pulmonary complication rates in chest X-rays (25.9% vs 17.9%, p=0.47) or lung weight 1223 IQR (909.5-1500) mg vs. 1239 IQR (900-1507) mg. Conclusion: In this trial, PLR during CPR did not improve survival to hospital discharge with CPC 1-2. No evidence of adverse effects has been found.Clinical Trial Registration: ClinicalTrials.gov: NCT01952197, registration date: Sept 27, 2013, https://clinicaltrials.gov/ct2/show/NCT01952197.

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“…This could be explained by the higher prevalence of cardiovascular disease and lifestyle risk factors in men [ 21 ]. Many studies have shown that survival outcomes differ between the sexes, although the findings are somewhat contradictory [ 14 , 22 – 25 ].…”

Section: Discussionmentioning

confidence: 99%

“…Animal studies have shown that estrogen administration may improve cardiac arrest outcomes [ 11 , 12 ]. Contrarily, some studies have reported that the OHCA survival rate among females in the reproductive age, was similar to that in males [ 13 , 14 ]. Further research is required to explain these conflicting results.…”

Section: Introductionmentioning

confidence: 95%

Gender effect in survival after out-of-hospital cardiac arrest: A nationwide, population-based, case-control propensity score matched study based Korean national cardiac arrest registry

Choi

Chang

et al. 2022

PLoS ONE

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Objective This study aimed to describe the relationship between sex and survival of patients with out-of-hospital cardiac arrest (OHCA) and further investigate the potential impact of female reproductive hormones on survival outcomes, by stratifying the patients into two age groups. Methods This retrospective, national population-based observational, case-control study, included Korean OHCA data from January 1, 2009, to December 31, 2016. We used multiple logistic regression with propensity score-matched data. The primary outcome was survival-to-discharge. Results Of the 94,160 patients with OHCA included, 34.2% were women. Before propensity score matching (PSM), the survival-to-discharge rate was 5.2% for females and 9.1% for males, in the entire group (OR 0.556, 95% CI [–0.526–0.588], P<0.001). In the reproductive age group (age 18–44 years), the survival-to-discharge rate was 14% for females and 15.6% for males (OR 0.879, 95% CI [0.765–1.012], P = 0,072) and in the post-menopause age group (age ≥ 55 years), the survival-to-discharge rate was 4.1% for females and 7% for males (OR 0.562, 95% CI [0.524–0.603], P<0.001). After PSM (28,577 patients of each sex), the survival-to-discharge rate was 5.4% for females and 5.4% for males (OR, 1.009 [0.938–1.085], P = 0.810). In the reproductive age group, the survival-to-discharge rate was 14.5% for females and 11.5% for males (OR 1.306, 95% CI [1.079–1.580], P = 0.006) and in the post-menopause age group, the survival-to-discharge rate was 4.2% for females and 4.6% for males (OR 0.904, 95% CI [0.828–0.986], P = 0.022). After adjustment for confounders, women of reproductive age were more likely to survive at hospital discharge. However, there was no statistically significant difference in neurological outcome (OR 1.238, 95% CI [0.979–1.566], P = 0.074). Conclusions Females of reproductive age had a better chance of survival when matched for confounding factors. Further studies using sex hormones are needed to improve the survival rate of patients with OHCA.

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Sex-specific differences in survival after out-of-hospital cardiac arrest: a nationwide, population-based observational study

Cited by 32 publications

References 48 publications

Sex differences in survival after out-of-hospital cardiac arrest: a meta-analysis

Sex differences in survival after out-of-hospital cardiac arrest: a meta-analysis

Clinical Outcomes and Safety of Passive Leg Raising in Out-of-Hospital Cardiac Arrest. A Randomized Clinical Trial.

Gender effect in survival after out-of-hospital cardiac arrest: A nationwide, population-based, case-control propensity score matched study based Korean national cardiac arrest registry

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