Sex differences in the prehospital management of out-of-hospital cardiac arrest

Introduction: Cardiac catheterization is recommended for patients resuscitated from out-of-hospital cardiac arrest (OHCA) with a suspected cardiac etiology. Women are less likely than men to receive cardiac catheterization in other presentations of cardiovascular disease, but it remains unknown whether this disparity extends to OHCA. Objective: To determine whether patient sex is associated with undergoing cardiac catheterization after OHCA. Methods: We included all adult cases in the 2011 California Office of Statewide Health Planning and Development (OSHPD) database with a present-on-admission diagnosis of cardiac arrest (ICD-9-CM 427.5) or sudden cardiac death (ICD-9-CM 798) who were admitted from the emergency department to an acute care hospital. Data extracted from the OSHPD database included patient demographics, diagnoses, and procedures. ICD-9-CM procedure codes from the OSHPD database were used to identify patients who received cardiac catheterization. To determine factors associated with undergoing cardiac catheterization, we used a hierarchical logistic regression model that included age, sex, race, ethnicity, insurance type, ventricular arrest rhythm, and treatment at a hospital with 24/7 percutaneous coronary intervention capability. Results: We studied 4493 men and 3287 women admitted following OHCA. Women were older (median age 70 vs 64 years; p<0.001), had had fewer ventricular arrest rhythms (21.8% vs 31.7%; p<0.001), and received fewer cardiac catheterization procedures [12.5% vs 21.4%; p<0.0001]. This sex difference in cardiac catheterization persisted in the multivariable hierarchical model (adjusted OR 0.65; 95% CI 0.57-0.76; p<0.0001) and in a subgroup analysis including only patients with ventricular arrest rhythms (adjusted OR 0.63; 95% CI 0.51-0.78; p<0.0001) Conclusion: Sex differences exist in cardiac catheterization following resuscitation from OHCA. Future efforts should focus on understanding and resolving these differences.

Download Full-text

Women have lower chances than men to be resuscitated and survive out-of-hospital cardiac arrest

European Heart Journal ◽

10.1093/eurheartj/ehz297 ◽

2019 ◽

Vol 40 (47) ◽

pp. 3824-3834 ◽

Cited By ~ 24

Author(s):

Marieke T Blom ◽

Iris Oving ◽

Jocelyn Berdowski ◽

Irene G M van Valkengoed ◽

Abdenasser Bardai ◽

...

Keyword(s):

Overall Survival ◽

Cardiac Arrest ◽

Sex Differences ◽

Hospital Admission ◽

Survival Rates ◽

Hospital Treatment ◽

Care Utilization ◽

Entire Study ◽

Hospital Cardiac Arrest ◽

Resuscitation Attempt

AbstractAimsPrevious 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 resultsWe 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.ConclusionIn 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.

Download Full-text

Predicting factors for long-term survival in patients with out-of-hospital cardiac arrest – a propensity score-matched analysis

10.1101/664441 ◽

2019 ◽

Author(s):

Anna Lena Lahmann ◽

Dario Bongiovanni ◽

Anna Berkefeld ◽

Maximilian Kettern ◽

Lucas Martinez ◽

...

Keyword(s):

Cardiac Arrest ◽

Propensity Score ◽

Best Practice ◽

Multivariate Regression Analysis ◽

Critically Ill Patient ◽

Term Survival ◽

St Segment Elevation ◽

Predicting Factors ◽

Prehospital Management ◽

Hospital Cardiac Arrest

AbstractBackgroundOut-of-hospital cardiac arrest (OHCA) is one of the leading causes of death worldwide, with acute coronary syndromes accounting for most of the cases.While the benefit of early revascularization has been clearly demonstrated in patients with ST-segment-elevation myocardial infarction (STEMI), diagnostic pathways remain unclear in the absence of STEMI. We aimed to characterize OHCA patients presenting to 2 tertiary cardiology centers and identify predicting factors associated with survival.MethodsWe retrospectively analyzed 519 patients after OHCA from February 2003 to December 2017 at 2 centers in Munich, Germany. Patients undergoing immediate coronary angiography (CAG) were compared to those without. Propensity score (PS) matching analysis and multivariate regression analysis were performed to identify predictors for improved outcome.ResultsImmediate CAG was performed in 385 (74.1%) patients after OHCA with presumed cardiac cause of arrest.As a result of multivariate analysis after propensity score matching, we found that ROSC at admission and immediate CAG were associated with better 30-days-survival [(OR, 6.54; 95% CI, 2.03-21.02), (OR, 2.41; 95% CI, 1.04-5.55)], and 1-year-survival [(OR, 4.49; 95% CI, 1.55-12.98), (OR, 2.54; 95% CI, 1.06-6.09)].ConclusionsIn our study, ROSC at admission and immediate CAG were independent predictors of survival in cardiac arrest survivors. Improvement in prehospital management including bystander CPR and best practice post-resuscitation care with optimized triage of patients to an early invasive strategy may help ameliorate overall outcome of this critically-ill patient population.

Download Full-text

Sex Differences in “Do Not Attempt Resuscitation” Orders After Out-of-Hospital Cardiac Arrest and the Relationship to Critical Hospital Interventions

Clinical Therapeutics ◽

10.1016/j.clinthera.2019.03.017 ◽

2019 ◽

Vol 41 (6) ◽

pp. 1029-1037 ◽

Cited By ~ 1

Author(s):

Sarah M. Perman ◽

Bonnie J. Siry ◽

Adit A. Ginde ◽

Anne V. Grossestreuer ◽

Benjamin S. Abella ◽

...

Keyword(s):

Cardiac Arrest ◽

Sex Differences ◽

Resuscitation Orders ◽

The Relationship ◽

Hospital Cardiac Arrest

Download Full-text

Abstract 186: Sex Differences in Outcomes for Out-Of-Hospital Cardiac Arrest

Circulation ◽

10.1161/circ.140.suppl_2.186 ◽

2019 ◽

Vol 140 (Suppl_2) ◽

Author(s):

Pavitra Kotini-Shah ◽

Oksana Pugach ◽

Ruizhe Chen ◽

Marina Del Rios ◽

Kimberly Vellano ◽

...

Keyword(s):

United States ◽

Cardiac Arrest ◽

Sex Differences ◽

Coronary Angiography ◽

Neurological Outcome ◽

The United States ◽

Neurological Outcomes ◽

Bystander Cpr ◽

Favorable Neurological Outcome ◽

Hospital Cardiac Arrest

Introduction: Approximately 1,000 out-of-hospital cardiac arrest (OHCA) occur per day in the United States. Although survival rates remains low, the extent to which OHCA neurological outcomes differ between men and women remains poorly characterized. Methods: Within the national Cardiac Arrest Registry to Enhance Survival (CARES) registry, we identified 195,722 adult individuals with an OHCA between 2013-2017. Using multi-variable logistic regression models, we evaluated for sex differences in rates of survival to hospital discharge and favorable neurological outcome (survival with discharge CPC score of 1 or 2), adjusted for cardiac arrest characteristics, race, location, year of arrest, age, and use of targeted temperature management (TTM) and coronary angiography. Results: Overall, 70,767 (31%) patients were women. Median age was 64 and 62 years for women and men, respectively. An initial shockable rhythm (14.9% vs. 25.7%) and a witnessed arrest (40.9% vs. 45.6%) was more common in men. Bystander CPR was provided to 37% of women and 39% of men. Men were less likely to survive to hospital discharge than women (8.7% vs. 10.9%; adjusted OR 0.75, 95% CI 0.73, 0.78). Similarly, men were less likely to have favorable neurological outcome (6.6% vs. 9.2% for women; adjusted OR 0.78, 95% CI 0.74, 0.82). Further interaction analysis for the pre-hospital elements found small, but statistically significant sex differences in favorable neurological survival for witnessed status (among female OR 2.29, 95% CI 2.10, 2.49; among males OR 2.07, 95% CI 1.92, 2.23, p= 0.04) and for bystander CPR (among females OR 1.20, 95% CI 1.11, 1.29; among males OR 1.34, 95% CI 1.27, 1.42, p= 0.01). Interaction of sex with the hospital level variables of TTM and coronary angiography, for the subset of patients that survived to hospital admission, had no sex differences in favorable neurological outcome. Conclusion: Our analysis shows that for OHCA in the United States, women have better survival outcomes than men. There was a sex differences in the pre-hospital variable of BCPR, but not in the other modifiable variables of TTM and coronary angiography. Further study is needed to better understand sex differences in overall survival and neurological outcomes.

Download Full-text

Sex differences in the association of comorbidity with shockable initial rhythm in out-of-hospital cardiac arrest

Resuscitation ◽

10.1016/j.resuscitation.2021.08.034 ◽

2021 ◽

Vol 167 ◽

pp. 173-179

Author(s):

Laura H. van Dongen ◽

Iris Oving ◽

Pauline W. Dijkema ◽

Stefanie G. Beesems ◽

Marieke T. Blom ◽

...

Keyword(s):

Cardiac Arrest ◽

Sex Differences ◽

Initial Rhythm ◽

Hospital Cardiac Arrest

Download Full-text

Out-of-hospital Cardiac Arrest in the Republic of Crimea: Analysis of Epidemiology and Practice of Care

Russian Sklifosovsky Journal Emergency Medical Care ◽

10.23934/2223-9022-2020-9-3-338-347 ◽

2020 ◽

Vol 9 (3) ◽

pp. 338-347

Author(s):

A. A. Birkun ◽

L. P. Frolova ◽

G. N. Buglak ◽

S. S. Olefirenko

Keyword(s):

Cardiac Arrest ◽

Response Time ◽

Prehospital Care ◽

Spontaneous Circulation ◽

Annual Data ◽

Clear Understanding ◽

Study Results ◽

Prehospital Management ◽

The Republic ◽

Hospital Cardiac Arrest

Introduction. Efficient organization of measures aimed at decreasing mortality from out-of-hospital cardiac arrest (OHCA) warrants a clear understanding of OHCA epidemiology and performance of the prehospital care system in such cases. The study was aimed at performing respective analysis and identifying the ways for improving prehospital management of OHCA in the Republic of Crimea.Material and methods. Annual data from the Crimean OHCA and Resuscitation Registry for 2018 were utilized. All OHCA cases attended by emergency medical services (EMS) with attempted cardiopulmonary resuscitation (CPR) were included, regardless of cardiac arrest etiology or patients’ age (n=419). For ensuring conformity and comparability of the study results, data collection and analysis were executed in correspondence with the statements of the Utstein recommendations.Results. The overall incidence of EMS-attended OHCA in the Republic of Crimea was 673.3 per 100,000 population per year, the incidence of OHCA with attempted CPR – 21.9 per 100,000 population per year, the proportion of CPR attempts out of all OHCA cases – 3.3%. Mean patient age was 66.9 years, and 52.7% were male. The etiology was cardiac in 42.5% cases. In 71.8% cases OHCA was witnessed by EMS, in 25.5% – by a bystander before EMS arrival. Bystanders initiated CPR in 5.7% cases. The initial rhythm was asystole in 80.4% of all cases. When excluding EMS-witnessed cases, the mean EMS response time was 13 min. 5.0% patients had a sustained return of spontaneous circulation at hospital admission. Survival was associated with lower EMS response time (p=0.027), administration of shock (p<0.001) and advanced airway management with endotracheal tube or laryngeal mask (p=0.047).Conclusion. High incidence of OHCA, low rates of CPR commencement and low rates of survival from OHCA in the Republic of Crimea determine the necessity of implementing a comprehensive program to improve prehospital care in the region. Considering the critical relevance of early intervention in OHCA and the revealed low bystander CPR rate, the measures for involving community into the process of prehospital care should form the basis of this program.

Download Full-text