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

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.

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156 Prehospital determinants of successful resuscitation after traumatic and non-traumatic out-of-hospital cardiac arrest

Emergency Medicine Journal ◽

10.1136/emj-2020-rcemabstracts.6 ◽

2020 ◽

Vol 37 (12) ◽

pp. 825.1-825

Author(s):

Ed Barnard ◽

Daniel Sandbach ◽

Tracy Nicholls ◽

Alastair Wilson ◽

Ari Ercole

Keyword(s):

Overall Survival ◽

Cardiac Arrest ◽

Hospital Admission ◽

Hospital Discharge ◽

Multivariable Analysis ◽

Discharge Data ◽

Successful Resuscitation ◽

Bystander Cpr ◽

Number Percentage ◽

Hospital Cardiac Arrest

Aims/Objectives/BackgroundOut-of-hospital cardiac arrest (OHCA) is prevalent in the UK. Reported survival is lower than in countries with comparable healthcare systems; a better understanding of outcome determinants may identify areas for improvement. Aim: to compare differential determinants of survival to hospital admission and survival to hospital discharge for traumatic (TCA) and non-traumatic cardiac arrest (NCTA).Methods/DesignAn analysis of 9109 OHCA in East of England between 1 January 2015 and 31 July 2017. Univariate descriptives and multivariable analysis were used to understand the determinants of survival for NTCA and TCA. Two Utstein outcome variables were used: survival to hospital admission and hospital discharge. Data reported as number (percentage), number (percentage (95% CI)) and median (IQR) as appropriate. Continuous data have been analysed with a Mann-Whitney U test, and categorical data have been analysed with a χ2 test. Analyses were performed using the R statistical programming language.Results/ConclusionsThe incidence of OHCA was 55.1 per 100 000 population/year. The overall survival to hospital admission was 27.6% (95%CI 26.7% to 28.6%) and the overall survival to discharge was 7.9% (95%CI 7.3% to 8.5%). Survival to hospital admission and survival to hospital discharge were both greater in the NTCA group compared with the TCA group: 27.9% vs 19.3% p=0.001, and 8.0% vs 3.8% p=0.012 respectively.Determinants of NTCA and TCA survival were different, and varied according to the outcome examined. In NTCA, bystander cardiopulmonary resuscitation (CPR) was associated with survival at discharge but not at admission, and the likelihood of bystander-CPR was dependent on geographical socioeconomic status.NTCA and TCA are clinically distinct entities with different predictors for outcome and should be reported separately. Determinants of survival to hospital admission and discharge differ in a way that likely reflects the determinants of neurological injury. Bystander CPR public engagement may be best focused in more deprived areas.

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Prehospital determinants of successful resuscitation after traumatic and non-traumatic out-of-hospital cardiac arrest

Emergency Medicine Journal ◽

10.1136/emermed-2018-208165 ◽

2019 ◽

Vol 36 (6) ◽

pp. 333-339 ◽

Cited By ~ 15

Author(s):

Ed B G Barnard ◽

Daniel D Sandbach ◽

Tracy L Nicholls ◽

Alastair W Wilson ◽

Ari Ercole

Keyword(s):

Overall Survival ◽

Cardiac Arrest ◽

Hospital Admission ◽

Hospital Discharge ◽

Multivariable Analysis ◽

Neurological Injury ◽

Successful Resuscitation ◽

Traumatic Cardiac Arrest ◽

Bystander Cpr ◽

Hospital Cardiac Arrest

BackgroundOut-of-hospital cardiac arrest (OHCA) is prevalent in the UK. Reported survival is lower than in countries with comparable healthcare systems; a better understanding of outcome determinants may identify areas for improvement.MethodsAn analysis of 9109 OHCA attended in East of England between 1 January 2015 and 31 July 2017. Univariate descriptives and multivariable analysis were used to understand the determinants of survival for non-traumatic cardiac arrest (NTCA) and traumatic cardiac arrest (TCA). Two Utstein outcome variables were used: survival to hospital admission and hospital discharge.ResultsThe incidence of OHCA was 55.1 per 100 000 population/year. The overall survival to hospital admission was 27.6% (95% CI 26.7% to 28.6%) and the overall survival to discharge was 7.9% (95% CI 7.3% to 8.5%). Survival to hospital admission and survival to hospital discharge were both greater in the NTCA group compared with the TCA group: 27.9% vs 19.3% p=0.001, and 8.0% vs 3.8% p=0.012 respectively.Determinants of NTCA and TCA survival were different, and varied according to the outcome examined. In NTCA, bystander cardiopulmonary resuscitation (CPR) was associated with survival at discharge but not at admission, and the likelihood of bystander CPR was dependent on geographical socioeconomic status. An air ambulance was associated with increased survival to both hospital admission and discharge in NTCA, but only with survival to admission in TCA.ConclusionNTCA and TCA are clinically distinct entities with different predictors for outcome—future OHCA reports should aim to separate arrest aetiologies. Determinants of survival to hospital admission and discharge differ in a way that likely reflects the determinants of neurological injury. Bystander CPR public engagement may be best focused in more deprived areas.

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

Critical Care ◽

10.1186/s13054-020-03331-5 ◽

2020 ◽

Vol 24 (1) ◽

Author(s):

Hao Lei ◽

Jiahui Hu ◽

Leiling Liu ◽

Danyan Xu

Keyword(s):

Cardiac Arrest ◽

Sex Differences ◽

Hospital Admission ◽

Meta Analysis ◽

Neurological Outcomes ◽

Significant Difference ◽

Treatment Measures ◽

Clinically Significant ◽

To Receive ◽

Hospital Cardiac Arrest

Abstract 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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P507Cumulative comorbidity and survival in out-of-hospital cardiac arrest

EP Europace ◽

10.1093/europace/euaa162.260 ◽

2020 ◽

Vol 22 (Supplement_1) ◽

Cited By ~ 1

Author(s):

L Van Dongen ◽

I Oving ◽

S G Beesems ◽

M T Blom ◽

H L Tan

Keyword(s):

Cardiac Arrest ◽

Hospital Admission ◽

Disease Burden ◽

Survival Rates ◽

Care Needs ◽

Lower Survival Rate ◽

Horizon 2020 ◽

Comorbidity Burden ◽

Medical Histories ◽

Hospital Cardiac Arrest

Abstract Funding Acknowledgements EU Horizon 2020 - 733381, CVON2017-15 RESCUED, CVON2018-30 Predict2, an unconditional grant from Physio-Control Inc., Redmond, WA USA. OnBehalf ARREST Introduction Multiple chronic health conditions have been associated with survival after out-of-hospital cardiac arrest (OHCA). The influence of cumulative disease burden on survival rates at successive stages of post-resuscitation care is unknown. Purpose To study the relationship between cumulative disease burden (Charlson Comorbidity Index [CCI]) and survival rates in the course of post-resuscitation care. Methods From a prospective community-based OHCA registry, 2544 OHCA patients aged ≥18y with presumed cardiac cause in 2010-2014 were included. CCI was determined using medical histories from general practitioners and hospital correspondence, and categorized into: no (CCI = 0), moderate (CCI = 1-2) or high (CCI≥3) disease burden. The following stages of post-resuscitation care were defined: (1) pre-hospital: from OHCA to hospital admission, (2) in-hospital: from hospital admission to hospital discharge. The association between CCI and overall survival and survival at successive stages of care was assessed using logistic regression analyses. Results were stratified according to sex. Results In the pre-hospital stage, no association between CCI and survival to hospital admission was found (OR 0.93, 95%CI 0.73-0.1.18, P = 0.61) (Figure 1). In contrast, during the in-hospital stage high CCI was significantly associated with lower survival rate (OR 0.41, 95% CI 0.27-0.61, P < 0.01) (Figure 1), but, when stratified according to sex (pinteraction= <0.01), this association was only statistically significant in men (OR 0.34; 95%CI 0.21-0.55; P < 0.01), and not in women (OR 0.68; 95%CI 0.31-1.50; P = 0.33). When assessed individually, OHCA patients with congestive heart failure (24.8% vs. 12.0%, P < 0.01), peripheral vascular disease (11.7% vs. 5.4%, P < 0.01), diabetes (22.0% vs. 13.2%, P < 0.01), renal disease (17.1% vs. 5.9%, P < 0.01), malignancy (17.8% vs. 9.6%, P < 0.01), chronic pulmonary disorder (19.9% vs. 13.7%, P < 0.01), or dementia (0.3% vs. 3.0%, P < 0.01), were less likely to survive during the in-hospital stage. Conclusion Pre-existing comorbidity burden plays a significant role in OHCA survival, but only during the in-hospital stage. In order to ultimately improve survival after OHCA, in-hospital care needs further study taking pre-existing comorbidity burden into account. Abstract Figure 1

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Temporal Trends in Characteristics and Outcomes Associated With In‐Hospital Cardiac Arrest: A 20‐Year Analysis (1999–2018)

Journal of the American Heart Association ◽

10.1161/jaha.121.021572 ◽

2021 ◽

Author(s):

Lingling Wu ◽

Bharat Narasimhan ◽

Kirtipal Bhatia ◽

Kam S. Ho ◽

Chayakrit Krittanawong ◽

...

Keyword(s):

Overall Survival ◽

Cardiac Arrest ◽

Ventricular Tachycardia ◽

Electrical Activity ◽

Temporal Trends ◽

Survival Rates ◽

Pulseless Electrical Activity ◽

Adjusted Model ◽

Hospital Cardiac Arrest ◽

Overall Survival Rates

Background Despite advances in resuscitation medicine, the burden of in‐hospital cardiac arrest (IHCA) remains substantial. The impact of these advances and changes in resuscitation guidelines on IHCA survival remains poorly defined. To better characterize evolving patient characteristics and temporal trends in the nature and outcomes of IHCA, we undertook a 20‐year analysis of a national database. Methods and Results We analyzed the National Inpatient Sample (1999–2018) using International Classification of Diseases , Ninth Revision and Tenth Revision, Clinical Modification ( ICD‐9‐CM and ICD‐10‐CM ) codes to identify all adult patients suffering IHCA. Subgroup analysis was performed based on the type of cardiac arrest (ie, ventricular tachycardia/ventricular fibrillation or pulseless electrical activity‐asystole). An age‐ and sex‐adjusted model and a multivariable risk‐adjusted model were used to adjust for potential confounders. Over the 20‐year study period, a steady increase in rates of IHCA was observed, predominantly driven by pulseless electrical activity‐asystole arrest. Overall, survival rates increased by over 10% after adjusting for risk factors. In recent years (2014–2018), a similar trend toward improved survival is noted, though this only achieved statistical significance in the pulseless electrical activity‐asystole cohort. Conclusions Though the ideal quality metric in IHCA is meaningful neurological recovery, survival is the first step toward this. As overall IHCA rates rise, overall survival rates are improving in tandem. However, in more recent years, these improvements have plateaued, especially in the realm of ventricular tachycardia/ventricular fibrillation‐related survival. Future work is needed to better identify characteristics of IHCA nonsurvivors to improve resource allocation and health care policy in this area.

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Algorithm to Improve Resuscitation Outcomes in Patients With Traumatic Out-of-Hospital Cardiac Arrest

10.21203/rs.3.rs-960250/v1 ◽

2021 ◽

Author(s):

Hsin-Min Lee ◽

Chia-Ti Wang ◽

Chien-Chin Hsu ◽

Kuo-Tai Chen

Keyword(s):

Cardiac Arrest ◽

Hospital Admission ◽

Chart Review ◽

Survival Rates ◽

Retrospective Chart Review ◽

Venous Catheter ◽

Spontaneous Circulation ◽

Before And After ◽

End Tidal ◽

Hospital Cardiac Arrest

Abstract Backgroun:This study proposed an algorithm to improve resuscitation outcomes in the emergency department (ED) for patients with traumatic out-of-hospital cardiac arrest (TOHCA). We also performed a retrospective chart review of patient outcomes before and after implementing the algorithm and sought to define factors that might influence patient outcomes.Methods: In September 2018, we implemented an algorithm for patients with TOHCA. This algorithm rapidly identifies possible causes of TOHCA and recommends appropriate interventions. We retrospectively reviewed the outcomes of all patients with TOHCA during a 5-year period and compared the results before and after the implementation of the algorithm.Results:After this algorithm was implemented, the use of the ED interventions of blood transfusion, placement of a large-bore central venous catheter, and thoracostomy increased significantly. Return of spontaneous circulation (ROSC), hospital admission, and survival rates also increased (before vs. after: ROSC: 23.6% vs. 41.5%, P = 0.035; hospital admission: 18.2% vs. 24.6%, P = 0.394; survival: 0.0% vs. 4.6%, P = 0.107). Admitted patients exhibited a higher end-tidal CO2 level than nonadmitted patients [admitted vs. nonadmitted: 41.5 (33.3–52.0) vs. 12.0 (7.5–18.8), P = 0.001].Conclusion:Our algorithm prioritizes the three major treatable causes of TOHCA: impedance of venous return, hypovolemia, and hypoxia. We found that ROSC, hospital admission, and survival rates increased with the increasing implementation of the ED interventions recommended by the algorithm.

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