Association between sex and survival after out‐of‐hospital cardiac arrest: A systematic review and meta‐analysis

Bijman, Laura; Alotaibi, Raied; Jackson, Caroline; Clegg, Gareth; Halbesma, Nynke

doi:10.1002/emp2.12943

Cited by 3 publications

(2 citation statements)

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“…Our multivariable analysis findings, indicating no significant association between sex and survival outcomes, are consistent with the results of recent systematic reviews and meta‐analyses, 34 , 38 as well as other observational studies. 12 , 13 However, they are not in line with other studies suggesting an females have higher odds of survival, 23 , 39 and others indicating females have lower odds of survival.…”

Section: Discussionsupporting

confidence: 92%

“…Specifically, males experienced a higher incidence of OHCA in public locations and a greater proportion of witnessed arrests and shockable rhythms compared to females. Previous studies, including systematic reviews and meta‐analyses, 23,33–35 have consistently reported similar advantages in baseline characteristics for males. This may explain the higher crude survival rates observed in males.…”

Section: Discussionmentioning

confidence: 74%

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Epidemiology and outcome of out‐of‐hospital cardiac arrest in Salt Lake City: Sex‐based investigations

Awad,

Hopkins,

Palatinus

et al. 2024

JACEP Open

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ObjectivesPrior research indicates sex disparities in the incidence and outcomes of out‐of‐hospital cardiac arrest (OHCA). This study investigates the presence of such differences in Salt Lake City, Utah.MethodsWe analyzed data from the Salt Lake City Fire Department (2008‒2023). We included adults with non‐traumatic OHCA. We calculated the annual incidence of OHCA and examined sex‐specific survival outcomes using multivariable logistic regression, adjusting for OHCA characteristics known to be associated with survival.ResultsThe annual incidence of OHCA was 76 per 100,000 person‐years. Among the 894 OHCA cases included in the analysis, 67.5% were males, 37.3% achieved return of spontaneous circulation (ROSC), and 13.6% survived hospital discharge. Unadjusted analysis revealed that males had significantly higher OHCA in public locations (43.9% vs. 28.6%), witnessed arrests (54.5% vs. 47.8%), and shockable rhythms (33.3% vs. 22.9%). Males also showed higher rates of ROSC (37.5% vs. 36.9%), hospital discharge survival (14.5% vs. 11.7%), and neurologically intact survival. After adjusting for the OHCA characteristics, there was no significant differences between males and females in ROSC, survival to hospital discharge, and favorable neurological function with adjusted odds ratios (male vs. female) of 0.92 (95% confidence interval [CI] 0.73‒1.16), 0.85 (95% CI 0.59‒1.22), and 0.92 (95% CI 0.62‒1.40), respectively.ConclusionApproximately, 128 adults suffer OHCA in Salt Lake City annually. Males initially showed higher crude survival rates, but after adjusting for OHCA characteristics, no significant sex differences in survival outcomes were found. Enhancing OHCA characteristics could benefit both sexes. Investigations into the relationship between sex‐ and region‐specific factors influencing OHCA outcomes are needed.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 74%

Epidemiology and outcome of out‐of‐hospital cardiac arrest in Salt Lake City: Sex‐based investigations

Awad,

Hopkins,

Palatinus

et al. 2024

JACEP Open

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Global Sex Disparities in Bystander Cardiopulmonary Resuscitation After Out‐of‐Hospital Cardiac Arrest: A Scoping Review

Chen,

Lo,

et al. 2024

JAHA

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This scoping review collates evidence for sex biases in the receipt of bystander cardiopulmonary resuscitation (BCPR) among patients with out‐of‐hospital cardiac arrest patients globally. The MEDLINE, PsycINFO, CENTRAL, and Embase databases were screened for relevant literature, dated from inception to March 9, 2022. Studies evaluating the association between BCPR and sex/gender in patients with out‐of‐hospital cardiac arrest, except for pediatric populations and cardiac arrest cases with traumatic cause, were included. The review included 80 articles on BCPR in men and women globally; 58 of these studies evaluated sex differences in BCPR outcomes. Fifty‐nine percent of the relevant studies (34/58) indicated that women are less likely recipients of BCPR, 36% (21/58) observed no significant sex differences, and 5% (3/58) reported that women are more likely to receive BCPR. In other studies, women were found to be less likely to receive BCPR in public but equally or more likely to receive BCPR in residential settings. The general reluctance to perform BCPR on women in the Western countries was attributed to perceived frailty of women, chest exposure, pregnancy, gender stereotypes, oversexualization of women's bodies, and belief that women are unlikely to experience a cardiac arrest. Most studies worldwide indicated that women were less likely to receive BCPR than men. Further research from non‐Western countries is needed to understand the impact of cultural and socioeconomic settings on such biases and design customized interventions accordingly.

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Sex and 30-day survival following out-of-hospital cardiac arrest in Scotland 2011–2020

Bijman,

Wild,

Clegg

et al. 2024

Int J Emerg Med

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Background Differences in 30-day survival between males and females following out-of-hospital cardiac arrest (OHCA) are well documented. Biological sex does not appear to be responsible for this survival gap independently of potential mediating factors. We investigated the role of potential mediating factors in the association between sex and 30-day survival after OHCA in Scotland. Methods A retrospective cohort study of adult non-emergency medical services (EMS)-witnessed OHCA cases was conducted. We included incidents from the whole of Scotland where resuscitation was attempted by the Scottish Ambulance Service (SAS) between April 1, 2011 and March 1, 2020. Logistic regression was used to assess the contribution of age, socioeconomic status, urban–rural location of the incident, initial cardiac rhythm, bystander cardiopulmonary resuscitation (CPR) and location of the arrest (home or away from home). Results The cohort consisted of 20,585 OHCA cases (13,130 males and 7,455 females). Median (IQR) age was 69 years (22) for males versus 72 years (23) for females. A higher proportion of males presented with initial shockable rhythm (29.4% versus 12.4%) and received bystander CPR (56.7% versus 53.2%) compared with females. A higher proportion of females experienced OHCA at home (78.8% versus 66.8%). Thirty-day survival after OHCA was higher for males compared with females (8.2% versus 6.2%). Males had higher age-adjusted odds for 30-day survival after OHCA than females (OR, 1.26; (95% CI), 1.12–1.41). Mediation analyses suggested a role for initial cardiac rhythm and location of the arrest (home or away from home). Conclusion Males had higher age-adjusted 30-day survival after OHCA than females. However, after adjusting for confounding/mediating variables, sex was not associated with 30-day survival after OHCA. Our findings suggest that initial cardiac rhythm and location of the arrest are potential mediators of higher 30-day OHCA survival in males than females. Improving proportions of females who present with initial shockable rhythm may reduce sex differences in survival after OHCA.

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Association between sex and survival after out‐of‐hospital cardiac arrest: A systematic review and meta‐analysis

Cited by 3 publications

References 83 publications

Epidemiology and outcome of out‐of‐hospital cardiac arrest in Salt Lake City: Sex‐based investigations

Epidemiology and outcome of out‐of‐hospital cardiac arrest in Salt Lake City: Sex‐based investigations

Global Sex Disparities in Bystander Cardiopulmonary Resuscitation After Out‐of‐Hospital Cardiac Arrest: A Scoping Review

Sex and 30-day survival following out-of-hospital cardiac arrest in Scotland 2011–2020

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