Gender differences and survival after out of hospital cardiac arrest

Rob, Daniel; Kaválková, Petra; Šmalcová, Jana; Franěk, Ondřej; Šmíd, Ondřej; Komárek, Arnošt; Pisinger, Michael; Bělohlávek, Jan

doi:10.1016/j.ajem.2022.02.032

Cited by 15 publications

(24 citation statements)

References 20 publications

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“…All included studies were cohort studies. 2 , 7 , 8 , 9 , 10 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 Twelve studies reported data from North‐America, 9 , 10 , 35 , 36 , 38 , 43 , 44 , 45 , 46 , 47 , 49 , 52 7 from Europe, 8 , 40 , 41 , 44 , 48 , 51 , 53 6 from Asia, 2 , 33 , 34 , 39 , 42 , 50 and 2 from Oceania. 7 ,…”

Section: Resultsmentioning

confidence: 99%

“…Eleven studies only included non‐traumatic OHCAs/OHCAs of presumed cardiac origin, 2 , 7 , 8 , 10 , 33 , 36 , 38 , 42 , 43 , 44 , 51 the other 15 included OHCAs of all etiologies. 9 , 34 , 35 , 37 , 39 , 40 , 41 , 45 , 46 , 47 , 48 , 49 , 50 , 52 , 53 This difference in etiology is unlikely to have had a major impact on the effect estimates as OHCAs of non‐cardiac origin account for a relatively small proportion of OHCAs. 54 Of the 26 included studies, 3 studies only report crude estimates 8 , 10 , 41 and of the other 23 studies, 7 studies report both crude and adjusted estimates 2 , 9 , 34 , 37 , 42 , 47 , 52 and 16 only reported adjusted estimates.…”

Section: Resultsmentioning

confidence: 99%

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

et al. 2023

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The current literature on sex differences in 30‐day survival following out‐of‐hospital cardiac arrest (OHCA) is conflicting, with 3 recent systematic reviews reporting opposing results. To address these contradictions, this systematic literature review and meta‐analysis aimed to synthesize the literature on sex differences in survival after OHCA by including only population‐based studies and through separate meta‐analyses of crude and adjusted effect estimates. MEDLINE and Embase databases were systematically searched from inception to March 23, 2022 to identify observational studies reporting sex‐specific 30‐day survival or survival until hospital discharge after OHCA. Two meta‐analyses were conducted. The first included unadjusted effect estimates of the association between sex and survival (comparing males vs females), whereas the second included effect estimates adjusted for possible mediating and/or confounding variables. The PROSPERO registration number was CRD42021237887, and the search identified 6712 articles. After the screening, 164 potentially relevant articles were identified, of which 26 were included. The pooled estimate for crude effect estimates (odds ratio [OR], 1.42; 95% confidence interval [CI], 1.22–1.66) indicated that males have a higher chance of survival after OHCA than females. However, the pooled estimate for adjusted effect estimates shows no difference in survival after OHCA between males and females (OR, 0.93; 95% CI, 0.84–1.03). Both meta‐analyses involved high statistical heterogeneity between studies: crude pooled estimate I 2 = 95.7%, adjusted pooled estimate I 2 = 91.3%. There does not appear to be a difference in survival between males and females when effect estimates are adjusted for possible confounding and/or mediating variables in non‐selected populations.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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

et al. 2023

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“…All studies included only patients with OHCA. Thirteen studies included only OHCA of cardiac etiology [ 17 , 21 , 25 , 42 , 46 , 48 , 53 , 56 – 59 , 63 , 65 ] and fifteen studies included OHCA of both cardiac and non-cardiac etiologies [ 43 – 45 , 47 , 49 – 52 , 54 , 55 , 60 – 62 , 64 ]. Among the latter, seven also included patients whose cardiac arrest was due to trauma [ 20 , 49 – 52 , 61 , 62 ] and five did not specify whether traumatic cardiac arrests were excluded or not [ 43 – 45 , 54 , 55 ].…”

Section: Resultsmentioning

confidence: 99%

“…Thirteen studies included only OHCA of cardiac etiology [ 17 , 21 , 25 , 42 , 46 , 48 , 53 , 56 – 59 , 63 , 65 ] and fifteen studies included OHCA of both cardiac and non-cardiac etiologies [ 43 – 45 , 47 , 49 – 52 , 54 , 55 , 60 – 62 , 64 ]. Among the latter, seven also included patients whose cardiac arrest was due to trauma [ 20 , 49 – 52 , 61 , 62 ] and five did not specify whether traumatic cardiac arrests were excluded or not [ 43 – 45 , 54 , 55 ]. Twenty-two studies provided survival data from OHCA to discharge (or to day-30), while six studies excluded patients that did not survive to hospital admission, reporting data from hospital admission to discharge (or to day-30) only (Additional file 2 : Table S2) [ 44 , 45 , 47 , 48 , 53 , 55 ].…”

Section: Resultsmentioning

confidence: 99%

“…The data covered four continents (Europe, Asia, America and Oceania) over a period of 33 years (1988-2021). There were data from single centre studies [43,45,[47][48][49], national registries [20,21,25,44,46,[50][51][52][53][54][55][56] or local emergency medical services registries (e.g., comprised of all OHCAs registered in a city, in several countries or in several countries over a period of time) [17,42,[57][58][59][60][61][62][63][64][65].…”

Section: Included Studiesmentioning

confidence: 99%

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Sex and out-of-hospital cardiac arrest survival: a systematic review

Lakbar

Ippolito

Nassiri

et al. 2022

Ann. Intensive Care

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Background The literature is unresolved on whether female receive advanced cardiac life support less than do male and on whether female have a survival advantage over male after cardiopulmonary resuscitation. Methods We systematically searched PubMed, Embase and Web of Science databases (from inception to 23-April-2022) for papers reporting outcomes in adult male and female after out-of-hospital cardiac arrest. The main study outcome was the rate of adjusted survival to hospital discharge or 30 days. Secondary outcomes included unadjusted survival to hospital discharge and favourable neurological outcome. Results A total of 28 studies were included, involving 1,931,123 patients. Female were older than male, their cardiac arrests were less likely to be witnessed and less likely to present with a shockable rhythm. Unadjusted analysis showed that females had a lower likelihood of survival than males (OR 0.68 [0.62–0.74], I2 = 97%). After adjustment, no significant difference was identified between male and female in survival at hospital discharge/30 days (OR 1.01 [0.93–1.11], I2 = 87%). Data showed that male had a significantly higher likelihood of favorable neurological outcome in unadjusted analysis but this trend disappeared after adjustment. Both the primary outcome (adjusted for several variables) and the secondary outcomes were associated with substantial heterogeneity. The variables examined using meta-regression, subgroup and sensitivity analyses (i.e., study type, location, years, population, quality of adjustment, risk of bias) did not reduce heterogeneity. Conclusions The adjusted rate of survival to hospital discharge/30 days was similar for male and female despite an initial seeming survival advantage for male. The validity of this finding is limited by substantial heterogeneity despite in-depth investigation of its causes, which raises concerns regarding latent inequalities in some reports nonetheless. Further study on this topic may require inclusion of factors not reported in the Utstein template and in-depth analysis of decision-making processes.

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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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Gender differences and survival after out of hospital cardiac arrest

Cited by 15 publications

References 20 publications

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

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

Sex and out-of-hospital cardiac arrest survival: a systematic review

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

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