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

Abstract

Background Sex differences exist in the diagnosis and treatment of several cardiovascular diseases. Our objective was to determine whether sex differences exist in the use of guideline-recommended treatments in out-of-hospital cardiac arrest (OHCA). Methods We included adult patients with non-traumatic OHCA treated by emergency medical services (EMS) in the Resuscitation Outcomes Consortium Prehospital Resuscitation using an IMpedance valve and Early versus Delayed (ROC PRIMED) database during 2007–2009. Outcomes included prehospital treatment intervals, procedures, and medications. Data were analysed using multivariable linear and logistic regression models that adjusted for sex, age, witnessed arrest, public location, bystander cardiopulmonary resuscitation (CPR), and first known rhythm of ventricular tachycardia/fibrillation. Results We studied 15,584 patients; 64% were male and median age was 68 years (interquartile range 55–80). In multivariable analyses, intervals from EMS dispatch to first rhythm capture (p=0.001) and first EMS CPR (p=0.001) were longer in women than in men. Women were less likely to receive successful intravenous or intraosseous access (OR 0.78, 95% CI 0.71–0.86) but equally likely to receive a successful advanced airway (OR 0.94, 95% CI 0.86–1.02). Women were less likely to receive adrenaline (OR 0.81, 95% CI 0.74–0.88), atropine (OR 0.86, 95% CI 0.80–0.92), and lidocaine or amiodarone (OR 0.68, 95% CI 0.61–0.75). Conclusion Women were less likely than men to receive guideline-recommended treatments for OHCA. The reasons for these differences require further exploration, and EMS provider education and training should specifically address these sex differences in the treatment of OHCA.

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

“…Studies have shown that there are significant differences in pathophysiology between men and women, and there may be different clinical symptoms and prognoses [ 5 , 6 ]. Compounding this, research has identified differences in the medical services received by males and females after admission [ 7 , 8 ]. The medical services include post-resuscitation care and nursing measures.…”

Gender Differences in the Quality of EMS Care Nationwide for Chest Pain and Out-of-Hospital Cardiac Arrest

“…Numerous studies show that women are less likely to receive evidence-based therapies for diagnosed AMI (Balady et al, 2011;Blomkalns et al, 2005;Dey et al, 2009;Jneid et al, 2008;Koopman et al, 2013;Poon et al, 2012;Pope et al, 2000), but most research on gender disparities related to AMI has focused on hospital and posthospital interventions. The few studies that have compared the prehospital management of patients with possible AMI (i.e., chest pain [CP]), established AMI, or out-ofhospital cardiac arrest (OHCA) by gender have reported inconsistent findings concerning the presence of gender disparities (Bush, Glickman, Fernandez, Garvey, & Glickman, 2013;Meisel et al, 2010;Mumma & Umarov, 2016;Rothrock, Brandt, Godfrey, Silvestri, & Pagane, 2000;Safdar et al, 2014;Tataris, Mercer, & Govindarajan, 2015;Wigginton, Pepe, Bedolla, DeTamble, & Atkins, 2002;Zive et al, 2011). The majority of previous studies are based on small sample sizes and have not taken into account differences in sociodemographic characteristics and EMS capacity when comparing treatment differences by gender.…”

Influence of patient gender on response time intervention at the Emergency Dispatch Centre

“…Женама се ређе успостављала успешна интравенска или интраосеална линија, али се нaпредно обезбеђење дисајних путева адекватно успостављало. Жене су ређе добијале адреналин, атропин и лидокаин или амјодарон (5). Друге студије су показале да жене у мањем проценту примају аспирин и да им се ређе ради 12-одводни ЕКГ него мушкарцимa.…”