Elsevier

Resuscitation

Volume 100, March 2016, Pages 76-81
Resuscitation

Clinical paper
Effect of gender on outcome of out of hospital cardiac arrest in the Resuscitation Outcomes Consortium

https://doi.org/10.1016/j.resuscitation.2015.12.002Get rights and content

Abstract

Introduction

This study examined the relationship between gender and outcomes of non-traumatic out-of-hospital cardiac arrest (OHCA).

Methods

All eligible, consecutive, non-traumatic Emergency Medical Services (EMS) treated OHCA patients in the Resuscitation Outcomes Consortium between December 2005 and May 2007. Patient age was analyzed as a continuous variable and stratified in two age cohorts: 15–45 and >55 years of age (yoa). Unadjusted and adjusted (based on Utstein characteristics) chi square tests and logistic regression models were employed to examine the relationship between gender, age, and survival outcomes.

Results

This study enrolled 14,690 patients: of which 36.4% were women with a mean age of 68.3 and 63.6% of them men with a mean age of 64.2. Women survived to hospital discharge less often than men (6.4% vs. 9.1%, p < 0.001); the unadjusted OR was 0.69, 95%CI: 0.60, 0.77 whereas when adjusted for all Utstein predictors the difference was not significant (OR: 1.16, 95%CI: 0.98, 1.36, p = 0.07). The adjusted survival rate for younger women (15–45 yoa) was 11.1% vs. 9.8% for younger men (OR: 1.66, 95%CI: 1.04, 2.64, p = 0.03) but no difference in discharge rates was observed in the >55 cohort (OR: 0.94, 95%CI: 0.78, 1.15, p = 0.57).

Conclusions

Women who suffer OHCAs have lower rates of survival and have unfavourable Utstein predictors. When survival is adjusted for these predictors survival is similar between men and women except in younger women suggesting that age modifies the association of gender and survival from OHCA; a result that supports a protective hormonal effect among premenopausal women.

Section snippets

Background

The median incidence of cardiac arrest treated by Emergency Medical Services (EMS), across the sites participating in the Resuscitation Outcomes Consortium (ROC) is 52 per 100,000 population.1 Survival-to-hospital discharge rates after out-of-hospital cardiac arrest (OHCA) vary. In 2008, the survival-to-discharge rates across the ROC sites varied from 3.0% to 16.3%.1

Certain medical conditions/diseases have gender1

Design

The Resuscitation Outcomes Consortium (ROC) Epistry-Cardiac Arrest registry is a prospective, population-based, multicentre, North American cohort study of non-traumatic OHCA.38, 39 The ROC Epistry Study met the requirements for minimal risk research in the United States40 and Canada41, and was approved for waiver of informed consent by 161 institutional research ethics boards.

Setting

ROC is a North American network of 10 US and Canadian sites that investigate OHCA (Fig. 1). ROC has one data

Results

This study of 14,690 consecutive patients treated by EMS included 5340 (36.4%) women with a mean age of 68.3 and 9350 (63.6%) men with a mean age of 64.2. (Fig. 1 and Table 1) The unadjusted incidence rate of treated OHCA for women ranged from 34 to 104 per 100,000 person years (median 41) across ROC sites while for men it ranged from 64 to 123 per 100,000 person years (median 85).

Event characteristics are displayed in Table 1. Many of the Utstein predictors of survival are more likely to be

Discussion

Data from a prospective, North American multisite population-based database of OHCA patients attended by participating EMS agencies suggests that women who suffer an OHCA are less likely to experience event characteristics associated with survival and less likely to survive. When survival is adjusted for this imbalance in predictors of outcome, women are more likely to obtain a ROSC in the prehospital setting but the gender difference in survival to discharge disappears. However, in women

Conclusion

Women who suffer an OHCA are less likely to have Utstein event characteristics associated with survival such as arresting in a public location or an initial shockable rhythm or bystander resuscitation and have a lower rate of survival to discharge. After adjusting for the imbalance in these predictors, there was no observed gender difference in survival. As in other studies, women in the 15–45 year old cohort had a higher survival rate than men, a protective hormonal effect among premenopausal

Conflict of interest statement

All Authors have no conflict of interest with any financial and personal relationships with other people or organizations that could inappropriately influence (bias) their work.

Acknowledgements

The ROC is supported by a series of cooperative agreements to 10 regional clinical centres and one Data Coordinating Centre (5U01 HL077863—University of Washington Data Coordinating Centre, HL077865—University of Iowa, HL077866—Medical College of Wisconsin, HL077867—University of Washington, HL077871—University of Pittsburgh, HL077872—St. Michael's Hospital, HL077873—Oregon Health and Science University, HL077881—University of Alabama at Birmingham, HL077885—Ottawa Hospital Research Institute,

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