Short communicationSex differences in the prehospital management of out-of-hospital cardiac arrest☆
Introduction
Out-of-hospital cardiac arrest (OHCA) is the most common cause of death from cardiac disease in the United States,1 with 52.1 cases treated by emergency medical services (EMS) per 100,000 individuals annually.2 The majority of patients with OHCA die before hospital admission.3 To improve outcomes, the International Liaison Committee on Resuscitation, American Heart Association, and European Resuscitation Council provide guidelines for OHCA treatment.4, 5, 6 These guidelines include cardiopulmonary resuscitation (CPR), intravenous (IV) or intraossesous (IO) access, medications, airway management, and defibrillation for shockable rhythms. Survival in OHCA is associated with several of these interventions, including high-quality CPR3, 7 and rapid defibrillation.3, 8
Sex differences in the prehospital management of other forms of cardiac disease exist9, 10, 11, 12 and are associated with increased morbidity and mortality in women.10, 11 Similarly, important sex differences may occur in prehospital interventions for OHCA. In this study, we use the Resuscitation Outcomes Consortium (ROC) Prehospital Resuscitation using an IMpedance valve and Early versus Delayed (PRIMED) database to determine whether sex differences exist in prehospital treatment intervals, procedures, and medications among adults with OHCA. We hypothesise that women have longer prehospital treatment intervals and are less likely than men to receive procedures and medication.
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Study design
We performed a retrospective cohort study using the ROC-PRIMED database. This study was exempt from review by our Institutional Review Board.
Population and setting
The ROC encompasses 11 regions in the United States and Canada serving approximately 23.7 million people.13 During 2007−2009, adults with OHCA were enrolled in the ROC-PRIMED impedance threshold device trial.14 In the current study, we included adults (≥18 years) with non-traumatic OHCA and complete sex and age data in the public-use ROC-PRIMED database
Results
After excluding patients with traumatic arrest (n = 100), exsanguination (n = 39), missing sex (n = 1,208), no cardiac arrest (n = 43), “do not resuscitate” orders (n = 199), legally dead (n = 219), age <18 years (n = 24), and missing age (n = 29), we studied 15,584 adult patients with OHCA. Of those, 10,023 (64%) were male (Table 1). In multivariable analyses, the interval from EMS dispatch to first advanced life support (ALS) crew arrival was similar in men and women (p = 0.438). However, intervals from
Discussion
Overall, women were less likely than men to receive timely prehospital CPR and rhythm capture, IV or IO access, and medications. Our data suggest that EMS providers are less adherent to guidelines4, 5, 6 and less aggressive in their resuscitation of women with OHCA. Our results are similar to smaller study demonstrating that women were less likely to receive prehospital post-resuscitation care in alignment with guidelines.16
We found longer times to first EMS rhythm capture and first EMS CPR,
Conclusion
Important sex differences exist in the prehospital care of patients with OHCA. Women experience longer times to CPR and cardiac rhythm capture, and they are less likely to receive IV/IO access and medications. The reasons for these differences should be explored further, and EMS provider education and training should specifically address sex differences in the treatment of OHCA.
Conflicts of Interest: None.
Sources of support: None.
Acknowledgements
This manuscript was prepared using ROC-PRIMED research materials obtained from the NHLBI and does not necessarily reflect the opinions or views of ROC or NHLBI.
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2022, Mayo Clinic Proceedings
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A Spanish translated version of the abstract of this article appears as Appendix in the final online version at http://dx.doi.org/10.1016/j.resuscitation.2016.05.029.