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Sex Differences in Resuscitation and Survival of Out-of-Hospital Cardiac Arrest
Study Questions:
Do differences in care utilization and outcomes for out-of-hospital cardiac arrest (OHCA) differ by sex?
Methods:
Data from the ARREST (Amsterdam Resuscitation Studies), an ongoing prospective community-based registry of all emergency medical service (EMS)–treated resuscitation attempts after OHCA since July 2005 in the study region, were used for the present study. Adults ages ≥20 years who experienced OHCA and were treated by EMS between January 2006 and December 2012 were included. Resuscitation was considered attempted if EMS personnel evaluated the OHCA, and the victim received attempts at external defibrillation (by first responders or EMS personnel) and/or chest compressions by EMS personnel. EMS-treated OHCAs were deemed to have cardiac causes unless an unequivocal noncardiac cause (e.g., trauma, drowning) was documented by EMS personnel, hospital physicians, or coroners. Noncardiac or in-hospital cardiac arrest, and those lost to follow-up were excluded. Outcomes of interest included the chance of resuscitation attempt by EMS, shockable initial rhythm, and in-hospital treatment.
Results:
A total of 5,717 EMS-treated OHCAs were identified, of which 28% were female. Women with OHCA were less likely than men to receive a resuscitation attempt by a bystander (67.9% vs. 72.7%; p < 0.001), even when OHCA was witnessed (69.2% vs. 73.9%; p < 0.001). Women who were resuscitated had lower odds than men for overall survival to hospital discharge (odds ratio [OR], 0.57; 95% confidence interval [CI], 0.48-0.67; 12.5% vs. 20.1%; p < 0.001). Women also had a lower odds for survival from OHCA to hospital admission (OR, 0.88; 95% CI, 0.78–0.99; 33.6% vs. 36.6%; p = 0.033), and for survival from hospital admission to discharge (OR, 0.49; 95% CI, 0.40–0.60; 33.1% vs. 51.7%), compared to men. These sex differences were explained by a lower rate of shockable initial rhythm in women (33.7% vs. 52.7%; p < 0.001). After adjustment for resuscitation parameters, female sex remained independently associated with a lower rate of shockable initial rhythm.
Conclusions:
The investigators concluded that in the case of OHCA, women are less often resuscitated by bystanders than men. When resuscitation is attempted, women have lower survival rates at each successive stage of care. These sex gaps are likely explained by a lower rate of shockable initial rhythm in women, which can only partly be explained by resuscitation characteristics.
Perspective:
This well-done population study contains two key messages. First, women who experience OHCA are less likely to receive resuscitation attempts from bystanders. Lack of early treatment and likely early recognition of a cardiac arrest reduce the change of a shockable initial rhythm and survival. Efforts to improve early resuscitation from bystanders are important. Second, women were less likely to have a shockable initial rhythm; efforts to understand the mechanistic factors for this sex difference are warranted.
Clinical Topics: Arrhythmias and Clinical EP, Prevention, Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias
Keywords: Arrhythmias, Cardiac, Cardiopulmonary Resuscitation, Drowning, Emergency Medical Services, Emergency Responders, Heart Arrest, Out-of-Hospital Cardiac Arrest, Patient Discharge, Primary Prevention, Resuscitation, Survival Rate, Treatment Outcome
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