Associations between gender and cardiac arrest outcomes in Pan-Asian out-of-hospital cardiac arrest patients

Ng YY 1 , Wah W 2 , Liu N 3 , Zhou SA 4 , Ho AF 5 , Pek PP 6 Show all authors , Shin SD 7 , Tanaka H 8 , Khunkhlai N 9 , Lin CH 10 , Wong KD 11 , Cai WW 4 , Ong ME 12 , PAROS Clinical Research Network

Affiliations 

  • 1 Medical Department, Singapore Civil Defence Force, Singapore; Department of Emergency Medicine, Singapore General Hospital, Singapore
  • 2 Centre for Infectious Disease Epidemiology and Research, Saw Swee Hock School of Public Health, National University of Singapore, Singapore
  • 3 Department of Emergency Medicine, Singapore General Hospital, Singapore; Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore. Electronic address: liu.nan@sgh.com.sg
  • 4 Department of Emergency Medicine, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang, China
  • 5 SingHealth Emergency Medicine Residency Program, Singapore
  • 6 Department of Emergency Medicine, Singapore General Hospital, Singapore
  • 7 Department of Emergency Medicine, College of Medicine, Seoul National University, Seoul, Republic of Korea
  • 8 Department of EMS System, Graduate School, Kokushikan University, Tokyo, Japan
  • 9 Department of Emergency Medicine, Rajavithi Hospital, Bangkok, Thailand
  • 10 Department of Emergency Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
  • 11 Emergency Department, Hospital Pulau Pinang, Penang, Malaysia
  • 12 Department of Emergency Medicine, Singapore General Hospital, Singapore; Health Services and Systems Research, Duke-NUS Medical School, Singapore
Resuscitation, 2016 May;102:116-21.
PMID: 26970031 DOI: 10.1016/j.resuscitation.2016.03.002

Abstract

BACKGROUND: The incidence of out-of-hospital cardiac arrest (OHCA) in women is thought to be lower than that of men, with better outcomes in some Western studies.
OBJECTIVES: This study aimed to investigate the effect of gender on OHCA outcomes in the Pan-Asian population.
METHODOLOGY: This was a retrospective, secondary analysis of the Pan Asian Resuscitation Outcomes Study (PAROS) data between 2009 and 2012. We included OHCA cases which were presumed cardiac etiology, aged 18 years and above and resuscitation attempted by emergency medical services (EMS) systems. We used multi-level mixed-effects logistic regression models to account for the clustering effect of individuals within the country. Primary outcome was survival to hospital discharge.
RESULTS: We included a total of 40,159 OHCA cases, 40% of which were women. We found that women were more likely to be older and have an initial non-shockable arrest rhythm; they were more likely to receive bystander cardio-pulmonary resuscitation (CPR). The univariate analysis showed that women were significantly less likely to have return of spontaneous circulation (ROSC) at scene or in the emergency department (ED), and had lower rates of survival-to-admission and discharge, and poorer overall and cerebral performance outcomes. There was however, no significant gender difference on outcomes after adjustment of other confounders. Women in the reproductive age group (age 18-44 years) were significantly more likely to have ROSC at scene or in the ED, higher rates of survival-to-admission and discharge, and have better overall and cerebral performance outcomes after adjustment for differences in baseline and pre-hospital factors. Menopausal women (age 55 years and above) were less likely to survive to admission after adjusting for other pre-hospital characteristics but not after age adjustment.
CONCLUSION: Differences in survival outcomes between reproductive and menopausal women highlight a need for further investigations into the plausible social, pathologic or hormonal basis.
KEYWORDS: Gender; Out-of-hospital cardiac arrest; Registry

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

MeSH terms
Similar publications