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October 19, 2020Critical CareOpen Access

Female sex was associated with a significantly lower chance of overall survival to hospital discharge after out-of-hospital cardiac arrest compared with male sex (OR 0.73).

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Why the study?

Conflicting results exist and there is no uniform agreement regarding sex differences in survival and prognosis after out-of-hospital cardiac arrest.

Does female sex reduce survival and favorable neurological outcomes in patients with out-of-hospital cardiac arrest compared to male sex?

Population

1,268,664 patients across 33 studies

Comparison

Females vs males

Design

Meta-analysis

Key result

Female sex was associated with a significantly lower chance of overall survival to hospital discharge after out-of-hospital cardiac arrest compared with male sex (OR 0.73).

Authors

HLHao LeiJHJiahui HuLLLeiling Liu

Discussion

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Member takes

Overview

Female sex associated with lower OHCA survival; confirms disparities in large cohorts and leaves open questions on targeted interventions.

Study Design

Type

Meta-Analysis (n=1,268,664)

Structured PICO

Does female sex reduce survival and favorable neurological outcomes in patients with out-of-hospital cardiac arrest compared to male sex?

P
Population
1,268,664 patients with out-of-hospital cardiac arrest included in a meta-analysis of 33 retrospective cohort studies to evaluate sex differences in survival and prognosis.
E
Exposure
Female sex
C
Comparator
Male sex
O
Outcome
Survival from OHCA to discharge (overall survival rate)hard clinical

Main Result

Odds Ratio: 0.73 (95% CI 0.62–0.86)

Female patients with out-of-hospital cardiac arrest have significantly lower rates of survival to discharge and favorable neurological outcomes compared to males, potentially driven by differences in baseline characteristics and lower rates of in-hospital interventions.

Limitations

  • Only searched three major databases, potentially missing some studies
  • Included only observational studies, making it difficult to control for confounding factors
  • Post-resuscitation care guidelines changed over the years the included studies were conducted
  • Different emergency medical systems with varying medical levels and termination of resuscitation rules
  • High heterogeneity among the included studies
  • Potential immortal time bias in post-resuscitation care research
  • Presence of several confounding factors
  • High statistical heterogeneity among the included retrospective cohort studies due to baseline differences

Cite This Study

Lei et al. (2020) conducted a meta-analysis in Out-of-hospital cardiac arrest (OHCA) (n=1,268,664). Female sex vs. Male sex was evaluated on Survival from OHCA to discharge (OR 0.73, 95% CI 0.62-0.86). Female sex was associated with a significantly lower chance of overall survival to hospital discharge after out-of-hospital cardiac arrest compared with male sex (OR 0.73).

synapsesocial.com/papers/6a21119ba37b8f8d92967e98https://doi.org/10.1186/s13054-020-03331-5
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Sex differences in outcome following community-based cardiopulmonary arrest2000 · 79 citations
  2. 2Gender-specific Research for Emergency Diagnosis and Management of Ischemic Heart Disease: Proceedings from the 2014Academic Emergency MedicineConsensus Conference Cardiovascular Research Workgroup2014 · 39 citations
  3. 3Increase in survival and bystander CPR in out-of-hospital shockable arrhythmia: bystander CPR and female gender are predictors of improved outcome. Experiences from Sweden in an 18-year perspective2011 · 173 citations
  4. 4Sex Differences in Survival From Out‐of‐Hospital Cardiac Arrest in the Era of Regionalized Systems and Advanced Post‐Resuscitation Care2016 · 103 citations
  5. 5Death talk: gender differences in talking about one’s own impending death2014 · 75 citations