Key result
After adjustment for confounding variables, female sex was not associated with a significant difference in survival to hospital discharge or 30 days compared to male sex following out-of-hospital cardiac arrest (OR 1.01).
Why the study?
The literature is unresolved on whether females receive advanced cardiac life support less than males and whether females have a survival advantage after cardiopulmonary resuscitation.
Does female sex compared to male sex affect survival to hospital discharge or 30 days in adults after out-of-hospital cardiac arrest?
Systematic Review (n=1,931,123)
Does female sex compared to male sex affect survival to hospital discharge or 30 days in adults after out-of-hospital cardiac arrest?
Odds Ratio: 1.01 (95% CI 0.93–1.11)
Adjusted survival rates to hospital discharge or 30 days are similar between males and females after out-of-hospital cardiac arrest, despite females presenting with worse baseline prognostic factors.
No sex-based survival difference after OHCA adjustment; confirms lack of independent prognostic effect and supports sex-neutral care.
Background The literature is unresolved on whether female receive advanced cardiac life support less than do male and on whether female have a survival advantage over male after cardiopulmonary resuscitation. Methods We systematically searched PubMed, Embase and Web of Science databases (from inception to 23-April-2022) for papers reporting outcomes in adult male and female after out-of-hospital cardiac arrest. The main study outcome was the rate of adjusted survival to hospital discharge or 30 days. Secondary outcomes included unadjusted survival to hospital discharge and favourable neurological outcome. Results A total of 28 studies were included, involving 1,931,123 patients. Female were older than male, their cardiac arrests were less likely to be witnessed and less likely to present with a shockable rhythm. Unadjusted analysis showed that females had a lower likelihood of survival than males (OR 0.68 [0.62–0.74], I 2 = 97%). After adjustment, no significant difference was identified between male and female in survival at hospital discharge/30 days (OR 1.01 [0.93–1.11], I 2 = 87%). Data showed that male had a significantly higher likelihood of favorable neurological outcome in unadjusted analysis but this trend disappeared after adjustment. Both the primary outcome (adjusted for several variables) and the secondary outcomes were associated with substantial heterogeneity. The variables examined using meta-regression, subgroup and sensitivity analyses (i.e., study type, location, years, population, quality of adjustment, risk of bias) did not reduce heterogeneity. Conclusions The adjusted rate of survival to hospital discharge/30 days was similar for male and female despite an initial seeming survival advantage for male. The validity of this finding is limited by substantial heterogeneity despite in-depth investigation of its causes, which raises concerns regarding latent inequalities in some reports nonetheless. Further study on this topic may require inclusion of factors not reported in the Utstein template and in-depth analysis of decision-making processes.
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Lakbar et al. (2022) conducted a systematic review in Out-of-hospital cardiac arrest (n=1,931,123). Female sex vs. Male sex was evaluated on Adjusted survival to hospital discharge or 30 days (OR 1.01, 95% CI 0.93-1.11). After adjustment for confounding variables, female sex was not associated with a significant difference in survival to hospital discharge or 30 days compared to male sex following out-of-hospital cardiac arrest (OR 1.01).
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