Key result
Female sex is linked to ~44% higher resuscitation rates after out-of-hospital sudden cardiac arrest.
Why the study?
Whether previously observed sex-related differences in coronary artery disease syndromes also apply to patients with out-of-hospital sudden cardiac arrest treated in a standardized fashion was uncertain.
Does female sex compared to male sex influence presentation and resuscitation rates in patients with out-of-hospital sudden cardiac arrest treated with standardized advanced cardiac life support?
Cohort (n=4,147)
No
Does female sex compared to male sex influence presentation and resuscitation rates in patients with out-of-hospital sudden cardiac arrest treated with standardized advanced cardiac life support?
Despite being older and presenting less frequently with shockable rhythms (VF/VT), women with out-of-hospital cardiac arrest achieved significantly higher resuscitation rates than men when treated with standardized ACLS protocols.
Answers are grounded in this paper and cite their sources.
Higher resuscitation rates in women should not yet alter out-of-hospital cardiac arrest protocols; leaves open whether sex-specific factors influence outcomes.
Objective To examine whether previously observed sex-related differences in coronary artery disease syndromes also apply to patients with out-of-hospital sudden cardiac arrest, a probable subset of patients with coronary artery disease who are easy to recognize and are treated in a standardized fashion. Design Prospective, population-based study conducted over a 6-yr period. Setting A large urban municipality (population, 1.1 million) served by a single emergency medical services system with centralized medical direction and standardized protocols. Patients All patients with out-of-hospital, nontraumatic, primary cardiac arrest. Interventions Standardized advanced cardiac life support protocols. Measurements and main results During the 6 yrs of the study, 4147 consecutive patients were studied, 42% of whom were women (p <.001). Although women were significantly older than men (mean age, 68.7 +/- 18 vs. 61.7 +/- 17 yrs; p =.001), there were no significant differences for the percentages of witnessed and unwitnessed arrests, response intervals, and the length and type of treatment provided. Although men were more likely to have ventricular fibrillation/ventricular tachycardia on presentation (41% vs. 30%), women had more asystole (8.8% vs. 7%) and (organized) pulseless electrical activity than men (24% vs. 18%; p <.001). Nevertheless, more women were resuscitated (13.5% vs. 10.7%; p =.005), particularly women with non-ventricular fibrillation/ventricular tachycardia presentation (12.6% vs. 9.6%; p <.02). These differences were more pronounced when controlling for age (95% confidence interval, 1.44 [1.25-1.74]). Conclusions In cases of out-of-hospital sudden cardiac arrest, women have significantly better resuscitation rates than men, especially when controlling for age, particularly among women with non-ventricular fibrillation/ventricular tachycardia presentations. Additional studies are required to validate these observations, not only for long-term survival and external validity, but also for other potential genetic factors and potential discrepancies with other studies.
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Wigginton et al. (2002) conducted a cohort in Out-of-hospital, nontraumatic, primary cardiac arrest (n=4,147). Female sex (treated with standardized advanced cardiac life support protocols) vs. Male sex (treated with standardized advanced cardiac life support protocols) was evaluated on Resuscitation rate (1.44 (controlling for age), 95% CI 1.25-1.74, p=0.005). Women with out-of-hospital sudden cardiac arrest had higher resuscitation rates than men.
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