1
|
Awad E, Farhat H, Shami R, Gholami N, Mortada B, Rumbolt N, Azizurrahman A, Arabi AR, Alinier G. Incidence, characteristics, and prehospital outcomes of out-of-hospital cardiac arrest in Qatar: a nationwide gender-based investigation. Int J Emerg Med 2024; 17:105. [PMID: 39223459 PMCID: PMC11367972 DOI: 10.1186/s12245-024-00679-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 04/02/2024] [Indexed: 09/04/2024] Open
Abstract
BACKGROUND Research on incidence and characteristics of Out-of-Hospital Cardiac Arrest (OHCA) in the Middle East is limited. We assessed the incidence, prehospital characteristics, and outcomes of OHCA in Qatar, a Middle Eastern country. Subsequently, we performed gender-specific analysis. METHODS This was a retrospective examination of data obtained from the OHCA registry at Hamad Medical Corporation (HMC) in Qatar from 2017 to 2022. We included adults, non-traumatic, EMS-treatment OHCA. We calculated the incidence of adult OHCA and conducted descriptive analyses for prehospital characteristics, and prehospital outcomes presented by return of spontaneous circulation (ROSC). We evaluated gender differences in prehospital characteristics and ROSC using Student's t-test and the Chi-Square test as appropriate. Furthermore, we conducted a multivariable logistic regression analysis to investigate the correlation between gender and achieving ROSC. RESULTS We included 4,306 adult OHCA patients, with 869 (20.2%) being females. The mean annual incidence of adult OHCA was 27.4 per 100,000 population-year. Males had a higher annual incidence of OHCA than females. Among all cases, 36.3% occurred in a public location, 25.8% had an initial shockable rhythm, and 28.8% achieved ROSC. Males had a higher proportion of bystander CPR, arrests in public locations, and initial shockable rhythms. While unadjusted analysis showed no significant gender differences in achieving ROSC, adjusted analysis revealed that male gender was associated with higher odds of achieving ROSC (adjusted OR male vs. female 1.38, 95% CI 1.15-1.66, p < 0.001). CONCLUSIONS Approximately 720 adults undergo non-traumatic OHCA in Qatar every year, with a higher incidence observed in males. Male gender was associated with higher odds of achieving ROSC. Further gender-specific research in OHCA intervention and outcome in the Middle East is required.
Collapse
Affiliation(s)
- Emad Awad
- Dept of Emergency Medicine, School of Medicine, University of Utah, Salt Lake City, UT, USA
- College of Health Science, University of Doha for Science and Technology, Doha, Qatar
- Department of Emergency Medicine, University of British Columbia, Vancouver, Canada
| | - Hassan Farhat
- Hamad Medical Corporation Ambulance Service (HMCAS), Hamad Medical Corporation, Doha, Qatar
- Faculty of Medicine "Ibn El Jazzar", University of Sousse, Sousse, Tunisia
| | - Rakan Shami
- College of Health Science, University of Doha for Science and Technology, Doha, Qatar
| | - Nooreh Gholami
- College of Health Science, University of Doha for Science and Technology, Doha, Qatar
| | - Bothina Mortada
- College of Health Science, University of Doha for Science and Technology, Doha, Qatar
| | - Niki Rumbolt
- College of Health Science, University of Doha for Science and Technology, Doha, Qatar
| | - Adnaan Azizurrahman
- College of Health Science, University of Doha for Science and Technology, Doha, Qatar
| | | | - Guillaume Alinier
- Hamad Medical Corporation Ambulance Service (HMCAS), Hamad Medical Corporation, Doha, Qatar.
- Weill Cornell Medicine - Qatar, Doha, Qatar.
- School of Health and Social Work, University of Hertfordshire, Hatfield, UK.
- Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK.
| |
Collapse
|
2
|
Awad E, Hopkins C, Palatinus H, Hunt‐Smith TT, Ryba C, Youngquist S. Epidemiology and outcome of out-of-hospital cardiac arrest in Salt Lake City: Sex-based investigations. J Am Coll Emerg Physicians Open 2024; 5:e13189. [PMID: 38774259 PMCID: PMC11107878 DOI: 10.1002/emp2.13189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 04/07/2024] [Accepted: 05/02/2024] [Indexed: 05/24/2024] Open
Abstract
Objectives Prior research indicates sex disparities in the incidence and outcomes of out-of-hospital cardiac arrest (OHCA). This study investigates the presence of such differences in Salt Lake City, Utah. Methods We analyzed data from the Salt Lake City Fire Department (2008‒2023). We included adults with non-traumatic OHCA. We calculated the annual incidence of OHCA and examined sex-specific survival outcomes using multivariable logistic regression, adjusting for OHCA characteristics known to be associated with survival. Results The annual incidence of OHCA was 76 per 100,000 person-years. Among the 894 OHCA cases included in the analysis, 67.5% were males, 37.3% achieved return of spontaneous circulation (ROSC), and 13.6% survived hospital discharge. Unadjusted analysis revealed that males had significantly higher OHCA in public locations (43.9% vs. 28.6%), witnessed arrests (54.5% vs. 47.8%), and shockable rhythms (33.3% vs. 22.9%). Males also showed higher rates of ROSC (37.5% vs. 36.9%), hospital discharge survival (14.5% vs. 11.7%), and neurologically intact survival. After adjusting for the OHCA characteristics, there was no significant differences between males and females in ROSC, survival to hospital discharge, and favorable neurological function with adjusted odds ratios (male vs. female) of 0.92 (95% confidence interval [CI] 0.73‒1.16), 0.85 (95% CI 0.59‒1.22), and 0.92 (95% CI 0.62‒1.40), respectively. Conclusion Approximately, 128 adults suffer OHCA in Salt Lake City annually. Males initially showed higher crude survival rates, but after adjusting for OHCA characteristics, no significant sex differences in survival outcomes were found. Enhancing OHCA characteristics could benefit both sexes. Investigations into the relationship between sex- and region-specific factors influencing OHCA outcomes are needed.
Collapse
Affiliation(s)
- Emad Awad
- Department of Emergency Medicine, School of MedicineUniversity of UtahSalt Lake CityUtahUSA
- BC Resuscitation Research Collaborative (BC RESURECT), Department of Emergency Medicine, University of British ColumbiaVancouverBritish ColumbiaCanada
| | - Christy Hopkins
- Department of Emergency Medicine, School of MedicineUniversity of UtahSalt Lake CityUtahUSA
| | - Helen Palatinus
- Department of Emergency Medicine, School of MedicineUniversity of UtahSalt Lake CityUtahUSA
| | | | - Christopher Ryba
- Department of Emergency Medicine, School of MedicineUniversity of UtahSalt Lake CityUtahUSA
- Salt Lake City Fire DepartmentSalt Lake CityUtahUSA
| | - Scott Youngquist
- Department of Emergency Medicine, School of MedicineUniversity of UtahSalt Lake CityUtahUSA
- Salt Lake City Fire DepartmentSalt Lake CityUtahUSA
| |
Collapse
|
3
|
Lakbar I, Ippolito M, Nassiri A, Delamarre L, Tadger P, Leone M, Einav S. Sex and out-of-hospital cardiac arrest survival: a systematic review. Ann Intensive Care 2022; 12:114. [PMID: 36534195 PMCID: PMC9763524 DOI: 10.1186/s13613-022-01091-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 12/05/2022] [Indexed: 12/23/2022] Open
Abstract
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], I2 = 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], I2 = 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.
Collapse
Affiliation(s)
- Ines Lakbar
- grid.5399.60000 0001 2176 4817Aix-Marseille University, Publique Hôpitaux de Marseille, Marseille, France ,grid.414244.30000 0004 1773 6284Department of Anesthesiology and Intensive Care, Hôpital Nord, 13015 Marseille, France ,grid.5399.60000 0001 2176 4817CEReSS, Health Service Research and Quality of Life Centre, School of Medicine – La Timone Medical, Aix-Marseille University, Marseille, France
| | - Mariachiara Ippolito
- grid.10776.370000 0004 1762 5517Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.), University of Palermo, Palermo, Italy ,grid.412510.30000 0004 1756 3088Department of Anaesthesia, Intensive Care and Emergency, Policlinico Paolo Giaccone, Via del Vespro 129, 90127 Palermo, Italy
| | - Aviv Nassiri
- grid.9619.70000 0004 1937 0538Department of Military Medicine and Tzameret, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel ,Medical Corps, Israel Defense Forces, Tel HaShomer, Israel
| | - Louis Delamarre
- grid.5399.60000 0001 2176 4817Aix-Marseille University, Publique Hôpitaux de Marseille, Marseille, France ,grid.414244.30000 0004 1773 6284Department of Anesthesiology and Intensive Care, Hôpital Nord, 13015 Marseille, France
| | | | - Marc Leone
- grid.5399.60000 0001 2176 4817Aix-Marseille University, Publique Hôpitaux de Marseille, Marseille, France ,grid.414244.30000 0004 1773 6284Department of Anesthesiology and Intensive Care, Hôpital Nord, 13015 Marseille, France ,grid.5399.60000 0001 2176 4817CEReSS, Health Service Research and Quality of Life Centre, School of Medicine – La Timone Medical, Aix-Marseille University, Marseille, France
| | - Sharon Einav
- grid.415593.f0000 0004 0470 7791Intensive Care Unit, Shaare Zedek Medical Center, Jerusalem, Israel
| |
Collapse
|
4
|
Wittwer MR, Aldridge E, Hein C, Thorrowgood M, Zeitz C, Beltrame JF, Arstall MA. Sex Differences in Incidence and Outcome of Out-of-Hospital Cardiac Arrest Within a Local Health Network. Front Cardiovasc Med 2022; 9:870696. [PMID: 35463759 PMCID: PMC9024218 DOI: 10.3389/fcvm.2022.870696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 03/16/2022] [Indexed: 11/16/2022] Open
Abstract
Introduction Sex and gender differences in presentation and characteristics of out-of-hospital cardiac arrest (OHCA) are established in cohorts with presumed cardiac aetiology but not non-cardiac etiology. This study investigated the effect of sex on incidence and outcome of OHCA according to presumed and adjudicated aetiology within a local health network. Methods Population-based observational cohort study of emergency medical services (EMS) attended OHCAs within an Australian local health network. Cases identified from an EMS registry between 2012-2016 were linked to a hospital registry. Age-standardised incidence and baseline characteristics were stratified by sex for EMS-treated OHCA, non-EMS witnessed presumed cardiac and obvious non-cardiac sub-cohorts, and hospitalised cases. Logistic regression was used to explore the primary outcome of survival to hospital discharge. Results We identified 2,024 EMS-attended and 780 EMS-treated OHCAs. The non-EMS witnessed sub-cohorts comprised 504 presumed cardiac and 168 obvious non-cardiac OHCAs. Adjudicated aetiology was recorded in 123 hospitalised cases. Age-standardised incidence for women was almost half that of men across all groups. Across cohorts, women were generally older and arrested with a non-shockable initial rhythm in an area of low socioeconomic status. There was no sex difference in the primary outcome for the main EMS-treated cohort or in the non-cardiac sub-cohorts. The sex difference in outcome in the presumed cardiac sub-cohort was not present after multivariable adjustment. Conclusions There are sex differences in incidence and outcome of EMS-treated OHCA that appear to be driven by differences in susceptibility to cardiac arrhythmias and underlying etiology, rather than treatment delays or disparities.
Collapse
Affiliation(s)
- Melanie R. Wittwer
- Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
- Northern Adelaide Local Health Network, Adelaide, SA, Australia
- *Correspondence: Melanie R. Wittwer
| | - Emily Aldridge
- Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
- Northern Adelaide Local Health Network, Adelaide, SA, Australia
| | - Cindy Hein
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | | | - Chris Zeitz
- Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
- Central Adelaide Local Health Network, Adelaide, SA, Australia
| | - John F. Beltrame
- Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
- Central Adelaide Local Health Network, Adelaide, SA, Australia
| | - Margaret A. Arstall
- Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
- Northern Adelaide Local Health Network, Adelaide, SA, Australia
| |
Collapse
|