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Chen C, Lo CYZ, Ho MJC, Ng Y, Chan HCY, Wu WHK, Ong MEH, Siddiqui FJ. Global Sex Disparities in Bystander Cardiopulmonary Resuscitation After Out-of-Hospital Cardiac Arrest: A Scoping Review. J Am Heart Assoc 2024; 13:e035794. [PMID: 39248262 DOI: 10.1161/jaha.124.035794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/10/2024]
Abstract
This scoping review collates evidence for sex biases in the receipt of bystander cardiopulmonary resuscitation (BCPR) among patients with out-of-hospital cardiac arrest patients globally. The MEDLINE, PsycINFO, CENTRAL, and Embase databases were screened for relevant literature, dated from inception to March 9, 2022. Studies evaluating the association between BCPR and sex/gender in patients with out-of-hospital cardiac arrest, except for pediatric populations and cardiac arrest cases with traumatic cause, were included. The review included 80 articles on BCPR in men and women globally; 58 of these studies evaluated sex differences in BCPR outcomes. Fifty-nine percent of the relevant studies (34/58) indicated that women are less likely recipients of BCPR, 36% (21/58) observed no significant sex differences, and 5% (3/58) reported that women are more likely to receive BCPR. In other studies, women were found to be less likely to receive BCPR in public but equally or more likely to receive BCPR in residential settings. The general reluctance to perform BCPR on women in the Western countries was attributed to perceived frailty of women, chest exposure, pregnancy, gender stereotypes, oversexualization of women's bodies, and belief that women are unlikely to experience a cardiac arrest. Most studies worldwide indicated that women were less likely to receive BCPR than men. Further research from non-Western countries is needed to understand the impact of cultural and socioeconomic settings on such biases and design customized interventions accordingly.
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Affiliation(s)
- Christina Chen
- Prehospital and Emergency Research Centre, Health Services and Systems Research Duke-NUS Medical School Singapore Singapore
| | | | - Maxz J C Ho
- National University Hospital Singapore Singapore
| | - Yaoyi Ng
- Yong Loo Lin School of Medicine National University of Singapore Singapore Singapore
| | | | - Wellington H K Wu
- Yong Loo Lin School of Medicine National University of Singapore Singapore Singapore
| | - Marcus E H Ong
- Department of Emergency Medicine Singapore General Hospital Singapore Singapore
| | - Fahad J Siddiqui
- Prehospital and Emergency Research Centre, Health Services and Systems Research Duke-NUS Medical School Singapore Singapore
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Park DH, Park GJ, Kim YM, Chai HS, Kim SC, Kim H, Lee SW. Barriers to successful dispatcher-assisted cardiopulmonary resuscitation in out-of-hospital cardiac arrest in Korea. Resusc Plus 2024; 19:100725. [PMID: 39091585 PMCID: PMC11293587 DOI: 10.1016/j.resplu.2024.100725] [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: 03/22/2024] [Revised: 07/04/2024] [Accepted: 07/08/2024] [Indexed: 08/04/2024] Open
Abstract
Introduction Dispatcher-assisted cardiopulmonary resuscitation (DA-CPR) improves bystander CPR rates and survival outcomes. This study aimed to identify barriers to successful DA-CPR in patients with out-of-hospital cardiac arrest (OHCA). Methods This retrospective observational study used data from a nationwide OHCA database from 2017 to 2021. Adult emergency medical services (EMS)-treated patients with OHCA with a presumed cardiac etiology were enrolled. The main exposure variable was compliance with DA-CPR. The primary outcome was good neurological recovery at hospital discharge. Multivariable logistic regression analysis was conducted to identify the major factors associated with unsuccessful DA-CPR with and without multiple imputations. Causal mediation analysis was conducted using witnessed status as a mediator. Results In the final analysis, 49,165 patients with OHCA were included. A total of 36,865 (75.0%) patients successfully underwent DA-CPR. A higher proportion of good neurological recovery was observed in the successful DA-CPR group than in the non-successful DA-CPR group (P < 0.001). The following factors were identified as risk factors for unsuccessful DA-CPR: age > 65 years, male sex, OHCA occurring in a non-metropolitan area or private place, unwitnessed status, whether the bystander was a non-family member or non-cohabitant, female sex or had not received CPR training, and primary call dispatchers not receiving any first-aid training. Additional analyses after multiple imputations showed similar results. Mediation effect was significant for most risk factors for unsuccessful DA-CPR. Conclusions Bystander characteristics (non-family member or non-cohabitant, female, and uneducated status for CPR) and primary call dispatchers not receiving first-aid training were identified as risk factors for unsuccessful DA-CPR.
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Affiliation(s)
- Dong Hyun Park
- Department of Emergency Medicine, Chungbuk National University Hospital, Cheongju, Republic of Korea
| | - Gwan Jin Park
- Department of Emergency Medicine, Chungbuk National University Hospital, Cheongju, Republic of Korea
| | - Young Min Kim
- Department of Emergency Medicine, Chungbuk National University Hospital, Cheongju, Republic of Korea
| | - Hyun Seok Chai
- Department of Emergency Medicine, Chungbuk National University Hospital, Cheongju, Republic of Korea
| | - Sang Chul Kim
- Department of Emergency Medicine, Chungbuk National University Hospital, Cheongju, Republic of Korea
| | - Hoon Kim
- Department of Emergency Medicine, Chungbuk National University Hospital, Cheongju, Republic of Korea
| | - Suk Woo Lee
- Department of Emergency Medicine, Chungbuk National University Hospital, Cheongju, Republic of Korea
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Munot S, Bray JE, Redfern J, Bauman A, Marschner S, Semsarian C, Denniss AR, Coggins A, Middleton PM, Jennings G, Angell B, Kumar S, Kovoor P, Vukasovic M, Bendall JC, Evens T, Chow CK. Bystander cardiopulmonary resuscitation differences by sex - The role of arrest recognition. Resuscitation 2024; 199:110224. [PMID: 38685374 DOI: 10.1016/j.resuscitation.2024.110224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 04/03/2024] [Accepted: 04/20/2024] [Indexed: 05/02/2024]
Abstract
PURPOSE To assess whether bystander cardiopulmonary resuscitation (CPR) differed by patient sex among bystander-witnessed out-of-hospital cardiac arrests (OHCA). METHODS This study is a retrospective analysis of paramedic-attended OHCA in New South Wales (NSW) between January 2017 to December 2019 (restricted to bystander-witnessed cases). Exclusions included OHCA in aged care, medical facilities, with advance care directives, from non-medical causes. Multivariate logistic regression examined the association of patient sex with bystander CPR. Secondary outcomes were OHCA recognition, bystander AED application, initial shockable rhythm, and survival outcomes. RESULTS Of 4,491cases, females were less likely to receive bystander CPR in private residential (Adjusted Odds ratio [AOR]: 0.82, 95%CI: 0.70-0.95) and public locations (AOR: 0.58, 95%CI:0.39-0.88). OHCA recognition during the emergency call was lower for females arresting in public locations (84.6% vs 91.6%, p = 0.002) and this partially explained the association of sex with bystander CPR (∼44%). This difference in recognition was not observed in private residential locations (p = 0.2). Bystander AED use was lower for females (4.8% vs 9.6%, p < 0.001); however, after adjustment for location and other covariates, this relationship was no longer significant (AOR: 0.83, 95%CI: 0.60-1.12). Females were less likely to be in an initial shockable rhythm (AOR: 0.52, 95%CI: 0.44-0.61), but more likely to survive the event (AOR: 1.34, 95%CI: 1.15-1.56). There was no sex difference in survival to hospital discharge (AOR: 0.96, 95%CI: 0.77-1.19). CONCLUSION OHCA recognition and bystander CPR differ by patient sex in NSW. Research is needed to understand why this difference occurs and to raise public awareness of this issue.
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Affiliation(s)
- Sonali Munot
- Westmead Applied Research Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.
| | - Janet E Bray
- School of Public Health and Preventive Medicine, Monash University, Victoria, Australia
| | - Julie Redfern
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Adrian Bauman
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Simone Marschner
- Westmead Applied Research Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Christopher Semsarian
- Agnes Ginges Centre for Molecular Cardiology at Centenary Institute, The University of Sydney, Sydney, Australia
| | | | - Andrew Coggins
- Westmead Applied Research Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia; Department of Emergency Medicine, Westmead Hospital, Sydney, Australia
| | - Paul M Middleton
- South Western Emergency Research Institute, Ingham Institute, SWSLHD, Sydney, Australia
| | - Garry Jennings
- Sydney Health Partners, Charles Perkins Centre, The University of Sydney, Australia
| | - Blake Angell
- The George Institute for Global Health, University of New South Wales, Newtown, Australia
| | - Saurabh Kumar
- Westmead Applied Research Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia; Department of Cardiology, Westmead Hospital, Sydney, Australia
| | - Pramesh Kovoor
- Department of Cardiology, Westmead Hospital, Sydney, Australia
| | - Matthew Vukasovic
- Department of Emergency Medicine, Westmead Hospital, Sydney, Australia
| | - Jason C Bendall
- New South Wales Ambulance, Sydney, New South Wales, Australia; School of Medicine and Public Health (Anaesthesia and Intensive Care), The University of Newcastle, Australia
| | - T Evens
- New South Wales Ambulance, Sydney, New South Wales, Australia
| | - Clara K Chow
- Westmead Applied Research Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia; Department of Cardiology, Westmead Hospital, Sydney, Australia; The George Institute for Global Health, University of New South Wales, Newtown, Australia
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Blewer AL, Starks MA, Malta‐Hansen C, Sasson C, Ong MEH, Al‐Araji R, McNally BF, Viera AJ. Sex Differences in Receipt of Bystander Cardiopulmonary Resuscitation Considering Neighborhood Racial and Ethnic Composition. J Am Heart Assoc 2024; 13:e031113. [PMID: 38410966 PMCID: PMC10944027 DOI: 10.1161/jaha.123.031113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 12/19/2023] [Indexed: 02/28/2024]
Abstract
BACKGROUND Bystander cardiopulmonary resuscitation (B-CPR) and defibrillation for out-of-hospital cardiac arrest (OHCA) vary by sex, with women being less likely to receive these interventions in public. It is unknown whether sex differences persist when considering neighborhood racial and ethnic composition. We examined the odds of receiving B-CPR stratified by location and neighborhood. We hypothesized that women in predominantly Black neighborhoods will have a lower odds of receiving B-CPR. METHODS AND RESULTS We conducted a retrospective study using the Cardiac Arrest Registry to Enhance Survival (CARES). Neighborhoods were classified by census tract. We modeled the odds of receipt of B-CPR (primary outcome), automatic external defibrillation application, and survival to hospital discharge (secondary outcomes) by sex. CARES collected 457 621 arrests (2013-2019); after appropriate exclusion, 309 662 were included. Women who had public OHCA had a 14% lower odds of receiving B-CPR (odds ratio [OR], 0.86 [95% CI, 0.82-0.89]), but effect modification was not seen by neighborhood (P=not significant). In predominantly Black neighborhoods, women who had public OHCA had a 13% lower odds of receiving B-CPR (adjusted OR, 0.87 [95% CI, 0.76-0.98]) and 12% lower odds of receiving automatic external defibrillation application (adjusted OR, 0.88 [95% CI, 0.78-0.99]). In predominantly Hispanic neighborhoods, women who had public OHCA were less likely to receive B-CPR (adjusted OR, 0.83 [95% CI, 0.73-0.96]) and less likely to receive automatic external defibrillation application (adjusted OR, 0.74 [95% CI, 0.64-0.87]). CONCLUSIONS Women with public OHCA have a decreased likelihood of receiving B-CPR and automatic external defibrillation application. Findings did not differ significantly according to neighborhood composition. Despite this, our work has implications for considering strategies to reduce disparities around bystander response.
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Affiliation(s)
- Audrey L. Blewer
- Department of Family Medicine and Community HealthDuke UniversityDurhamNC
- Department of Population Health SciencesDuke UniversityDurhamNC
| | | | | | - Comilla Sasson
- Department of Emergency MedicineUniversity of ColoradoDenverCO
| | - Marcus Eng Hock Ong
- Health Services and Systems ResearchDuke–National University of Singapore Medical SchoolSingapore
- Department of Emergency MedicineSingapore General HospitalSingapore
| | - Rabab Al‐Araji
- Rollins School of Public HealthEmory UniversityAtlantaGA
| | - Bryan F. McNally
- Rollins School of Public HealthEmory UniversityAtlantaGA
- Department of Emergency MedicineEmory University School of MedicineAtlantaGA
| | - Anthony J. Viera
- Department of Family Medicine and Community HealthDuke UniversityDurhamNC
- Department of Population Health SciencesDuke UniversityDurhamNC
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Paratz ED, Nehme E, Heriot N, Sundararajan V, Page G, Fahy L, Rowe S, Anderson D, Stub D, La Gerche A, Nehme Z. Sex disparities in bystander defibrillation for out-of-hospital cardiac arrest. Resusc Plus 2024; 17:100532. [PMID: 38188595 PMCID: PMC10770583 DOI: 10.1016/j.resplu.2023.100532] [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: 11/27/2023] [Accepted: 12/01/2023] [Indexed: 01/09/2024] Open
Abstract
Background Previous studies have suggested that females experiencing out-of-hospital cardiac arrest (OHCA) receive lower rates of both bystander cardiopulmonary resuscitation (CPR) and defibrillation compared to males. Whether this disparity has improved over time is unknown. Methods A state-wide OHCA registry in Victoria, Australia collected data over twenty years (2002-2021) regarding rates of bystander interventions in OHCA. Characteristics and outcomes of each OHCA were compared with logistic regression according to sex and time (defined in two-year periods). Results 32,502 OHCAs were included (69.7% male). Both bystander CPR and defibrillation rates increased for females over time (p < 0.0001). There was no sex disparity in receipt of bystander CPR after adjustment for baseline differences. Females were less likely than males to receive bystander defibrillation, with sex disparity increasing from 2010 onwards (adjOR 0.26 (95%CI 0.09-0.80) in 2020-21 for females compared to males). Conclusion Initiatives to increase bystander CPR and defibrillation have resulted in higher overall rates of bystander interventions in the last two decades and no significant sex differences in provision of bystander CPR. However, females receive less bystander defibrillation than males, and sex disparity is increasing. Strategies to promote bystander defibrillation in females experiencing OHCA with a shockable rhythm should be a priority.
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Affiliation(s)
- Elizabeth D. Paratz
- HEART Lab, St Vincent’s Institute of Medical Research, 9 Princes St., Fitzroy, VIC 3065, Australia
- Department of Cardiology, St Vincent’s Hospital Melbourne, 41 Victoria Parade, Fitzroy, VIC 3065, Australia
- Cardiology Department, Baker Heart & Diabetes Institute, 75 Commercial Rd., Prahran, VIC 3181, Australia
- Department of Medicine, St Vincent’s Hospital Melbourne, The University of Melbourne, 29 Regent Street, Fitzroy, VIC 3065, Australia
- Ambulance Victoria, 31 Joseph St., Blackburn North, VIC 3130, Australia
| | - Emily Nehme
- Ambulance Victoria, 31 Joseph St., Blackburn North, VIC 3130, Australia
- School of Public Health & Preventive Medicine, Monash University, 553 St Kilda Rd., Melbourne, VIC 3004, Australia
| | - Natalie Heriot
- Ambulance Victoria, 31 Joseph St., Blackburn North, VIC 3130, Australia
| | - Vijaya Sundararajan
- Department of Medicine, St Vincent’s Hospital Melbourne, The University of Melbourne, 29 Regent Street, Fitzroy, VIC 3065, Australia
| | | | - Louise Fahy
- HEART Lab, St Vincent’s Institute of Medical Research, 9 Princes St., Fitzroy, VIC 3065, Australia
- Department of Cardiology, St Vincent’s Hospital Melbourne, 41 Victoria Parade, Fitzroy, VIC 3065, Australia
| | - Stephanie Rowe
- HEART Lab, St Vincent’s Institute of Medical Research, 9 Princes St., Fitzroy, VIC 3065, Australia
- Department of Cardiology, St Vincent’s Hospital Melbourne, 41 Victoria Parade, Fitzroy, VIC 3065, Australia
| | - David Anderson
- Ambulance Victoria, 31 Joseph St., Blackburn North, VIC 3130, Australia
| | - Dion Stub
- Ambulance Victoria, 31 Joseph St., Blackburn North, VIC 3130, Australia
- School of Public Health & Preventive Medicine, Monash University, 553 St Kilda Rd., Melbourne, VIC 3004, Australia
- Department of Cardiology, Alfred Health, 55 Commercial Rd., Prahran, VIC 3181, Australia
| | - Andre La Gerche
- HEART Lab, St Vincent’s Institute of Medical Research, 9 Princes St., Fitzroy, VIC 3065, Australia
- Department of Cardiology, St Vincent’s Hospital Melbourne, 41 Victoria Parade, Fitzroy, VIC 3065, Australia
- Cardiology Department, Baker Heart & Diabetes Institute, 75 Commercial Rd., Prahran, VIC 3181, Australia
| | - Ziad Nehme
- Ambulance Victoria, 31 Joseph St., Blackburn North, VIC 3130, Australia
- School of Public Health & Preventive Medicine, Monash University, 553 St Kilda Rd., Melbourne, VIC 3004, Australia
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Yoon H, Kim KH, Ro YS, Park JH, Shin SD, Song KJ, Hong KJ, Jeong J. Sex Disparities in Prehospital Advanced Cardiac Life Support in Out-of-Hospital Cardiac Arrest in South Korea. PREHOSP EMERG CARE 2023; 27:170-176. [PMID: 34990298 DOI: 10.1080/10903127.2022.2025635] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Sex disparities have been reported in the prehospital and in-hospital care among patients with out-of-hospital cardiac arrest (OHCA). The aim of this study was to investigate the association between sex and prehospital advanced cardiac life support (ACLS) interventions provided by emergency medical services (EMS). METHODS This was a cross-sectional observational study using a nationwide OHCA registry in South Korea. The study included adult OHCAs with presumed cardiac etiology from January 2016 to December 2019. The main exposure was the sex of the victim, and the primary outcomes were prehospital ACLS interventions, including advanced airway management (AAM), intravenous access (IV), and epinephrine (EPI) administration. Multivariable logistic regression analysis accounted for age group, health insurance, comorbidities, place of arrest, urbanization level, witness status, bystander CPR and initial rhythm was performed to calculate adjusted odds ratios (AORs) with 95% confidence intervals (95% CIs). RESULTS Among 71,154 eligible patients, females with OHCA received less prehospital ACLS interventions than males: risk difference, (95% CIs) -2.76 (-3.41;-2.11) for AAM, -6.03 (-6.79;-5.27) for IV, and -3.81 (-4.37;-3.25) for EPI. In multivariable logistic regression analysis, female sex was significantly associated with a lower probability of prehospital ACLS provision: AOR, (95% CIs) 0.87 (0.84-0.91) for AAM, 0.85 (0.82-0.88) for IV, and 0.81 (0.77-0.84) for EPI. CONCLUSION Compared to male patients, female patients were less likely to receive prehospital ACLS. This offers opportunities for EMS systems to reduce disparities and to improve compliance with OHCA resuscitation guidelines and outcomes through quality improvement and educational interventions.
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Affiliation(s)
- Hanna Yoon
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea.,Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea
| | - Ki Hong Kim
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea.,Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea
| | - Young Sun Ro
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea.,Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea
| | - Jeong Ho Park
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea.,Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea
| | - Sang Do Shin
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea.,Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea
| | - Kyoung Jun Song
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea.,Department of Emergency Medicine, Seoul National University Boramae Medical Center, Seoul, Korea
| | - Ki Jeong Hong
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea.,Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea
| | - Joo Jeong
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea.,Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
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Perman SM, Vogelsong MA, Del Rios M. Is all bystander CPR created equal? Further considerations in sex differences in cardiac arrest outcomes. Resuscitation 2023; 182:109649. [PMID: 36436692 DOI: 10.1016/j.resuscitation.2022.11.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 11/18/2022] [Indexed: 11/26/2022]
Affiliation(s)
- Sarah M Perman
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO, United States.
| | - Melissa A Vogelsong
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Stanford, CA, United States
| | - Marina Del Rios
- Department of Emergency Medicine, University of Iowa Carver School of Medicine, Iowa City, IA, United States
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8
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Kwak J, Ok Ahn K, Chan PS. Sex difference in the association between type of bystander CPR and clinical outcomes in patients with out of hospital cardiac arrest. Resusc Plus 2022; 13:100342. [PMID: 36593881 PMCID: PMC9803815 DOI: 10.1016/j.resplu.2022.100342] [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: 09/25/2022] [Revised: 12/06/2022] [Accepted: 12/09/2022] [Indexed: 12/24/2022] Open
Abstract
Background A recent study suggested that women with out-of-hospital cardiac arrest have a smaller survival benefit with bystander cardiopulmonary resuscitation than men. We evaluated whether this weaker association between bystander cardiopulmonary resuscitation and survival in women is related to dispatcher-assisted vs unassisted bystander cardiopulmonary resuscitation. Methods In a national registry in the Republic of Korea, we identified adult patients with out-of-hospital cardiac arrest during 2013-2018. The main exposure was type of bystander cardiopulmonary resuscitation (categorized as none, dispatcher-assisted, and unassisted). The primary outcome was favourable neurological survival. Multivariable logistic regression evaluated for an interaction between sex and type of bystander cardiopulmonary resuscitation. Results Of 93,245 patients with out-of-hospital cardiac arrest, there were 31,578 (33.9%) women and 61,667 (66.1%) men. Overall, both types of bystander cardiopulmonary resuscitation were associated with favourable neurological survival (unassisted: adjusted OR, 1.81 [95% CI: 1.66-1.98]; dispatcher-assisted: adjusted OR, 1.44 [95% CI: 1.33-1.56]). When unassisted cardiopulmonary resuscitation was administered, the association between bystander cardiopulmonary resuscitation and favourable neurological survival was similar between women and men: adjusted ORs of 1.59 (95% CI: 1.30-1.95) in women and 1.88 (95% CI: 1.71-2.08) in men; interaction p = 0.65). In contrast, when dispatcher-assisted cardiopulmonary resuscitation was administered, the association differed by sex: adjusted ORs of 1.08 (95% CI: 0.90-1.92) in women and 1.55 (95% CI: 1.42-1.69) in men; interaction p < 0.0002). Conclusions Dispatcher-assisted cardiopulmonary resuscitation was associated with favourable neurological survival in men but not in women whereas unassisted bystander cardiopulmonary resuscitation was associated with favourable neurological survival in women and men.
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Affiliation(s)
- Junyoung Kwak
- Department of Emergency Medicine, Myongji Hospital and Hanyang University College of Medicine, Goyang-si, South Korea
| | - Ki Ok Ahn
- Department of Emergency Medicine, Myongji Hospital and Hanyang University College of Medicine, Goyang-si, South Korea,Corresponding author at: 679-24 Hwajung-Dong, Deokyang-Gu, Goyang-Si, Gyeonggi-Do 412-270, South Korea.
| | - Paul S. Chan
- Saint Luke's Mid America Heart Institute and the University of Missouri-Kansas City, MO, USA
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Abstract
PURPOSE OF REVIEW Out-of-hospital cardiac arrest (OHCA) is a time-critical emergency in which a rapid response following the chain of survival is crucial to save life. Disparities in care can occur at each link in this pathway and hence produce health inequities. This review summarises the health inequities that exist for OHCA patients and suggests how they may be addressed. RECENT FINDINGS There is international evidence that the incidence of OHCA is increased with increasing deprivation and in ethnic minorities. These groups have lower rates of bystander CPR and bystander-initiated defibrillation, which may be due to barriers in accessing cardiopulmonary resuscitation training, provision of public access defibrillators, and language barriers with emergency call handlers. There are also disparities in the ambulance response and in-hospital care following resuscitation. These disadvantaged communities have poorer survival following OHCA. SUMMARY OHCA disproportionately affects deprived communities and ethnic minorities. These groups experience disparities in care throughout the chain of survival and this appears to translate into poorer outcomes. Addressing these inequities will require coordinated action that engages with disadvantaged communities.
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Liu N, Ning Y, Ong MEH, Saffari SE, Ryu HH, Kajino K, Lin CH, Karim SA, Rao GR, Ho AFW, Lim SL, Siddiqui FJ. Gender disparities among adult recipients of layperson bystander cardiopulmonary resuscitation by location of cardiac arrest in Pan-Asian communities: A registry-based study. EClinicalMedicine 2022; 44:101293. [PMID: 35198919 PMCID: PMC8850341 DOI: 10.1016/j.eclinm.2022.101293] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 01/14/2022] [Accepted: 01/19/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Bystander cardiopulmonary resuscitation (BCPR) is a critical component of the 'chain of survival' in reducing mortality among out-of-hospital cardiac arrest (OHCA) victims. Inconsistent findings on gender disparities among adult recipients of layperson BCPR have been reported in the literature. We aimed to fill this knowledge gap by investigating the extent of gender disparities in a cross-national setting within Pan-Asian communities. METHODS We utilised data collected from the Pan-Asian Resuscitation Outcomes Study (PAROS), an international, multicentre, prospective study conducted between 2009 and 2018. We included all OHCA cases with non-traumatic arrest aetiology transported by emergency medical services and excluded study sites that did not consistently collect information about the location of cardiac arrest. Logistic regression was used to analyse the association between gender and BCPR, stratified by location. FINDINGS We analysed a cohort of 56,192 OHCA cases with an overall BCPR rate of 36.2% (20,329/56,192). At public locations, the BCPR rate was 31.2% (631/2022) for female and 36.4% (3235/8892) for male OHCA victims; while at home, the rate was 38.3% (6838/17,842) for females and 35.1% (9625/27,436) for males. Controlling for site differences and several factors in multivariable logistic regression, we found females less likely to receive BCPR than males in public locations (odds ratio [OR]=0.89, 95% confidence interval [CI]: 0.70-0.99), but more likely to receive BCPR at home (OR=1.16, 95% CI: 1.11-1.21). INTERPRETATION In Pan-Asian communities, gender differences exist in adult recipients of BCPR and differ between home and public locations. Future studies should account for additional information on bystanders and societal factors to identify targets for interventions. FUNDING The study was supported by grants from the National Medical Research Council (NMRC/CSA/0049/2013) and Laerdal Foundation (20040).
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Affiliation(s)
- Nan Liu
- Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
- Health Services Research Centre, Singapore Health Services, Singapore, Singapore
- Institute of Data Science, National University of Singapore, Singapore, Singapore
- Corresponding author at: Duke-NUS Medical School, National University of Singapore, Singapore, Singapore.
| | - Yilin Ning
- Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
| | - Marcus Eng Hock Ong
- Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
- Health Services Research Centre, Singapore Health Services, Singapore, Singapore
- Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore
| | - Seyed Ehsan Saffari
- Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
- National Neuroscience Institute, Singapore, Singapore
| | - Hyun Ho Ryu
- Department of Emergency Medicine, Chonnam National University Medical School and Hospital, Gwangju, Republic of Korea
| | - Kentaro Kajino
- Department of Emergency and Critical Care Medicine, Kansai Medical University, Moriguchi, Osaka, Japan
| | - Chih-Hao Lin
- Department of Emergency Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Sarah Abdul Karim
- Department of Emergency Medicine, Hospital Sungai Buloh, Sungai Buloh, Selangor, Malaysia
| | - G.V. Ramana Rao
- GVK Emergency Management and Research Institute (GVK EMRI), Secunderabad, Telangana, India
| | - Andrew Fu Wah Ho
- Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
- Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore
| | - Shir Lynn Lim
- Department of Cardiology, National University Heart Centre, Singapore, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, Singapore, Singapore
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11
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Ferguson C. Dispatcher-assisted CPR can it do harm as well as good? Resuscitation 2021; 170:274-275. [PMID: 34896243 DOI: 10.1016/j.resuscitation.2021.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 12/01/2021] [Indexed: 10/19/2022]
Abstract
Outcomes for patients with out-of-hospital cardiac arrest can be improved by bystander cardiopulmonary resuscitation (CPR). Dispatcher-assisted CPR increases both the likelihood of CPR being performed, and the chance of survival for the arrested patient. Due to the urgency of the situation, CPR may be advised in patients who are subsequently found not to be in cardiac arrest. Ng and colleagues look at whether bystander CPR causes harm in this group of patients.
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12
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van Wees C, Rietdijk W, Mandigers L, van der Graaf M, Scholte NTB, Adriaansens KO, van den Berg RCM, den Uil CA. Do Women Have a Higher Mortality Risk Than Men following ICU Admission after Out-of-Hospital Cardiac Arrest? A Retrospective Cohort Analysis. J Clin Med 2021; 10:jcm10184286. [PMID: 34575397 PMCID: PMC8470772 DOI: 10.3390/jcm10184286] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 09/14/2021] [Accepted: 09/17/2021] [Indexed: 11/29/2022] Open
Abstract
Purpose: previous studies showed that women have a higher mortality risk than men after out-of-hospital cardiac arrest (OHCA). This sex difference may disappear after adjustment for cardiac arrest characteristics. Most studies also included patients who were not admitted to the intensive care unit (ICU). We analyzed whether sex impacts the mortality of ICU-admitted OHCA patients. Methods: a retrospective cohort analysis of 1240 OHCA patients admitted to the ICU (310 women, 25%, AgeMedian 64.0 (IQR 53.8–73.0)) at an academic hospital in the Netherlands between 1 January 2007 and 31 December 2018. The primary outcome was 90-day mortality; the secondary outcome was a favorable cerebral performance category (CPC) score at ICU discharge and ICU length of stay (ICU LOS). Results: we found no association between sex and 90-day mortality (hazard ratio (HR) 0.867; 95% confidence interval (95% CI) 0.678–1.108) after adjusting for relevant cardiac arrest characteristics. Similarly, we found no difference for favorable CPC score (OR 1.117; 95% CI 0.777–1.608) or ICU LOS between sexes (Beta 0.428; 95% CI −0.442 to 1.298). Conclusions: after adjusting for cardiac arrest characteristics, we found no difference between women and men with respect to 90-day mortality, ICU LOS, and CPC score.
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Affiliation(s)
- Christiaan van Wees
- Department of Intensive Care, Erasmus University Medical Center, 3015 GD Rotterdam, The Netherlands; (C.v.W.); (L.M.); (C.A.d.U.)
- Department of Cardiology, Erasmus University Medical Center, 3015 GD Rotterdam, The Netherlands; (M.v.d.G.); (N.T.B.S.); (K.O.A.)
| | - Wim Rietdijk
- Department of Cardiology, Erasmus University Medical Center, 3015 GD Rotterdam, The Netherlands; (M.v.d.G.); (N.T.B.S.); (K.O.A.)
- Department of Hospital Pharmacy, Erasmus University Medical Center, Doctor Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
- Correspondence:
| | - Loes Mandigers
- Department of Intensive Care, Erasmus University Medical Center, 3015 GD Rotterdam, The Netherlands; (C.v.W.); (L.M.); (C.A.d.U.)
| | - Marisa van der Graaf
- Department of Cardiology, Erasmus University Medical Center, 3015 GD Rotterdam, The Netherlands; (M.v.d.G.); (N.T.B.S.); (K.O.A.)
| | - Niels T. B. Scholte
- Department of Cardiology, Erasmus University Medical Center, 3015 GD Rotterdam, The Netherlands; (M.v.d.G.); (N.T.B.S.); (K.O.A.)
| | - Karst O. Adriaansens
- Department of Cardiology, Erasmus University Medical Center, 3015 GD Rotterdam, The Netherlands; (M.v.d.G.); (N.T.B.S.); (K.O.A.)
| | | | - Corstiaan A. den Uil
- Department of Intensive Care, Erasmus University Medical Center, 3015 GD Rotterdam, The Netherlands; (C.v.W.); (L.M.); (C.A.d.U.)
- Department of Cardiology, Erasmus University Medical Center, 3015 GD Rotterdam, The Netherlands; (M.v.d.G.); (N.T.B.S.); (K.O.A.)
- Department of Intensive Care, Maasstad Ziekenhuis, 3079 DZ Rotterdam, The Netherlands
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13
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Perman SM, Wright AR, Daugherty SL. Closing the Gap: How Telephone Assisted Cardiopulmonary Resuscitation (TA-CPR) Can Aid in Reducing the Sex Disparity in the Provision of Bystander CPR. Resuscitation 2021; 164:139-141. [PMID: 34029616 DOI: 10.1016/j.resuscitation.2021.05.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 05/15/2021] [Indexed: 11/19/2022]
Affiliation(s)
- Sarah M Perman
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO, United States.
| | - Angela R Wright
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO, United States; University of Colorado EMS Institute, Aurora, CO, United States
| | - Stacie L Daugherty
- Division of Cardiology, Department of Medicine, University of Colorado School of Medicine, Aurora, CO, United States
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