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Chen CY, Fan CY, Chen IC, Chen YC, Cheng MT, Chiang W, Huang CH, Sung CW, Huang EPC. The interaction of sex and age on outcomes in emergency medical services-treated out-of-hospital cardiac arrest: A 5-year multicenter retrospective analysis. Resusc Plus 2024; 17:100552. [PMID: 38304634 PMCID: PMC10831158 DOI: 10.1016/j.resplu.2024.100552] [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: 10/25/2023] [Revised: 01/05/2024] [Accepted: 01/09/2024] [Indexed: 02/03/2024] Open
Abstract
Background Studies have established that sex and age influence outcomes following out-of-hospital cardiac arrest (OHCA). However, a knowledge gap exists regarding their interaction. This study aimed to investigate the interaction of age and sex and how they cooperatively influence OHCA outcomes. Methods This retrospective cohort study included adult, nontraumatic OHCA patients admitted to a university hospital and its affiliated hospitals in Taiwan from January 2017 to December 2021. Data including sex, age, body mass index, cardiac rhythm, and resuscitation information in the emergency department (ED) were collected from medical records. The study outcomes encompassed survival to intensive care unit (ICU) admission, survival to hospital discharge, and a favorable neurological outcome. Multivariable logistic regression was performed to estimate the influence of sex on study outcomes. Results We analyzed a total of 2,826 eligible subjects categorized into three groups: young (18-44 years, 149 males and 57 females), middle-aged (45-64 years, 524 males and 188 females), and old (≥65 years, 1,049 males and 859 females). Analysis of the effects of sex according to age stratification showed that old males had higher odds for survival to ICU admission (OR: 1.49, 95% CI: 1.21-1.83) and favorable neurological outcomes (OR: 2.74, 95% CI: 1.58-4.76) than did old females. Analysis of the effects of age according to sex stratification revealed that old males had lower odds for survival to hospital discharge (OR: 0.33, 95% CI: 0.21-0.51) and favorable neurological outcomes (OR: 0.26, 95% CI: 0.16-0.43) than did young males. Old females also showed the same trend as males, with lower odds for survival to hospital discharge (OR: 0.37, 95% CI: 0.17-0.78) and favorable neurological outcomes (OR: 0.11, 95% CI: 0.05-0.25) than did young females. Conclusions The interaction between sex and age in patients with OHCA results in diverse outcomes. Within the same sex, age demonstrated varying effects on distinct outcomes.
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Affiliation(s)
- Ching-Yu Chen
- Department of Emergency Medicine, National Taiwan University Hospital Yun-Lin Branch, Douliu, Taiwan
| | - Cheng-Yi Fan
- Department of Emergency Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan
| | - I-Chung Chen
- Department of Emergency Medicine, National Taiwan University Hospital Yun-Lin Branch, Douliu, Taiwan
| | - Yun-Chang Chen
- Department of Emergency Medicine, National Taiwan University Hospital Yun-Lin Branch, Douliu, Taiwan
| | - Ming-Tai Cheng
- Department of Emergency Medicine, National Taiwan University Hospital Yun-Lin Branch, Douliu, Taiwan
- Department of Emergency Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Wen‑Chu Chiang
- Department of Emergency Medicine, National Taiwan University Hospital Yun-Lin Branch, Douliu, Taiwan
- Department of Emergency Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Chien-Hua Huang
- Department of Emergency Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Chih-Wei Sung
- Department of Emergency Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan
- Department of Emergency Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Edward Pei-Chuan Huang
- Department of Emergency Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan
- Department of Emergency Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
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Dadon Z, Fridel T, Einav S. The association between CPR quality of In-hospital resuscitation and sex: A hypothesis generating, prospective observational study. Resusc Plus 2022; 11:100280. [PMID: 35935175 PMCID: PMC9352447 DOI: 10.1016/j.resplu.2022.100280] [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: 03/27/2022] [Revised: 07/12/2022] [Accepted: 07/12/2022] [Indexed: 11/21/2022] Open
Abstract
Introduction The relationship between sex and cardiopulmonary resuscitation (CPR) outcomes remains unclear. Particularly, questions remain regarding the potential contribution of unmeasured confounders. We aimed to examine the differences in the quality of chest compression delivered to men and women. Methods Prospective study of observational data recorded during consecutive resuscitations occurring in a single tertiary center (Feb-1-2015 to Dec-31-2018) with real-time follow-up to hospital discharge. The studied variables included time in CPR, no-flow-time and fraction, compression rate and depth and release velocity. The primary study endpoint was the unadjusted association between patient sex and the chest compression quality (depth and rate). The secondary endpoint was the association between the various components of chest compression quality, sex, and survival to hospital discharge/neurologically intact survival. Results Overall 260 in-hospital resuscitations (57.7% male patients) were included. Among these 100 (38.5%) achieved return of spontaneous circulation (ROSC) and 35 (13.5%) survived to hospital discharge. Female patients were significantly older. Ischemic heart disease and ventricular arrhythmias were more prevalent among males. Compression depth was greater in female vs male patients (54.9 ± 11.3 vs 51.7 ± 10.9 mm; p = 0.024). Other CPR quality-metrics were similar. The rates of ROSC, survival to hospital discharge and neurologically intact survival did not differ between males and females. Univariate analysis revealed no association between sex, quality metrics and outcomes. Discussion Women received deeper chest compressions during in-hospital CPR. Our findings require corroboration in larger cohorts but nonetheless underscore the need to maintain high-quality CPR in all patients using real-time feedback devices. Future studies should also include data on ventilation rates and volumes which may contribute to survival outcomes.
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McDonald N, Little N, Grierson R, Weldon E. Sex and Gender Equity in Prehospital Electrocardiogram Acquisition. Prehosp Disaster Med 2022; 37:1-7. [PMID: 35260220 PMCID: PMC8948485 DOI: 10.1017/s1049023x2200036x] [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: 10/29/2021] [Revised: 12/07/2021] [Accepted: 12/17/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Research in cardiac care has identified significant gender-based differences across many outcomes. Women with heart disease are less likely both to be diagnosed and to receive standard care. Gender-based disparities in the prehospital setting are under-researched, but they were found to exist within rates of 12-lead electrocardiogram (ECG) acquisition within one urban Emergency Medical Services (EMS) agency. STUDY OBJECTIVE This study evaluates the quality improvement (QI) initiative that was implemented in that agency to raise overall rates of 12-lead ECG acquisition and reduce the gap in acquisition rates between men and women. METHODS This QI project included two interventions: revised indications for 12-lead acquisition, and training that highlighted sex- and gender-based differences relevant to patient care. To evaluate this project, a retrospective database review identified all patient contacts that potentially involved cardiac assessment over 18 months. The primary outcome was the rate of 12-lead acquisition among patients with qualifying complaints. This was assessed by mean rates of acquisition in before and after periods, as well as segmented regression in an interrupted time series. Secondary outcomes included differences in rates of 12-lead acquisition, both overall and in individual complaint categories, each compared between men/women and before/after the interventions. RESULTS Among patients with qualifying complaints, the mean rate of 12-lead acquisition in the lead-in period was 22.5% (95% CI, 21.8% - 23.2%) with no discernible trend. The protocol change and training were each associated with a significant absolute level increase in the acquisition rate: 2.09% (95% CI, 0.21% - 4.0%; P = .03) and 3.2% (95% CI, 1.18% - 5.22%; P = .003), respectively. When compared by gender and time period, women received fewer 12-leads than men overall, and more 12-leads were acquired after the interventions than before. There were also significant interactions between gender and period, both overall (2.8%; 95% CI, 1.9% - 3.6%; P < .0001) and in all complaint categories except falls and heart problems. CONCLUSION This QI project resulted in an increase in 12-leads acquired. Pre-existing gaps in rates of acquisition between men and women were reduced but did not disappear. On-going research is examining the reasons behind these differences from the perspective of prehospital providers.
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Affiliation(s)
- Neil McDonald
- Winnipeg Fire Paramedic Service, Winnipeg, Manitoba, Canada
- Applied Health Sciences - University of Manitoba, Winnipeg, Manitoba, Canada
| | - Nicola Little
- Winnipeg Fire Paramedic Service, Winnipeg, Manitoba, Canada
| | - Rob Grierson
- Winnipeg Fire Paramedic Service, Winnipeg, Manitoba, Canada
- Department of Emergency Medicine - University of Manitoba, Winnipeg, Manitoba, Canada
- Shared Health Manitoba - Emergency Response Services, Winnipeg, Manitoba, Canada
| | - Erin Weldon
- Winnipeg Fire Paramedic Service, Winnipeg, Manitoba, Canada
- Department of Emergency Medicine - University of Manitoba, Winnipeg, Manitoba, Canada
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Awad EM, Humphries KH, Grunau BE, Christenson JM. Premenopausal-aged females have no neurological outcome advantage after out-of-hospital cardiac arrest: A multilevel analysis of North American populations. Resuscitation 2021; 166:58-65. [PMID: 34271125 DOI: 10.1016/j.resuscitation.2021.06.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 05/14/2021] [Accepted: 06/20/2021] [Indexed: 11/28/2022]
Abstract
AIM We investigated the impact of premenopausal age on neurological function at hospital discharge in patients with out-of-hospital cardiac arrest (OHCA). We hypothesized that premenopausal-aged females (18-47 years of age) with OHCA would have a higher probability of survival with favourable neurological function at hospital discharge compared with males of the same age group, older males, and older females (>53 years of age). METHODS Retrospective analyses of data from the Resuscitation Outcomes Consortium multi-center randomized controlled trial (June 2011-May 2015). We included adults with non-traumatic OHCA treated by emergency medical service. We stratified the cohort into four groups by age and sex: premenopausal-aged females (18-47 years of age), older females (≥53 years old), younger males (18-47 years of age), and older male. We used multilevel logistic regression to examine the association between age-sex and favourable neurological outcomes (modified Rankin Scale ≤ 3). RESULTS In total, 23,725 patients were included: 1050 (4.5%) premenopausal females; 1930 (8.1%) younger males; 7569 (31.9%) older females; and 13,176 (55.5%) older males. The multilevel analysis showed no difference in neurological outcome between younger males and younger females (OR 0.95, 95% CI 0.69-1.32, p = 0.75). Both older females (OR 0.36, 95% CI 0. 0.26-0.48, p < 0.001) and older males (OR 0.52, 95% CI 0.39-0.69, p < 0.001) had a significantly lower odds of favourable neurological outcome than younger females. Among all groups, older females had the worst outcomes. CONCLUSIONS We did not detect an association between premenopausal age and survival with good neurological outcome, suggesting females sex hormones do not impact OHCA outcomes. Our findings are not in line with results from other studies. Studies that rigorously evaluate menopausal status are required to definitively assess the impact of female sex hormones on outcomes.
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Affiliation(s)
- Emad M Awad
- Faculty of Medicine, Experimental Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Centre for Health Evaluation and Outcome Sciences, Vancouver, British Columbia, Canada.
| | - Karin H Humphries
- Division of Cardiology, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; BC Centre for Improved Cardiovascular Health, Vancouver, British Columbia, Canada; Centre for Health Evaluation and Outcome Sciences, Vancouver, British Columbia, Canada
| | - Brian E Grunau
- Department of Emergency Medicine, St. Paul's Hospital, Vancouver, British Columbia, Canada; Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Centre for Health Evaluation and Outcome Sciences, Vancouver, British Columbia, Canada
| | - Jim M Christenson
- Department of Emergency Medicine, St. Paul's Hospital, Vancouver, British Columbia, Canada; Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Centre for Health Evaluation and Outcome Sciences, Vancouver, British Columbia, Canada
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Awad E, Humphries K, Grunau B, Besserer F, Christenson J. The effect of sex and age on return of spontaneous circulation and survival to hospital discharge in patients with out of hospital cardiac arrest: A retrospective analysis of a Canadian population. Resusc Plus 2021; 5:100084. [PMID: 34223350 PMCID: PMC8244242 DOI: 10.1016/j.resplu.2021.100084] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 01/08/2021] [Accepted: 01/17/2021] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES We evaluated the effect of sex and age on out-of-hospital cardiac arrest (OHCA) outcomes in a Canadian population. METHODS This study was a retrospective analysis of the British Columbia (BC) Cardiac Arrest Registry (2011-16). We included adult, non-traumatic, EMS-treated OHCA. We stratified the cohort into four groups by age and sex: younger females (18-47 years of age), younger males (18-47 years of age), older females, and older males (>53 years old). We used logistic regression to examine the effect of sex and interaction effect of sex and age on ROSC and survival to hospital discharge. RESULTS We included 8115 patients; 31.4% were females. Females had a lower proportion of OHCA in public locations, bystander witnessed arrests, and with initial shockable rhythms. Overall, females had greater adjusted odds of ROSC (OR 1.29, 95% CI 1.15-1.42, p < 0.001). The ROSC advantage was significant in females with non-shockable rhythms (OR 1.48, 95% CI 1.24-1.78, p < 0.001) and females of premenopausal age. However, there was no significant difference in survival to hospital discharge between females and males overall or by sex-age groups. Both younger females and younger males have higher odds of survival to hospital discharge compared to older females and males. Older females had the lowest survival rate among all other sex-age groups. CONCLUSIONS Female sex was associated with ROSC but not survival to hospital discharge. In the post-arrest phase, females, specifically those in the older age group, had a higher death rate, demonstrating the need for sex- and age-specific research in pre-and-post-OHCA care.
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Affiliation(s)
- Emad Awad
- Faculty of Medicine, Experimental Medicine, University of British Columbia, Vancouver, BC, Canada
- BC Centre for Improved Cardiovascular Health, Vancouver, BC, Canada
- Centre for Health Evaluation and Outcome Sciences, Vancouver, BC, Canada
| | - Karin Humphries
- Division of Cardiology, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- BC Centre for Improved Cardiovascular Health, Vancouver, BC, Canada
- Centre for Health Evaluation and Outcome Sciences, Vancouver, BC, Canada
| | - Brian Grunau
- Centre for Health Evaluation and Outcome Sciences, Vancouver, BC, Canada
- Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada
- Department of Emergency Medicine, St. Paul’s Hospital, Vancouver, BC, Canada
| | - Floyd Besserer
- British Columbia Emergency Health Services, Vancouver, BC, Canada
- University Hospital of Northern British Columbia, Prince George, BC, Canada
- Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Jim Christenson
- Centre for Health Evaluation and Outcome Sciences, Vancouver, BC, Canada
- Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada
- Department of Emergency Medicine, St. Paul’s Hospital, Vancouver, BC, Canada
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Tønsager K, Krüger AJ, Ringdal KG, Rehn M. Data quality of Glasgow Coma Scale and Systolic Blood Pressure in scientific studies involving physician-staffed emergency medical services: Systematic review. Acta Anaesthesiol Scand 2020; 64:888-909. [PMID: 32270473 DOI: 10.1111/aas.13596] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 03/19/2020] [Accepted: 03/21/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND Emergency physicians on-scene provide highly specialized care to severely sick or injured patients. High-quality research relies on the quality of data, but no commonly accepted definition of EMS data quality exits. Glasgow Coma Score (GCS) and Systolic Blood Pressure (SBP) are core physiological variables, but little is known about the quality of these data when reported in p-EMS research. This systematic review aims to describe the quality of pre-hospital reporting of GCS and SBP data in studies where emergency physicians are present on-scene. METHODS A systematic literature search was performed using CINAHL, Cochrane, Embase, Medline, Norart, Scopus, SweMed + and Web of Science, in accordance with the PRISMA guidelines. Reported data on accuracy of reporting, completeness and capture were extracted to describe the quality of documentation of GCS and SBP. External and internal validity assessment was performed by extracting a set of predefined variables. RESULTS We included 137 articles describing data collection for GCS, SBP or both. Most studies (81%) were conducted in Europe and 59% of studies reported trauma cases. Reporting of GCS and SBP data were not uniform and may be improved to enable comparisons. Of the predefined external and internal validity data items, 26%-45% of data were possible to extract from the included papers. CONCLUSIONS Reporting of GCS and SBP is variable in scientific papers. We recommend standardized reporting to enable comparisons of p-EMS.
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Affiliation(s)
- Kristin Tønsager
- Department of Research The Norwegian Air Ambulance Foundation Oslo Norway
- Department of Anaesthesiology and Intensive Care Stavanger University Hospital Stavanger Norway
- Faculty of Health Sciences University of Stavanger Stavanger Norway
| | - Andreas J. Krüger
- Department of Research The Norwegian Air Ambulance Foundation Oslo Norway
- Department of Emergency Medicine and Pre-Hospital Services St. Olavs Hospital Trondheim Norway
| | - Kjetil G. Ringdal
- Department of Anaesthesiology Vestfold Hospital Trust Tønsberg Norway
- Norwegian Trauma Registry Oslo University Hospital Oslo Norway
| | - Marius Rehn
- Department of Research The Norwegian Air Ambulance Foundation Oslo Norway
- Faculty of Health Sciences University of Stavanger Stavanger Norway
- Pre-hospital Division Air Ambulance DepartmentOslo University Hospital Oslo Norway
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Dicker B, Conaglen K, Howie G. Gender and survival from out-of-hospital cardiac arrest: a New Zealand registry study. Emerg Med J 2018; 35:367-371. [DOI: 10.1136/emermed-2017-207176] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 03/07/2018] [Accepted: 03/21/2018] [Indexed: 11/03/2022]
Abstract
ObjectiveTo determine the relationships between survival from all-cause out-of-hospital cardiac arrest (OHCA) and gender in New Zealand.MethodsA retrospective observational study was conducted using data compliant with the Utstein guidelines from the St John New Zealand OHCA Registry for adult patients who were treated for an OHCA between 1 October 2013 and 30 September 2015. Univariate logistic regression was used to investigate factors associated with return of spontaneous circulation sustained to handover at hospital and survival to 30 days. Multivariate logistic regression models were used to investigate outcome differences in survival according to gender at 30 days postevent.ResultsWomen survived to hospital handover in 29% of cases, which was not significantly different from men (31%). When adjusted for age, location, aetiology, initial rhythm and witnessed status, there was no significant difference in 30-day survival between men (16%) and women (13%) (adjusted OR 1.22, 95% CI (0.96 to 1.55), p=0.11).ConclusionNo statistical differences were found in 30-day survival between genders when adjustments for unfavourable Utstein variables were accounted for.
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Impact of city police layperson education and equipment with automatic external defibrillators on patient outcome after out of hospital cardiac arrest. Resuscitation 2017; 118:27-34. [DOI: 10.1016/j.resuscitation.2017.06.017] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Revised: 06/08/2017] [Accepted: 06/16/2017] [Indexed: 01/09/2023]
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