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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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Kline KE, Russell AL, Stezoski JP, Gober IG, Dimeo EG, Janesko-Feldman K, Drabek T, Kochanek PM, Wagner AK. Differential Effects of Targeted Temperature Management on Sex-Dependent Outcomes After Experimental Asphyxial Cardiac Arrest. Ther Hypothermia Temp Manag 2024. [PMID: 38386544 DOI: 10.1089/ther.2023.0061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2024] Open
Abstract
Asphyxial cardiac arrest (ACA) survivors face lasting neurological disability from hypoxic ischemic brain injury. Sex differences in long-term outcomes after cardiac arrest (CA) are grossly understudied and underreported. We used rigorous targeted temperature management (TTM) to understand its influence on survival and lasting sex-specific neurological and neuropathological outcomes in a rodent ACA model. Adult male and female rats underwent either sham or 5-minute no-flow ACA with 18 hours TTM at either ∼37°C (normothermia) or ∼36°C (mild hypothermia). Survival, temperature, and body weight (BW) were recorded over the 14-day study duration. All rats underwent neurological deficit score (NDS) assessment on days 1-3 and day 14. Hippocampal pathology was assessed for cell death, degenerating neurons, and microglia on day 14. Although ACA females were less likely to achieve return of spontaneous circulation (ROSC), post-ROSC physiology and biochemical profiles were similar between sexes. ACA females had significantly greater 14-day survival, NDS, and BW recovery than ACA males at normothermia (56% vs. 29%). TTM at 36°C versus 37°C improved 14-day survival in males, producing similar survival in male (63%) versus female (50%). There were no sex or temperature effects on CA1 histopathology. We conclude that at normothermic conditions, sex differences favoring females were observed after ACA in survival, NDS, and BW recovery. We achieved a clinically relevant ACA model using TTM at 36°C to improve long-term survival. This model can be used to more fully characterize sex differences in long-term outcomes and test novel acute and chronic therapies.
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Affiliation(s)
- Kelsey E Kline
- Safar Center for Resuscitation Research, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Department of Neuroscience, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Ashley L Russell
- Safar Center for Resuscitation Research, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Jason P Stezoski
- Safar Center for Resuscitation Research, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Ian G Gober
- Safar Center for Resuscitation Research, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Emma G Dimeo
- Safar Center for Resuscitation Research, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Department of Neuroscience, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Keri Janesko-Feldman
- Safar Center for Resuscitation Research, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Tomas Drabek
- Safar Center for Resuscitation Research, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Patrick M Kochanek
- Safar Center for Resuscitation Research, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Department of Neuroscience, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Amy K Wagner
- Safar Center for Resuscitation Research, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Department of Neuroscience, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Springer A, Dreher A, Reimers J, Kaiser L, Bahlmann E, van der Schalk H, Wohlmuth P, Gessler N, Hassan K, Wietz J, Bein B, Spangenberg T, Willems S, Hakmi S, Tigges E. Gender disparities in patients undergoing extracorporeal cardiopulmonary resuscitation. Front Cardiovasc Med 2024; 10:1265978. [PMID: 38292453 PMCID: PMC10824923 DOI: 10.3389/fcvm.2023.1265978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 11/30/2023] [Indexed: 02/01/2024] Open
Abstract
Introduction The use of venoarterial extracorporeal membrane oxygenation (VA-ECMO) in extracorporeal cardiopulmonary resuscitation (eCPR) has emerged as a treatment option for selected patients who are experiencing refractory cardiac arrest (CA). In the light of increasing availability, the analyses of outcome-relevant predisposing characteristics are of growing importance. We evaluated the prognostic influence of gender in patients presenting with out-of-hospital cardiac arrest (OHCA) treated with eCPR. Methods We retrospectively analysed the data of 377 consecutive patients treated for OHCA using eCPR in our cardiac arrest centre from January 2016 to December 2022. The primary outcome was defined as the survival of patients until they were discharged from the hospital, with a favourable neurological outcome [cerebral performance category (CPC) score of ≤2]. Statistical analyses were performed using baseline comparison, survival analysis, and multivariable analyses. Results Out of the 377 patients included in the study, 69 (21%) were female. Female patients showed a lower prevalence rate of pre-existing coronary artery disease (48% vs. 75%, p < 0.001) and cardiomyopathy (17% vs. 34%, p = 0.01) compared with the male patients, while the mean age and prevalence rate of other cardiovascular risk factors were balanced. The primary reason for CA differed significantly (female: coronary event 45%, pulmonary embolism 23%, cardiogenic shock 17%; male: coronary event 70%, primary arrhythmia 10%, cardiogenic shock 10%; p = 0.001). The prevalence rate of witnessed collapse (97% vs. 86%; p = 0.016) and performance of bystander CPR (94% vs. 85%; p = 0.065) was higher in female patients. The mean time from collapse to the initiation of eCPR did not differ between the two groups (77 ± 39 min vs. 80 ± 37 min; p = 0.61). Overall, female patients showed a higher percentage of neurologically favourable survival (23% vs. 12%; p = 0.027) despite a higher prevalence of procedure-associated bleeding complications (33% vs. 16%, p = 0.002). The multivariable analysis identified a shorter total CPR duration (p = 0.001) and performance of bystander CPR (p = 0.03) to be associated with superior neurological outcomes. The bivariate analysis showed relevant interactions between gender and body mass index (BMI). Conclusion Our analysis suggests a significant survival benefit for female patients who obtain eCPR, possibly driven by a higher prevalence of witnessed collapse and bystander CPR. Interestingly, the impact of patient age and BMI on neurologically favourable outcome was higher in female patients than in male patients, warranting further investigation.
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Affiliation(s)
- A. Springer
- Department of Cardiology and Critical Care, Asklepios Clinic St. Georg, Hamburg, Germany
| | - A. Dreher
- Department of Cardiology and Critical Care, Asklepios Clinic St. Georg, Hamburg, Germany
| | - J. Reimers
- Department of Cardiology and Critical Care, Asklepios Clinic St. Georg, Hamburg, Germany
| | - L. Kaiser
- Department of Cardiology and Critical Care, Asklepios Clinic St. Georg, Hamburg, Germany
| | - E. Bahlmann
- Department of Cardiology and Critical Care, Asklepios Clinic St. Georg, Hamburg, Germany
| | - H. van der Schalk
- Department of Cardiology and Critical Care, Asklepios Clinic St. Georg, Hamburg, Germany
| | | | - N. Gessler
- Department of Cardiology and Critical Care, Asklepios Clinic St. Georg, Hamburg, Germany
- Asklepios ProResearch, Hamburg, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Luebeck, Hamburg, Germany
| | - K. Hassan
- Department of Cardiac Surgery, Asklepios Clinic St. Georg, Hamburg, Germany
| | - J. Wietz
- Department of Emergency Medicine, Asklepios Clinic St. Georg, Hamburg, Germany
| | - B. Bein
- Department of Anaesthesiology and Critical Care, Asklepios Clinic St. Georg, Hamburg, Germany
| | - T. Spangenberg
- Department of Cardiology and Critical Care, Asklepios Clinic Altona, Hamburg, Germany
| | - S. Willems
- Department of Cardiology and Critical Care, Asklepios Clinic St. Georg, Hamburg, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Luebeck, Hamburg, Germany
- Semmelweis-University, Budapest, Hungary
| | - S. Hakmi
- DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Luebeck, Hamburg, Germany
- Department of Cardiac Surgery, Asklepios Clinic St. Georg, Hamburg, Germany
| | - E. Tigges
- Department of Cardiology and Critical Care, Asklepios Clinic St. Georg, Hamburg, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Luebeck, Hamburg, Germany
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Wagner MK, Christensen AV, Hassager C, Stenbæk DS, Ekholm O, Borregaard B, Thrysoee L, Rasmussen TB, Thorup CB, Mols RE, Juel K, Berg SK. Sex Differences in Patient-Reported Outcomes in the Immediate Recovery Period After Resuscitation: Findings From the Cross-sectional DenHeart Survey. J Cardiovasc Nurs 2023; 38:279-287. [PMID: 37027133 PMCID: PMC10090329 DOI: 10.1097/jcn.0000000000000914] [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: 11/26/2022]
Abstract
BACKGROUND A paucity of resuscitation studies have examined sex differences in patient-reported outcomes upon hospital discharge. It remains unclear whether male and female patients differ in health outcomes in their immediate responses to trauma and treatment after resuscitation. OBJECTIVES The aim of this study was to examine sex differences in patient-reported outcomes in the immediate recovery period after resuscitation. METHODS In a national cross-sectional survey, patient-reported outcomes were measured by 5 instruments: symptoms of anxiety and depression (Hospital Anxiety and Depression Scale), illness perception (Brief Illness Perception Questionnaire [B-IPQ]), symptom burden (Edmonton Symptom Assessment Scale [ESAS]), quality of life (Heart Quality of Life Questionnaire), and perceived health status (12-Item Short Form Survey). RESULTS Of 491 eligible survivors of cardiac arrest, 176 (80% male) participated. Compared with male, resuscitated female reported worse symptoms of anxiety (Hospital Anxiety and Depression Scale-Anxiety score ≥8) (43% vs 23%; P = .04), emotional responses (B-IPQ) (mean [SD], 4.9 [3.12] vs 3.7 [2.99]; P = .05), identity (B-IPQ) (mean [SD], 4.3 [3.10] vs 4.0 [2.85]; P = .04), fatigue (ESAS) (mean [SD], 5.26 [2.48] vs 3.92 [2.93]; P = .01), and depressive symptoms (ESAS) (mean [SD], 2.60 [2.68] vs 1.67 [2.19]; P = .05). CONCLUSIONS Between sexes, female survivors of cardiac arrest reported worse psychological distress and illness perception and higher symptom burden in the immediate recovery period after resuscitation. Attention should focus on early symptom screening at hospital discharge to identify those in need of targeted psychological support and rehabilitation.
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Lee G, Sun Ro Y, Ho Park J, Jeong Hong K, Jun Song K, Do Shin S. Interaction between Bystander Sex and Patient Sex in Bystander Cardiopulmonary Resuscitation for Out-of-Hospital Cardiac Arrests. Resuscitation 2023; 187:109797. [PMID: 37080334 DOI: 10.1016/j.resuscitation.2023.109797] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 04/08/2023] [Accepted: 04/10/2023] [Indexed: 04/22/2023]
Abstract
BACKGROUND Bystander cardiopulmonary resuscitation (CPR) is a critical factor in improving out-of-hospital cardiac arrest (OHCA) survival. The aim of this study was to investigate the interaction effect of bystander sex and patient sex on the provision of bystander CPR. METHODS This was a retrospective cohort study using national OHCA registry in Korea. The inclusion criteria were adult bystander-witnessed OHCA patients with presumed cardiac etiology from January 2016 to December 2020. The primary outcome was the provision of bystander CPR. Multivariable logistic regression and interaction analysis were conducted to evaluate the impact of bystander sex on bystander CPR provision based on patient sex. RESULTS The study included 24,919 patients with OHCA, 58.2% with male-bystanders and 41.8% with female-bystanders. Female bystanders were less likely to perform bystander CPR than male bystanders (68.0% vs. 78.8%, adjusted OR (95% CI): 0.62 (0.58-0.66)). Among patients with CPR-trained bystanders, female bystanders had lower odds of bystander CPR (0.85 (0.73-0.97)). In the interaction analysis between bystander and patient sex, a significant difference was observed in the likelihood of bystander CPR according to the patient sex. Female bystanders had lower odds of bystander CPR than male bystanders for male patients (0.47 (0.43-0.50)). However, there were no significant differences between male and female bystanders for female patients (0.91 (0.88-1.07)). CONCLUSION Female bystanders have a lower likelihood of providing bystander CPR than male bystanders. Additionally, an interaction was observed between bystander sex and patient sex in the providing bystander CPR, with the association being more pronounced in male OHCA patients.
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Affiliation(s)
- Gyeongmin Lee
- Department of Emergency Medicine, Dongkuk University Hospital, Gyeonggi, Korea; Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea.
| | - Young Sun Ro
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea; Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea; Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, Korea.
| | - Jeong Ho Park
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea; Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea; Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, Korea.
| | - Ki Jeong Hong
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea; Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea; Department of Emergency Medicine, Seoul National University College of Medicine, 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 College of Medicine, Seoul, Korea; Department of Emergency Medicine, Seoul National University Boramae Medical Center, Seoul, Korea.
| | - Sang Do Shin
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea; Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea; Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, Korea.
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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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Choi HZ, Chang H, Ko SH, Kim MC. Gender effect in survival after out-of-hospital cardiac arrest: A nationwide, population-based, case-control propensity score matched study based Korean national cardiac arrest registry. PLoS One 2022; 17:e0258673. [PMID: 35544548 PMCID: PMC9094503 DOI: 10.1371/journal.pone.0258673] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 10/01/2021] [Indexed: 11/19/2022] Open
Abstract
Objective This study aimed to describe the relationship between sex and survival of patients with out-of-hospital cardiac arrest (OHCA) and further investigate the potential impact of female reproductive hormones on survival outcomes, by stratifying the patients into two age groups. Methods This retrospective, national population-based observational, case-control study, included Korean OHCA data from January 1, 2009, to December 31, 2016. We used multiple logistic regression with propensity score-matched data. The primary outcome was survival-to-discharge. Results Of the 94,160 patients with OHCA included, 34.2% were women. Before propensity score matching (PSM), the survival-to-discharge rate was 5.2% for females and 9.1% for males, in the entire group (OR 0.556, 95% CI [–0.526–0.588], P<0.001). In the reproductive age group (age 18–44 years), the survival-to-discharge rate was 14% for females and 15.6% for males (OR 0.879, 95% CI [0.765–1.012], P = 0,072) and in the post-menopause age group (age ≥ 55 years), the survival-to-discharge rate was 4.1% for females and 7% for males (OR 0.562, 95% CI [0.524–0.603], P<0.001). After PSM (28,577 patients of each sex), the survival-to-discharge rate was 5.4% for females and 5.4% for males (OR, 1.009 [0.938–1.085], P = 0.810). In the reproductive age group, the survival-to-discharge rate was 14.5% for females and 11.5% for males (OR 1.306, 95% CI [1.079–1.580], P = 0.006) and in the post-menopause age group, the survival-to-discharge rate was 4.2% for females and 4.6% for males (OR 0.904, 95% CI [0.828–0.986], P = 0.022). After adjustment for confounders, women of reproductive age were more likely to survive at hospital discharge. However, there was no statistically significant difference in neurological outcome (OR 1.238, 95% CI [0.979–1.566], P = 0.074). Conclusions Females of reproductive age had a better chance of survival when matched for confounding factors. Further studies using sex hormones are needed to improve the survival rate of patients with OHCA.
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Affiliation(s)
- Han Zo Choi
- Department of Emergency Medicine, Kyung Hee University Hospital at Gangdong, Seoul, South Korea
| | - Hansol Chang
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
- Department of Digital Health, Samsung Advanced Institute for Health Science & Technology (SAIHST), Sungkyunkwan University, Seoul, South Korea
| | - Seok Hoon Ko
- Department of Emergency Medicine, Kyung Hee University Medical Center, Seoul, South Korea
| | - Myung Chun Kim
- Department of Emergency Medicine, Kyung Hee University Hospital at Gangdong, Seoul, South Korea
- * E-mail:
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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: 13] [Impact Index Per Article: 6.5] [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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Lee GT, Hwang SY, Jo IJ, Kim TR, Yoon H, Cha WC, Sim MS, Shin SD, Shin TG, Choi JH. Gender difference in the clinical outcomes of patients with out-of-hospital cardiac arrest: A report using data from a national Korean registry. Medicine (Baltimore) 2021; 100:e27855. [PMID: 35049187 PMCID: PMC9191301 DOI: 10.1097/md.0000000000027855] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 11/01/2021] [Indexed: 01/14/2023] Open
Abstract
We explored gender differences in the characteristics and outcomes of patients with out-of-hospital cardiac arrest (OHCA) in Korea.We retrospectively analyzed a nationwide multicenter registry of out-of-hospital cardiac arrest patients that prospectively collected from January to December 2014, and explored the clinical outcomes of 670 successfully resuscitated adult patients with OHCA who were transferred to 27 hospitals. The effect of gender on the 30-day neurologically favorable survival (cerebral performance category 1 or 2) was analyzed after propensity score matching (PSM) of each patient in terms of clinical characteristics.We included 670 patients with OHCA, of whom 482 (72%) were male and 182 (28%) were female. The frequency of witnessed arrests and proportion of home arrests were similar between men and women (73.7% vs 71.3%, P = .59, and 55.0% vs 60.6% P = .21, respectively). Women were older than men (mean age, 65.9 vs 59.7 years, P < .001) and less likely to present with an initial shockable rhythm (27.7% vs 45.0%, P < .001). Women were less likely to undergo targeted temperature management (19.1% vs 35.9%, P < .001), coronary angiography (14.9% vs 36.1%, P < .001), or revascularization (7.4% vs 19.3%, P < .001). Compared with men, women exhibited poorer 30-day neurologically favorable survival (69.7% vs 83.0%, P = .001). However, the gender difference was not significant on PSM or inverse probability of treatment weighting (IPTW) analyses (P = .48 and P = .63, respectively).Female patients with OHCA exhibited poorer clinical characteristics and were less likely to receive treatment than men. After accounting for these differences, clinical outcomes did not differ by gender.
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Affiliation(s)
- Gun Tak Lee
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Department of Emergency Medicine, College of Medicine, Kangwon National University, Chuncheon, Gangwon, Korea
| | - Sung Yeon Hwang
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Department of Emergency Medicine, College of Medicine, Kangwon National University, Chuncheon, Gangwon, Korea
| | - Ik Joon Jo
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Tae Rim Kim
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hee Yoon
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Department of Emergency Medicine, College of Medicine, Kangwon National University, Chuncheon, Gangwon, Korea
| | - Won Chul Cha
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Min Seob Sim
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sang Do Shin
- Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Tae Gun Shin
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jin-Ho Choi
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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10
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Sex-specific differences and outcome in elderly patients after survived out-of-hospital cardiac arrest. Med Klin Intensivmed Notfmed 2021; 117:630-638. [PMID: 34651196 DOI: 10.1007/s00063-021-00869-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 08/20/2021] [Accepted: 08/23/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Little is known about sex differences in elderly patients after out-of-hospital cardiac arrest (OHCA) with return of spontaneous circulation (ROSC) and subsequent target temperature management (TTM). Therefore, this study was designed to evaluate sex-specific differences in survival and neurological outcome in elderly patients at 28-day and 180-day follow-up. METHODS A total of 468 nontraumatic OHCA survivors with preclinical ROSC and an age of ≥ 65 years were included in this study. Sex-specific differences in survival and a favorable neurological outcome according to the cerebral performance category (CPC) score were evaluated as clinical endpoints. RESULTS Of all participants included, 70.7% were men and 29.3% women. Women were significantly older (p = 0.011) and were more likely to have a nonshockable rhythm (p = 0.001) than men. Evaluation of survival rate and favorable neurological outcome by sex category showed no significant differences at 28-day and 180-day follow-up. In multiple stepwise logistic regression analysis, age (odds ratio 0.932 [95% confidence interval 0.891-0.951], p = 0.002) and time of hypoxia (0.899 [0.850-0.951], p < 0.001) proved to be independent predictors of survival only in male patients, whereas an initial shockable rhythm (4.325 [1.309-14.291], p = 0.016) was associated with 180-day survival in female patients. The majority of patients (93.7%) remained in the same CPC category when comparing 28-day and 180-day follow-up. CONCLUSION Our results show no significant sex-specific differences in survival or favorable neurological outcome in elderly patients after having survived OHCA, but sex-specific predictors for 180-day survival. Moreover, the neurological assessment 28 days after the index event also seems to provide a valid indication for the further prognosis in elderly patients.
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11
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Kotini-Shah P, Del Rios M, Khosla S, Pugach O, Vellano K, McNally B, Vanden Hoek T, Chan PS. Sex differences in outcomes for out-of-hospital cardiac arrest in the United States. Resuscitation 2021; 163:6-13. [PMID: 33798627 DOI: 10.1016/j.resuscitation.2021.03.020] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 03/18/2021] [Accepted: 03/22/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Approximately 1000 out-of-hospital cardiac arrest (OHCA) occur each day in the United States. Although sex differences exist for other cardiovascular conditions such as stroke and acute myocardial infarction, they are less well understood for OHCA. Specifically, the extent to which neurological and survival outcomes after OHCA differ between men and women remains poorly characterized in the U.S. METHODS AND RESULTS Within the national Cardiac Arrest Registry to Enhance Survival (CARES) registry, we identified 326,138 adults with an OHCA from 2013 to 2019. Using multivariable logistic regression, we evaluated for sex differences in rates of survival to hospital admission, survival to hospital discharge, and favorable neurological survival (i.e., without severe neurological disability), adjusted for demographics, cardiac arrest characteristics and bystander interventions. Overall, 117,281 (36%) patients were women. Median age was 62 and 65 years for men and women, respectively. An initial shockable rhythm (25.1% vs 14.7%, standardized difference of 0.26) and an arrest in a public location (22.2% vs. 11.3%; standardized difference of 0.30) were more common in men, but there were no meaningful sex differences in rates of witnessed arrests, bystander cardiopulmonary resuscitation, intra-venous access, or use of mechanical devices for delivering cardiopulmonary resuscitation. Overall, the unadjusted rates of all survival outcomes were similar between men and women: survival to hospital admission (27.0% for men vs. 27.9% for women, standardized difference of -0.02), survival to hospital discharge (10.5% for men vs. 8.6% for women, standardized difference of 0.07), and favorable neurological survival (9.0% for men vs. 6.6% for women, standardized difference of 0.09). After multivariable adjustment, however, men were less likely to survive to hospital admission (adjusted OR = 0.75, 95% CI: 0.73, 0.77), survive to hospital discharge (adjusted OR = 0.83, 95% CI: 0.80, 0.85), or have favorable neurological survival (adjusted OR = 0.88, 95% CI: 0.85, 0.91). CONCLUSIONS Compared to women, men with OHCA have more favorable cardiac arrest characteristics but were less likely to survive to hospital admission, survive to discharge, nor have favorable neurological survival.
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Affiliation(s)
- Pavitra Kotini-Shah
- Department of Emergency Medicine, University of Illinois at Chicago, IL, USA.
| | - Marina Del Rios
- Department of Emergency Medicine, University of Illinois at Chicago, IL, USA
| | - Shaveta Khosla
- Department of Emergency Medicine, University of Illinois at Chicago, IL, USA
| | - Oksana Pugach
- Institute for Health Research and Policy, University of Illinois at Chicago, IL, USA
| | - Kimberly Vellano
- CARES: Cardiac Arrest Registry to Enhance Survival, Emory University, Atlanta, GA, USA
| | - Bryan McNally
- CARES: Cardiac Arrest Registry to Enhance Survival, Emory University, Atlanta, GA, USA; Department of Emergency Medicine, School of Medicine, Emory University, Atlanta, GA, USA
| | - Terry Vanden Hoek
- Department of Emergency Medicine, University of Illinois at Chicago, IL, USA
| | - Paul S Chan
- Saint Luke's Mid America Heart Institute and the University of Missouri-Kansas City, MO, USA
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Abstract
OBJECTIVE The aim of the study was to compare outcomes after out-of-hospital cardiac arrest (OHCA) between comparable female and male OHCA cohorts in a large nationwide registry. METHODS This was a national multicentre retrospective, case-control propensity score-matched study based on French National Cardiac Arrest Registry data from 1 July 2011 to 21 September 2017. Female and male survival rates at D30 were compared. RESULTS At baseline 66 395 OHCA victims were included, of which 34.3% were women. At hospital admission, survival was 18.2% for female patients and 20.2% for male patients [odds ratio (OR), 1.138 (1.092-1.185)]; at 30 days, survival was 4.3 and 5.9%, respectively [OR, 1.290 (1.191-1.500)]. After matching (14 051 patients within each group), female patients received less advanced life support by mobile medical team (MMT), they also had a longer no-flow duration and shorter resuscitation effort by MMT than male patients. However, 15.3% of female patients vs. 9.1% of male patients were alive at hospital admission [OR, 0.557 (0.517-0.599)] and 3.2 vs. 2.6% at D30 [OR, 0.801 (0.697-0.921)], with no statistically significant difference in neurological outcome [OR, 0.966 (0.664-1.407)]. CONCLUSIONS In this large nationwide matched OHCA study, female patients had a better chance of survival with no significant difference in neurological outcome. We also noticed that female patients received delayed care with a shorter resuscitation effort compared to men; these complex issues warrant further specific investigation. Encouraging bystanders to act as quickly as possible and medical teams to care for female patients in the same way as male patients should increase survival rates.
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13
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Jacob B, Stock D, Chan V, Colantonio A, Cullen N. Predictors of in-hospital mortality following hypoxic-ischemic brain injury: a population-based study. Brain Inj 2019; 34:178-186. [PMID: 31674215 DOI: 10.1080/02699052.2019.1683897] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objective: To identify predictors of in-hospital mortality following Hypoxic-Ischemic Brain Injury (HIBI) using the Anderson Behavioral Model.Design and Setting: Population based retrospective cohort study in Ontario, Canada with data collected between 1 April 2002 and 31 March 2017.Patients: Adult patients aged 20 years and older with HIBI-related acute care admission were identified in the health administrative data. Multivariable cox proportional hazard regression models were used to identify predisposing, need and enabling factors that predict in-hospital mortality.Results: Of the 7492 patients admitted to acute care with HIBI, the in-hospital mortality rate was 71%. The predisposing factors associated with mortality were female sex (HR, 1.16; 95% CI, 1.10-1.23) and older age (65-79 vs. 20-34: HR, 1.17; 95% CI, 1.02-1.35). The need factors associated with mortality were the presence of COPD (HR, 1.10; 95% CI, 1.02-1.17), psychiatric illness (HR, 1.13; 95% CI, 1.05-1.20) injury due to cardiac illness (HR, 1.19; 95% CI, 1.12-1.26) and longer emergency department length of stay. Having spending any time in an alternate level of care and the application of tracheotomy procedures were found to reduce mortality.Conclusions: The acute/critical care centers need to consider these findings to adopt prevention strategies targeting reduced in-hospital mortality.
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Affiliation(s)
- Binu Jacob
- Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
| | - David Stock
- Toronto Rehabilitation Institute, University Health Network, Toronto, Canada.,Clinical Health and Epidemiology, Dalhousie University, Halifax, Canada
| | - Vincy Chan
- Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
| | - Angela Colantonio
- Toronto Rehabilitation Institute, University Health Network, Toronto, Canada.,Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada.,Institute for Clinical Evaluative Sciences, Toronto, Canada.,Department of Occupational Science & Occupational Therapy, University of Toronto, Toronto, Canada
| | - Nora Cullen
- Toronto Rehabilitation Institute, University Health Network, Toronto, Canada.,Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada.,West Park Healthcare Centre, Toronto, Canada
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14
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McLaughlin TJ, Jain SK, Voigt AH, Wang NC, Saba S. Comparison of Long-Term Survival Following Sudden Cardiac Arrest in Men Versus Women. Am J Cardiol 2019; 124:362-366. [PMID: 31103131 DOI: 10.1016/j.amjcard.2019.04.051] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Revised: 04/16/2019] [Accepted: 04/25/2019] [Indexed: 02/04/2023]
Abstract
Sudden cardiac death (SCA) is a major cause of mortality with estimates of 450,000 deaths annually in the United States. The incidence of SCA differs between the sexes. Data regarding survival of women compared with men after SCA are, however, conflicting. We, therefore, examined the long-term survival of women versus men after SCA. A total of 1,433 (41% women; 44% out-of-hospital) survivors of SCA at our institution between 2002 and 2012 were followed to the primary end point of death through February 20, 2017. Women in our cohort were older (p = 0.02), were less likely to be white (p = 0.01), or to have suffered an acute myocardial infarction at the time of SCA (p < 0.001). They also had significantly shorter PR (p < 0.001) and QRS (p < 0.001) durations on their surface electrocardiogram, were more likely to present with an initial ventricular rhythm other than ventricular tachycardia or ventricular fibrillation (29% vs 22%, p = 0.001) and less likely to receive an implantable cardioverter defibrillator (22% vs 31%, p < 0.001). Over a median follow-up of 3.6 years, 674 (45%) patients died (53% women vs 43% men, p < 0.001). After adjusting for unbalanced baseline covariates, the sex difference in survival disappeared (hazard ratio 1.05; 95% confidence interval 0.85 to 1.29, p = 0.66). In conclusion, our results demonstrate comparable long-term mortality after SCA for men and women. Differences in unadjusted mortality are mainly due to older age, different risk profiles at the time of index event, and differential treatment with implantable cardioverter defibrillator.
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15
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Jarman AF, Mumma BE, Perman SM, Kotini-Shah P, McGregor AJ. When the Female Heart Stops: Sex and Gender Differences in Out-of-Hospital Cardiac Arrest Epidemiology and Resuscitation. Clin Ther 2019; 41:1013-1019. [PMID: 31053294 DOI: 10.1016/j.clinthera.2019.03.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 03/21/2019] [Accepted: 03/27/2019] [Indexed: 11/16/2022]
Abstract
Sex- and gender-based differences are emerging as clinically significant in the epidemiology and resuscitation of patients with out-of-hospital cardiac arrest (OHCA). Female patients tend to be older, experience arrest in private locations, and have fewer initial shockable rhythms (ventricular fibrillation/ventricular tachycardia). Despite standardized algorithms for the management of OHCA, women are less likely to receive evidence-based interventions, including advanced cardiac life support medications, percutaneous coronary intervention, and targeted temperature management. While some data suggest a protective mechanism of estrogen in the heart, brain, and kidney, its role is incompletely understood. Female patients experience higher mortality from OHCA, prompting the need for sex-specific research.
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Affiliation(s)
- Angela F Jarman
- Department of Emergency Medicine, University of California-Davis, Sacramento, CA, USA.
| | - Bryn E Mumma
- Department of Emergency Medicine, University of California-Davis, Sacramento, CA, USA
| | - Sarah M Perman
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | | | - Alyson J McGregor
- Department of Emergency Medicine, Alpert Medical School, Brown University, Providence, RI, USA
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16
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La Garde RP, Cheung PY, Yaskina M, Lee TF, O'Reilly M, Schmölzer GM. Sex Differences Between Female and Male Newborn Piglets During Asphyxia, Resuscitation, and Recovery. Front Pediatr 2019; 7:290. [PMID: 31380324 PMCID: PMC6646717 DOI: 10.3389/fped.2019.00290] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 06/27/2019] [Indexed: 11/25/2022] Open
Abstract
Background: Male and female newborns have differences in their fetal development, fetal-to-neonatal transition, and postnatal morbidity. However, the cardiovascular fetal-to-neonatal adaption is similar between sexes. No study has examined sex differences in newborns during hypoxia, asphyxia, cardio-pulmonary resuscitation, or post-resuscitation recovery. Methods: Secondary analysis (two previous publications and two studies currently under peer-review) of 110 term newborn mixed breed piglets (1-3 days of age, weighing 2.0 ± 0.2 kg), which were exposed to 30 min normocapnic hypoxia followed by asphyxia until asystole, which was achieved by disconnecting the ventilator and clamping the endotracheal tube. This was followed by cardio-pulmonary resuscitation. For the analysis piglets were divided into female and male groups. Cardiac function, carotid blood flow, and cerebral and renal oxygenation were continuously recorded throughout the experiment. Results: A total of 35/41 (85%) female and 54/69 (78%) male piglets resuscitated achieved ROSC (p = 0.881). The median (IQR) time to achieve return of spontaneous circulation in females and males was 111 (80-228) s and 106 (80-206) s (p = 0.875), respectively. The 4-h survival rate was similar between females and males with 28/35 (80%) and 49/54 (91%) piglets surviving (p = 0.241), respectively. Conclusions: No difference between female and male newborn piglets was observed during hypoxia, asphyxia, resuscitation, and post-resuscitation recovery.
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Affiliation(s)
- Ramin P La Garde
- Medical University of Vienna, Vienna, Austria.,Neonatal Research Unit, Centre for the Studies of Asphyxia and Resuscitation, Royal Alexandra Hospital, Edmonton, AB, Canada
| | - Po-Yin Cheung
- Neonatal Research Unit, Centre for the Studies of Asphyxia and Resuscitation, Royal Alexandra Hospital, Edmonton, AB, Canada.,Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Maryna Yaskina
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Tze-Fun Lee
- Neonatal Research Unit, Centre for the Studies of Asphyxia and Resuscitation, Royal Alexandra Hospital, Edmonton, AB, Canada
| | - Megan O'Reilly
- Neonatal Research Unit, Centre for the Studies of Asphyxia and Resuscitation, Royal Alexandra Hospital, Edmonton, AB, Canada
| | - Georg M Schmölzer
- Neonatal Research Unit, Centre for the Studies of Asphyxia and Resuscitation, Royal Alexandra Hospital, Edmonton, AB, Canada.,Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
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17
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Wiel E, Di Pompéo C, Segal N, Luc G, Marc JB, Vanderstraeten C, El Khoury C, Escutnaire J, Tazarourte K, Gueugniaud PY, Hubert H. Age discrimination in out-of-hospital cardiac arrest care: a case-control study. Eur J Cardiovasc Nurs 2017; 17:505-512. [PMID: 29206063 DOI: 10.1177/1474515117746329] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Although some studies have questioned whether cardiopulmonary resuscitation (CPR) in older people could be futile, age is not considered an essential out-of-hospital cardiac arrest (OHCA) prognostic factor. However, in the daily clinical practice of mobile medical teams (MMTs), age seems to be an important factor affecting OHCA care. AIMS The purpose of this study was to compare OHCA care and outcomes between young patients (<65 years old) and older patients. METHODS We performed a case-control study based on data extracted from the French National Cardiac Arrest (CA) registry. All adult patients with CA recorded between July 2011 and May 2014 were included. Each older patient was matched on three criteria: sex, initial cardiac rhythm and no-flow duration. RESULTS We studied 4347 pairs. We found significantly less basic life support initiation, shorter advanced cardiac life support duration, less MMT automated chest compression, less MMT ventilation and less MMT epinephrine injection in the older patients. Significant differences were also observed for return of spontaneous circulation (odds ratio (OR)=0.84, 95% confidence interval (CI) 0.77-0.92, p<0.001), transport to hospital (OR=0.58, 95% CI 0.51-0.61, p<0.001), vital status at hospital admission (OR=0.55, 95% CI 0.50-0.60, p<0.001) and vital status 30 days after CA (OR=0.42, 95% CI 0.35-0.50, p<0.001). CONCLUSION All OHCA guidelines, ethical statements and clinical procedures do not propose age as a discrimination criterion in OHCA care. However, in our case-control study, we notice a shorter duration and less intensive care among older patients. This finding may partly explain the lower survival rate compared with younger people.
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Affiliation(s)
- Eric Wiel
- 1 Public Health Department, University of Lille, France.,2 SAMU 59 and Emergency Department, Lille University Hospital, France
| | | | - Nicolas Segal
- 3 Assistance Publique des Hôpitaux de Paris, Lariboisière Hospital, France
| | - Gérald Luc
- 1 Public Health Department, University of Lille, France
| | | | | | - Carlos El Khoury
- 5 RESCUE (Réseau Cardiologie Médecine d'Urgence) Network, Hussel Hospital, France
| | | | - Karim Tazarourte
- 6 SAMU 69 and Emergency Department, Lyon University Hospital, France
| | | | - Hervé Hubert
- 1 Public Health Department, University of Lille, France
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- 7 Research Group on the French National out-of-hospital cardiac arrest registry, RéAC, France
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18
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Sauter TC, Iten N, Schwab PR, Hautz WE, Ricklin ME, Exadaktylos AK. Out-of-hospital cardiac arrests in Switzerland: Predictors for emergency department mortality in patients with ROSC or on-going CPR on admission to the emergency department. PLoS One 2017; 12:e0188180. [PMID: 29145510 PMCID: PMC5690603 DOI: 10.1371/journal.pone.0188180] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 11/02/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND One of the leading causes of death is out-of-hospital cardiac arrest (OHCA) with an in-hospital mortality of about 70%. To identify predictors for the high mortality of OHCA patients and especially for women, that are considered at high risk for in-hospital mortality, we evaluated one specific setting of in-hospital treatment after OHCA: the emergency department (ED). METHODS Retrospective analysis of consecutive ED admissions with OHCA at the Inselspital Bern, Switzerland from 1st June 2012 to 31th Mai 2015. Demographic, preclinical and ED medical data were compared for patient groups with return of circulation (ROSC) and on-going resuscitation (CPR) on admission, as well as for subgroups with and without ED mortality. Predictors for ED mortality were investigated using univariate analysis with logistic regression. RESULTS In 354 patients (228 (64.4%) with ROSC; 126 (35.6%) with on-going CPR) we found an overall ED mortality of 28.5% (5.7% ROSC group; 69.8% on-going CPR group). Female gender (OR 7.053 (CI 95% 2.085; 24.853), p = 0.002) and greater age (OR 1.052 (95% CI 1.006-1.101), p = 0.029) were associated with ED mortality in the ROSC but not in the on-going CPR group. Ventricular fibrillation as initially monitored rhythm (OR 0.126 (95% CI 0.027-0.582), p = 0.008) and shorter CPR duration (OR 1.055 (95% CI 1.024;1.088), p = 0.001) were associated with ED survival in patients with ROSC but not in patients with on-going CPR on admission. In ROSC patients a higher lactate and lower pH were associated with mortality (pH: OR 0.009 (CI95% 0.000;0.420), p = 0.016; lactate: OR 1.183 (95% CI 1.037; 1.349), p = 0.013); similar in on-going CPR patients (pH 0.061 (95% CI 0.007, 0.558), p = 0.013, lactate: 1.146 (95% CI 1.041;1.261), p = 0.005). CONCLUSION Patients with ROSC who died during ED care were predominantly women and older patients, as well as patients with non-shockable initial heart rhythm and long CPR durations. In patients with on-going CPR on admission, no clinical or demographic predictors for ED mortality were found. Higher lactate and lower pH were predictors in both OHCA groups.
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Affiliation(s)
- Thomas C. Sauter
- Department of Emergency Medicine, Inselspital, University Hospital Bern, Bern, Switzerland
- * E-mail:
| | - Nora Iten
- Department of Emergency Medicine, Inselspital, University Hospital Bern, Bern, Switzerland
| | - Patrik R. Schwab
- Department of Emergency Medicine, Inselspital, University Hospital Bern, Bern, Switzerland
- Sanitaetspolizei Bern, Emergency Medical Service, Bern, Switzerland
| | - Wolf E. Hautz
- Department of Emergency Medicine, Inselspital, University Hospital Bern, Bern, Switzerland
| | - Meret E. Ricklin
- Department of Emergency Medicine, Inselspital, University Hospital Bern, Bern, Switzerland
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19
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Silva RMFLD, Silva BAGDLE, Silva FJME, Amaral CFS. Cardiopulmonary resuscitation of adults with in-hospital cardiac arrest using the Utstein style. Rev Bras Ter Intensiva 2017; 28:427-435. [PMID: 28099640 PMCID: PMC5225918 DOI: 10.5935/0103-507x.20160076] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Accepted: 10/17/2016] [Indexed: 12/02/2022] Open
Abstract
Objective The objective of this study was to analyze the clinical profile of patients
with in-hospital cardiac arrest using the Utstein style. Methods This study is an observational, prospective, longitudinal study of patients
with cardiac arrest treated in intensive care units over a period of 1
year. Results The study included 89 patients who underwent cardiopulmonary resuscitation
maneuvers. The cohort was 51.6% male with a mean age 59.0 years. The
episodes occurred during the daytime in 64.6% of cases.
Asystole/bradyarrhythmia was the most frequent initial rhythm (42.7%). Most
patients who exhibited a spontaneous return of circulation experienced
recurrent cardiac arrest, especially within the first 24 hours (61.4%). The
mean time elapsed between hospital admission and the occurrence of cardiac
arrest was 10.3 days, the mean time between cardiac arrest and
cardiopulmonary resuscitation was 0.68 min, the mean time between cardiac
arrest and defibrillation was 7.1 min, and the mean duration of
cardiopulmonary resuscitation was 16.3 min. Associations between gender and
the duration of cardiopulmonary resuscitation (19.2 min in women versus 13.5
min in men, p = 0.02), the duration of cardiopulmonary resuscitation and the
return of spontaneous circulation (10.8 min versus 30.7 min, p < 0.001)
and heart disease and age (60.6 years versus 53.6, p < 0.001) were
identified. The immediate survival rates after cardiac arrest, until
hospital discharge and 6 months after discharge were 71%, 9% and 6%,
respectively. Conclusions The main initial rhythm detected was asystole/bradyarrhythmia; the interval
between cardiac arrest and cardiopulmonary resuscitation was short, but
defibrillation was delayed. Women received cardiopulmonary resuscitation for
longer periods than men. The in-hospital survival rate was low.
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20
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Karam N, Marijon E, Bougouin W, Spaulding C, Jouven X. [Sudden cardiac death: Are women different?]. Ann Cardiol Angeiol (Paris) 2016; 65:390-394. [PMID: 27823677 DOI: 10.1016/j.ancard.2016.10.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Sudden cardiac death is a major public health problem with around 40,000 cases per year in France. Epidemiological, clinical and prognostic differences according to gender have been described in most cardiovascular diseases, including sudden cardiac death. In this article, we will review gender differences in sudden cardiac death incidence, circumstance of occurrence, management, and prognosis.
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Affiliation(s)
- N Karam
- Centre d'expertise mort subite (CEMS), hôpital européen Georges-Pompidou, 20-40, rue Leblanc, 75908 Paris cedex 15, France; Inserm Unit 970, centre de recherche cardiovasculaire (PARCC), 56, rue Leblanc, 75015 Paris, France; Département de cardiologie, hôpital européen Georges-Pompidou, AP-HP, 20-40, rue Leblanc, 75908 Paris cedex 15, France.
| | - E Marijon
- Centre d'expertise mort subite (CEMS), hôpital européen Georges-Pompidou, 20-40, rue Leblanc, 75908 Paris cedex 15, France; Inserm Unit 970, centre de recherche cardiovasculaire (PARCC), 56, rue Leblanc, 75015 Paris, France; Département de cardiologie, hôpital européen Georges-Pompidou, AP-HP, 20-40, rue Leblanc, 75908 Paris cedex 15, France; Université Paris Descartes, Paris, France
| | - W Bougouin
- Centre d'expertise mort subite (CEMS), hôpital européen Georges-Pompidou, 20-40, rue Leblanc, 75908 Paris cedex 15, France; Inserm Unit 970, centre de recherche cardiovasculaire (PARCC), 56, rue Leblanc, 75015 Paris, France; Département de cardiologie, hôpital européen Georges-Pompidou, AP-HP, 20-40, rue Leblanc, 75908 Paris cedex 15, France
| | - C Spaulding
- Centre d'expertise mort subite (CEMS), hôpital européen Georges-Pompidou, 20-40, rue Leblanc, 75908 Paris cedex 15, France; Inserm Unit 970, centre de recherche cardiovasculaire (PARCC), 56, rue Leblanc, 75015 Paris, France; Département de cardiologie, hôpital européen Georges-Pompidou, AP-HP, 20-40, rue Leblanc, 75908 Paris cedex 15, France; Université Paris Descartes, Paris, France
| | - X Jouven
- Centre d'expertise mort subite (CEMS), hôpital européen Georges-Pompidou, 20-40, rue Leblanc, 75908 Paris cedex 15, France; Inserm Unit 970, centre de recherche cardiovasculaire (PARCC), 56, rue Leblanc, 75015 Paris, France; Département de cardiologie, hôpital européen Georges-Pompidou, AP-HP, 20-40, rue Leblanc, 75908 Paris cedex 15, France; Université Paris Descartes, Paris, France
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Ng YY, Wah W, Liu N, Zhou SA, Ho AFW, Pek PP, Shin SD, Tanaka H, Khunkhlai N, Lin CH, Wong KD, Cai WW, Ong MEH. Associations between gender and cardiac arrest outcomes in Pan-Asian out-of-hospital cardiac arrest patients. Resuscitation 2016; 102:116-21. [DOI: 10.1016/j.resuscitation.2016.03.002] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Revised: 02/06/2016] [Accepted: 03/04/2016] [Indexed: 10/22/2022]
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Gender and survival after sudden cardiac arrest: A systematic review and meta-analysis. Resuscitation 2015; 94:55-60. [DOI: 10.1016/j.resuscitation.2015.06.018] [Citation(s) in RCA: 79] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Revised: 05/27/2015] [Accepted: 06/12/2015] [Indexed: 11/22/2022]
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Affiliation(s)
- Kees H Polderman
- From the CRISMA (Clinical Research, Investigation, and Systems Modeling of Acute Illness) Center, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA (K.H.P.); University of Pittsburgh Medical Center, Pittsburgh, PA (K.H.P.); University of Texas Health Science Center at Houston (J.V.); University of Texas Medical Branch at Galveston (J.V.); and University General Hospital, Houston, TX (J.V.).
| | - Joseph Varon
- From the CRISMA (Clinical Research, Investigation, and Systems Modeling of Acute Illness) Center, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA (K.H.P.); University of Pittsburgh Medical Center, Pittsburgh, PA (K.H.P.); University of Texas Health Science Center at Houston (J.V.); University of Texas Medical Branch at Galveston (J.V.); and University General Hospital, Houston, TX (J.V.)
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Karlsson V, Dankiewicz J, Nielsen N, Kern KB, Mooney MR, Riker RR, Rubertsson S, Seder DB, Stammet P, Sunde K, Søreide E, Unger BT, Friberg H. Association of gender to outcome after out-of-hospital cardiac arrest--a report from the International Cardiac Arrest Registry. Crit Care 2015; 19:182. [PMID: 25895673 PMCID: PMC4426639 DOI: 10.1186/s13054-015-0904-y] [Citation(s) in RCA: 82] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Accepted: 03/30/2015] [Indexed: 11/17/2022] Open
Abstract
Introduction Previous studies have suggested an effect of gender on outcome after out-of-hospital cardiac arrest (OHCA), but the results are conflicting. We aimed to investigate the association of gender to outcome, coronary angiography (CAG) and adverse events in OHCA survivors treated with mild induced hypothermia (MIH). Methods We performed a retrospective analysis of prospectively collected data from the International Cardiac Arrest Registry. Adult patients with a non-traumatic OHCA and treated with MIH were included. Good neurological outcome was defined as a cerebral performance category (CPC) of 1 or 2. Results A total of 1,667 patients, 472 women (28%) and 1,195 men (72%), met the inclusion criteria. Men were more likely to receive bystander cardiopulmonary resuscitation, have an initial shockable rhythm and to have a presumed cardiac cause of arrest. At hospital discharge, men had a higher survival rate (52% vs. 38%, P <0.001) and more often a good neurological outcome (43% vs. 32%, P <0.001) in the univariate analysis. When adjusting for baseline characteristics, male gender was associated with improved survival (OR 1.34, 95% CI 1.01 to 1.78) but no longer with neurological outcome (OR 1.24, 95% CI 0.92 to 1.67). Adverse events were common; women more often had hypokalemia, hypomagnesemia and bleeding requiring transfusion, while men had more pneumonia. In a subgroup analysis of patients with a presumed cardiac cause of arrest (n = 1,361), men more often had CAG performed on admission (58% vs. 50%, P = 0.02) but this discrepancy disappeared in an adjusted analysis. Conclusions Gender differences exist regarding cause of arrest, adverse events and outcome. Male gender was independently associated with survival but not with neurological outcome.
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Affiliation(s)
- Viktor Karlsson
- Department of Clinical Sciences, Lund University, 22184, Lund, Sweden.
| | - Josef Dankiewicz
- Department of Clinical Sciences, Lund University, 22184, Lund, Sweden. .,Department of Anaesthesiology and Intensive Care, Skåne University Hospital, Lund, 22185, Sweden.
| | - Niklas Nielsen
- Department of Clinical Sciences, Lund University, 22184, Lund, Sweden. .,Department of Anaesthesiology and Intensive Care, Helsingborg Hospital, 25187, Helsingborg, Sweden.
| | - Karl B Kern
- Sarver Heart Center, University of Arizona, 1501 N Campbell Ave, Tucson, AZ, 85724, USA.
| | - Michael R Mooney
- Minneapolis Heart Institute Foundation, Abbot Northwestern Hospital, 920 E 28th Street 100, Minneapolis, MN, 55407, USA.
| | - Richard R Riker
- Department of Critical Care Services and Neuroscience Institute, Maine Medical Center, 22 Bramhall Street, Portland, ME, 04102, USA.
| | - Sten Rubertsson
- Department of Surgical Sciences/Anaesthesiology and Intensive Care, Uppsala University, Akademiska sjukhuset, 75185, Uppsala, Sweden.
| | - David B Seder
- Department of Critical Care Services and Neuroscience Institute, Maine Medical Center, 22 Bramhall Street, Portland, ME, 04102, USA.
| | - Pascal Stammet
- Department of Anesthesia and Intensive Care, Centre Hospitalier de Luxembourg, 4, rue Barblé, L-1210, Luxembourg, Luxembourg.
| | - Kjetil Sunde
- Department of Anaesthesiology, Surgical ICU Ullevål, Oslo University Hospital, Oslo, Norway.
| | - Eldar Søreide
- Department of Anaesthesiology and Intensive Care, Stavanger University Hospital, 4068, Stavanger, Norway. .,Department of Clinical Medicine, University of Bergen, Jonas Lies veg 87, 5021, Bergen, Norway.
| | - Barbara T Unger
- Minneapolis Heart Institute Foundation, Abbot Northwestern Hospital, 920 E 28th Street 100, Minneapolis, MN, 55407, USA.
| | - Hans Friberg
- Department of Clinical Sciences, Lund University, 22184, Lund, Sweden. .,Department of Anaesthesiology and Intensive Care, Skåne University Hospital, Lund, 22185, Sweden.
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