Sex-Specific Differences in Survival After Out-of-Hospital Cardiac Arrest

A Nationwide, Population-Based Observational Study

Yoshikazu Goto; Akira Funada; Tetsuo Maeda; Hirofumi Okada; Yumiko Goto

Disclosures

Crit Care. 2019;23(263) 

In This Article

Results

From 2013 to 2016, in Japan, the details of attempted resuscitation for 498,050 patients with OHCA were documented in the FDMA database. Figure 1 indicates the inclusion and exclusion criteria of the present study. Patients with nonmedical causes of OHCA (e.g., trauma, accidental hypothermia, hanging, drowning, drug overdose or poisoning, or asphyxia) and EMS-witnessed arrest, those without resuscitation attempted by EMS personnel, those aged < 18 years, and those with unknown outcomes or age, were excluded. A group of 386,535 patients (77.6% of those in the registry) met the inclusion criteria and were hence included in this study. Patient matching was achieved for 72.2% (279,080 of 386,535) of the patients [64.3% (139,540 of 217,173) for men; 82.4% (139,540 of 169,362) for women]. Propensity matching considerably improved the absolute standardized differences in each age group (Additional file 1: Table S1–S8).

Figure 1.

Study inclusion flowchart. EMS emergency medical services

Table 1 presents the baseline characteristics of the women and men included in this study. Compared with the women, the included men were younger, less likely to experience OHCA in rural areas, and more likely to have a presumed cardiac origin and initial shockable rhythm; they were also more likely to be witnessed by a family member and receive advanced airway maintenance and epinephrine. In contrast, more women than men received bystander CPR following the instructions given by an EMS dispatcher. The overall crude 1-month survival outcomes were significantly better in men than in women. Multivariate logistic regression analysis in unmatched patients (Table 2) revealed that compared with women, men were independently associated with increased odds of achieving 1-month favorable outcomes (survival, adjusted OR = 1.07; 95% CI 1.03–1.11; CPC 1–2, adjusted OR = 1.22; 95% CI 1.16–1.29).

The crude 1-month survival outcomes in unmatched patients in each age group are presented in Additional file 2: Figure S1. Survival decreased with increasing age in both women and men (all P for trend < 0.001). The crude 1-month survival rate was significantly higher in men than in women in five groups: 30–39, 40–49, 50–59, 60–69, and 70–79 years. Multivariate logistic regression analysis revealed no significant sex-specific differences in the odds of 1-month survival (Figure 2). The crude 1-month CPC 1–2 in the unmatched patients in each age group is shown in Additional file 3: Figure S2. The crude 1-month CPC 1–2 gradually reduced with increasing age in both women and men (all P for trend < 0.001). The crude 1-month CPC 1–2 were significantly higher in men than in women in seven groups: < 30, 30–39, 40–49, 50–59, 60–69, 70–79, and 80–89 years. No significant differences in the 1-month CPC 1–2 were found between women and men after adjusting for confounders (Figure 3). Figures 4 and 5 present the 1-month survival outcomes of matched patients in each age group. There were no significant sex-specific differences in the adjusted odds of survival and CPC 1–2 in any group.

Figure 2.

Adjusted OR of women compared with men for 1-month survival in unmatched patients by age. CI confidence interval, OR odds ratio

Figure 3.

Adjusted OR of women compared with men for 1-month CPC 1–2 in unmatched patients by age. CI confidence interval, CPC Cerebral Performance Category scale, OR odds ratio

Figure 4.

One-month survival rate in matched patients by age. a Survival rate. b Adjusted OR of women compared with men for 1-month survival. CI confidence interval, OR odds ratio

Figure 5.

One-month CPC 1–2 rate in matched patients by age. a CPC 1–2 rate. b Adjusted OR of women compared with men for 1-month CPC 1–2. CI confidence interval, CPC Cerebral Performance Category scale, OR odds ratio

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