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Premenopausal-aged females have no neurological outcome advantage after out-of-hospital cardiac arrest: A multilevel analysis of North American populations

  • Emad M. Awad
    Correspondence
    Corresponding author at: The University of British Columbia, Experimental Medicine, Faculty of Medicine, 2775 Laurel Street, 10th Floor, Room 10117, Vancouver, BC V5Z 1M9, Canada.
    Affiliations
    Faculty of Medicine, Experimental Medicine, University of British Columbia, Vancouver, British Columbia, Canada

    Centre for Health Evaluation and Outcome Sciences, Vancouver, British Columbia, Canada
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  • Karin H. Humphries
    Affiliations
    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
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  • Brian E. Grunau
    Affiliations
    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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  • Jim M. Christenson
    Affiliations
    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
    Search for articles by this author

      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.

      Keywords

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