Abstract
Background
Women experience worse neurological outcomes following out-of-hospital cardiac arrest
(OHCA). It is unknown whether sex disparities exist in the use of targeted temperature
management (TTM), a standard of care treatment to improve neurological outcomes.
Methods
We performed a retrospective study of prospectively collected patients who survived
to hospital admission following OHCA from the Cardiac Arrest Registry to Enhance Survival
from 2013 through 2019. We compared receipt of TTM by sex in a mixed-effects model
adjusted for patient, arrest, neighborhood, and hospital factors, with the admitting
hospital modeled as a random intercept.
Results
Among 123,419 patients, women had lower rates of shockable rhythms (24.4 % vs. 39.2%,
P < .001) and lower rates of presumed cardiac aetiologies for arrest (74.3% vs. 81.1%,
P < .001). Despite receiving a similar rate of TTM in the field (12.1% vs. 12.6%,
P = .02), women received less TTM than men upon admission to the hospital (41.6% vs.
46.4%, P < .001). In an adjusted mixed-effects model, women were less likely than
men to receive TTM (Odds Ratio 0.91, 95% Confidence Interval 0.89 to 0.94). Among
the 27,729 patients with data indicating the reason for not using TTM, a higher percentage
of women did not receive TTM due to Do-Not-Resuscitate orders/family requests (15.1%
vs. 11.4%, p < .001) and non-shockable rhythms (11.1% vs. 8.4%, p < .001).
Conclusions
We found that women received less TTM than men, likely due to early care limitations
and a preponderance of non-shockable rhythms.
Keywords
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Article info
Publication history
Published online: October 28, 2021
Accepted:
October 1,
2021
Received in revised form:
September 28,
2021
Received:
July 29,
2021
Identification
Copyright
© 2021 Elsevier B.V. All rights reserved.
