Association between sex and survival after non-traumatic out of hospital cardiac arrest: A systematic review and meta-analysis



      Existing studies have shown conflicting results regarding the relationship of sex with survival after out of hospital cardiac arrest (OHCA). This systematic review evaluates the association of female sex with survival to discharge and survival to 30 days after non-traumatic OHCA.


      We searched Medline, Embase, CINAHL, Web of Science, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews from inception through June 2021 for studies evaluating female sex as a predictor of survival in adult patients with non-traumatic cardiac arrest. Random-effects inverse variance meta-analyses were performed to calculate pooled odds ratios (ORs) with 95% confidence intervals (CI). The GRADE approach was used to assess evidence quality.


      Thirty studies including 1,068,788 patients had female proportion of 41%. There was no association for female sex with survival to discharge (OR 1.03, 95% CI 0.95–1.12; I2 = 89%). Subgroup analysis of low risk of bias studies demonstrated increased survival to discharge for female sex (OR 1.20, 95% CI 1.18–1.23; I2 = 0%) and with high certainty, the absolute increase in survival was 2.2% (95% CI 0.1–3.6%). Female sex was not associated with survival to 30 days post-OHCA (OR 1.02, 95% CI 0.92–1.14; I2 = 79%).


      In adult patients experiencing OHCA, with high certainty in the evidence from studies with low risk of bias, female sex had a small absolute difference for the outcome survival to discharge and no difference in survival at 30 days. Future models that aim to stratify risk of survival post-OHCA should focus on sex-specific factors as opposed to sex as an isolated prognostic factor.


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      Linked Article

      • Female sex and prognosis following out-of-hospital cardiac arrest: Does lack of statistical significance equal clinically insignificant?
        ResuscitationVol. 179
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          Sex as a predictor of survival for non-traumatic out-of-hospital cardiac arrest (OHCA) has been an area of interest with conflicting results. Previous studies examining sex-based differences in outcomes showed that women who suffer OHCA have lower likelihood of survival to hospital discharge then their male counterparts.1–3 Contrary to this evidence, women have a higher likelihood of return of spontaneous circulation compared to men.4 Poor outcomes are likely driven by sex disparities in post-resuscitation care; women who suffer OHCA are less likely to receive bystander cardiopulmonary resuscitation (CPR), less frequently experience witnessed cardiac arrest in a public location and have non-shockable initial rhythms.
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