Abstract
Background
Prior studies have identified socio-cultural barriers in laypersons performing high-quality
cardiopulmonary resuscitation (CPR) in women. Whether the effect of layperson bystander
CPR on survival from out-of-hospital cardiac arrest (OHCA) differs by patients’ sex
is unknown.
Methods
Using data during 2013–2020 from an OHCA registry in the U.S., we identified adult
patients with non-traumatic OHCA. The primary outcome was favorable neurological survival
and the secondary outcome was survival to discharge. Multivariable logistic regression
models evaluated the interaction between patients’ sex and bystander CPR with survival,
adjusted for patient and cardiac arrest characteristics.
Results
Of 420,671 patients with OHCA, 151,145 (35.9 %) occurred in women and 269,526 (64.1 %)
in men. Rates of layperson bystander CPR were similar between women (38.3 %) and men
(40.0 %). Rates of favorable neurological survival were 11.4 % in those with bystander
CPR and 5.6 % in those without, but the association between bystander CPR and favorable
neurological survival was weaker for women than men (women: adjusted OR, 1.33 [95 %
CI: 1.27–1.39]; men: adjusted OR, 1.55 [95 % CI: 1.51–1.61]; interaction p < 0.001)].
Rates of survival to discharge were 13.1 % and 7.3 % in those with and without layperson
bystander CPR, and the association between bystander CPR was weaker for women than
men (women: adjusted OR, 1.21 [95 % CI: 1.16–1.26]; men: adjusted OR, 1.43 [95 % CI:
1.39–1.47]; interaction p < 0.001).
Conclusions
For OHCA, bystander CPR was associated with higher survival in women and men. However,
as currently practiced, the association between bystander CPR and higher survival
was weaker for women as compared with men.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to ResuscitationAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Improving survival from sudden cardiac arrest: the “chain of survival” concept. A statement for health professionals from the Advanced Cardiac Life Support Subcommittee and the Emergency Cardiac Care Committee, American Heart Association.Circulation. 1991; 83: 1832-1847
- The effect of bystander cardiopulmonary resuscitation on the survival of out-of-hospital cardiac arrests: a systematic review and meta-analysis.Scand J Trauma Resusc Emerg Med. 2018; 26: 86
- Predictors of survival from out-of-hospital cardiac arrest: a systematic review and meta-analysis.Circ Cardiovasc Qual Outcomes. 2010; 3: 63-81
- Resuscitation Outcomes Consortium I. Gender Disparities Among Adult Recipients of Bystander Cardiopulmonary Resuscitation in the Public.Circ Cardiovasc Qual Outcomes. 2018; 11: e004710
- Bystander CPR occurrences in out of hospital cardiac arrest between sexes.Resuscitation. 2021; 166: 1-6
- Temporal trends in out-of-hospital cardiac arrest outcomes in men and women from 2008 to 2015: A national observational study.Am J Emerg Med. 2021; 41: 174-178
- Women have lower chances than men to be resuscitated and survive out-of-hospital cardiac arrest.Eur Heart J. 2019; 40: 3824-3834
- Age x Gender Interaction Effect on Resuscitation Outcomes in Patients With Out-of-Hospital Cardiac Arrest.Am J Cardiol. 2017; 120: 387-392
- Public Perceptions on Why Women Receive Less Bystander Cardiopulmonary Resuscitation Than Men in Out-of-Hospital Cardiac Arrest.Circulation. 2019; 139: 1060-1068
- CARES: Cardiac Arrest Registry to Enhance Survival.Ann Emerg Med. 2009; 54: e672
- Out-of-hospital cardiac arrest surveillance –- Cardiac Arrest Registry to Enhance Survival (CARES), United States, October 1, 2005–December 31, 2010.MMWR Surveill Summ. 2011; 60: 1-19
- Recommended guidelines for reviewing, reporting, and conducting research on in-hospital resuscitation: the in-hospital 'Utstein style' American Heart Association.Circulation. 1997; 95: 2213-2239
- Cardiac arrest and cardiopulmonary resuscitation outcome reports: update and simplification of the Utstein templates for resuscitation registries: a statement for healthcare professionals from a task force of the International Liaison Committee on Resuscitation (American Heart Association, European Resuscitation Council, Australian Resuscitation Council, New Zealand Resuscitation Council, Heart and Stroke Foundation of Canada, InterAmerican Heart Foundation, Resuscitation Councils of Southern Africa).Circulation. 2004; 110: 3385-3397
- Assessment of neurological prognosis in comatose survivors of cardiac arrest.BRCT I Study Group. Lancet. 1994; 343: 1055-1059
- Using the Standardized Difference to Compare the Prevalence of a Binary Variable Between Two Groups in Observational Research.Commun Stat – Simul Comput. 2009; 38: 1228-1234
- Sex differences in outcomes for out-of-hospital cardiac arrest in the United States.Resuscitation. 2021; 163: 6-13
- Does the sex of a simulated patient affect CPR?.Resuscitation. 2015; 86: 82-87
Article Info
Publication History
Published online: September 23, 2022
Accepted:
September 20,
2022
Received in revised form:
September 17,
2022
Received:
June 21,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2022 Elsevier B.V. All rights reserved.
