Abstract

Introduction

Methods

Results

Discussion

Conclusions

Acknowledgements

Appendix A. Supplementary data

References

Abstract

Aim

     We investigated sex-related differences in the in-hospital management of patients with out-of-hospital cardiac arrest (OHCA).

Methods

     We retrospectively analyzed prospectively collected data from the Korean Cardiac Arrest Resuscitation Consortium (KoCARC) registry, a prospective, multicenter OHCA registry. We enrolled adult patients with OHCA between October 2015 and June 2020. The primary outcomes were coronary angiography (CAG), percutaneous coronary intervention (PCI), targeted temperature management (TTM), and extracorporeal membrane oxygenation (ECMO) performed in the hospital. Propensity score matching (PSM) was performed to minimize differences in baseline demographics and characteristics.

Results

     Among 12,321 patients in the KoCARC registry, we analyzed 8,177 with OHCA. PSM yielded 5,564 matched patients (2,782 women and men, respectively). In the unmatched cohort, women were less likely to undergo CAG, PCI, TTM, and ECMO. In the PSM cohort, women were less likely to undergo CAG and PCI (6.4% vs. 9.1%, p < 0.001 and 1.9% vs. 3.7%, p < 0.001). The duration of cardiopulmonary resuscitation was shorter in women (19 vs. 20 min, p < 0.001). TTM, ECMO use, and survival outcomes did not differ significantly between sexes. The subgroup analysis according to age showed that among patients aged < 65 years, women were less likely than men to undergo CAG and PCI (12.7% vs. 19.2%, p < 0.001 and 2.3% vs. 8.1%, p < 0.001).

Conclusions

     In the PSM cohort, women with OHCA underwent CAG and PCI less frequently than men, regardless of the initial rhythm. However, these sex-related differences narrowed with increasing age. Further studies are needed to confirm the sex-related disparities in the in-hospital management of patients with OHCA.

Introduction

     Annually, approximately 300,000 individuals in the United States and 275,000 in Europe experience out-of-hospital cardiac arrest (OHCA).1.,  ۲٫ Although the survival rate of patients with OHCA has increased, the mortality rate remains high.3.,  ۴٫,  ۵٫

     In the past decade, sex disparities in health care systems have been reported, particularly in OHCA characteristics and survival.6.,  ۷٫,  ۸٫,  ۹٫,  ۱۰٫,  ۱۱٫,  ۱۲٫,  ۱۳٫,  ۱۴٫,  ۱۵٫,  ۱۶٫ While men have a higher OHCA incidence than women,1.,  ۲٫,  ۳٫,  ۴٫,  ۵٫ women are less likely to experience witnessed cardiac arrest,6.,  ۷٫,  ۸٫,  ۹٫ as its occurrence in public places is more common in men.10.,  ۱۱٫ Women experiencing cardiac arrest are less likely to receive bystander cardiopulmonary resuscitation (CPR)5.,  ۱۲٫,  ۱۳٫,  ۱۴٫ and less frequently present with a shockable rhythm.15.,  ۱۶٫ Conflicting results regarding sex disparities in survival and prognosis after OHCA were noted.16.,  ۱۷٫,  ۱۸٫,  ۱۹٫,  ۲۰٫,  ۲۱٫,  ۲۲٫,  ۲۳٫,  ۲۴٫,  ۲۵٫,  ۲۶٫,  ۲۷٫,  ۲۸٫ However, the extent of sex disparities in OHCA remains unclear.

     Conflicting sex-related differences in the in-hospital management of OHCA patients have been reported.7.,  ۲۱٫,  ۲۲٫,  ۲۳٫,  ۲۴٫,  ۲۵٫,  ۲۹٫,  ۳۰٫,  ۳۱٫,  ۳۲٫,  ۳۳٫ While some studies reported that women with OHCA were less likely to undergo early coronary angiography (CAG),17.,  ۲۳٫,  ۲۴٫,  ۳۰٫,  ۳۱٫ Lindgren et al. did not observe this tendency.32. The findings on sex-related differences in performing percutaneous coronary intervention (PCI) are also conflicting.17.,  ۳۰٫,  ۲۲٫,  ۲۳٫,  ۲۴٫,  ۲۵٫ Targeted temperature management (TTM) was less frequently performed in women in older studies,17.,  ۲۳٫ whereas more recent studies showed no sex-related differences.22.,  ۲۴٫,  ۲۵٫,  ۳۰٫

Results

Demographics of all eligible patients

     A total of 12,321 patients with OHCA were registered in the KoCARC. Among these, 4,144 patients were excluded due to age < 18 years, unknown covariate data, and missing primary outcomes. Finally, the analysis included 8,177 patients (Fig. 1). The mean age of the total population was 68.1 ± ۱۵٫۶ years (median age, 71.0 [57.0–۸۰٫۰] years; 65.8% male, 34.2% female). Of the patients, 60.2% had witnessed arrest, 19.7% experienced cardiac arrest in public places, and 19.9% had a shockable rhythm. Bystander CPR was performed in 54.1% of the patients, defibrillation in 25.2%, and prehospital advanced airway management in 82.6%. CAG, PCI, TTM, and ECMO were performed in 13.3%, 4.9%, 10.2%, and 2.8% of the patients, respectively. Among the patients, 28.8% survived to admission, 13.4% survived to discharge, and 9.2% were discharged with good neurological outcomes (Table 1).