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Gender differences in short- and long-term outcome after out-of-hospital cardiac arrest. Analysis of the LINC trial.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, UCR-Uppsala Clinical Research Center.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
(English)Manuscript (preprint) (Other academic)
Abstract [en]

Background: We aimed to identify gender differences in survival after out-of-hospital cardiac arrest (OHCA).

Methods: 2,589 OHCA victims were analyzed, 33.3% women, from the LINC trial. After identifying gender differences in baseline characteristics, cardiac arrest (CA) events and survival rates, multivariable logistic regression was performed irrespective of treatment group.

Results: Unadjusted analysis demonstrated no difference between women and men in 4- hour survival, 22.1% vs. 24.4% (p=0.20). Women had lower survival rates at hospital discharge, 6.7% vs. 10.1% (p=0.003) and after 6 months, 5.9% vs. 9.5% (p=0.002). Women were older, 71.5 vs. 67.9 years of age (p<0.001), had lower rates of CA with suspected cardiac aetiology, 63.8% vs. 74.3% (p<0.001), and shockable first rhythm, 18.9% vs. 35.0% (p<0.001). More women had crew-witnessed CA, 9.3% vs. 6.0% (p=0.002). There was no difference regarding witnessed CA, 65.3% vs. 67.2% (p=0.33) and bystander CPR, 55.2% vs. 57.7% (p=0.24).

After adjusting for age, randomization group, witnessed CA, bystander CPR, first analysed rhythm and cardiac aetiology, female gender was an independent predictor for 4-hour survival, OR 1.34 (95% C.I. 1.06 – 1.69) but not for survival at hospital discharge, OR 1.19 (95% C.I. 0.83 – 1.72) or after 6 months, OR 1.12 (95% C.I. 0.76 – 1.63).

Fewer women were treated with coronary angiography, percutaneous coronary intervention and therapeutic hypothermia, 23.5% vs. 45.7% (p<0.001), 14.5% vs. 30.2% (p<0.001), 54.0% vs. 69.1% (p<0.001), respectively.

Conclusions: Female gender was an independent predictor for early survival. At hospital discharge and after 6 months these gender differences in survival were no longer found. 

Keyword [en]
Cardiac arrest, gender differences, out-of-hospital cardiac arrest, randomized controlled trial, mechanical chest compression, defibrillation, LUCAS CPR, external chest compressions, ventricular fibrillation, systole, pulseless electrical activity.
National Category
Medical and Health Sciences
Research subject
Anaesthesiology and Intensive Care
Identifiers
URN: urn:nbn:se:uu:diva-303993OAI: oai:DiVA.org:uu-303993DiVA: diva2:975069
Available from: 2016-09-28 Created: 2016-09-28 Last updated: 2016-09-28
In thesis
1. Mechanical chest compressions and gender differences in out-of-hospital-cardiac-arrest
Open this publication in new window or tab >>Mechanical chest compressions and gender differences in out-of-hospital-cardiac-arrest
2016 (English)Licentiate thesis, comprehensive summary (Other academic)
Abstract [en]

Paper I and II. Both early defibrillation and high quality chest compressions are affecting the chances of survival after cardiac arrest (CA). Manual chest compressions delivers only approximately 30% of normal cardiac output and is further deteriorating during transport. Mechanical chest compressions has in experimental studies delivered higher perfusion pressures, cerebral blood flow and end-tidal CO2 compared to manual CPR. Two pilot studies showed no difference in outcome compared to manual CPR. The LINC trial was the first large randomized trial testing the effectiveness and safety of mechanical chest compressions compared to manual CPR. The objectives were to determine whether CPR with mechanical chest compression and defibrillation during ongoing CPR, compared with CPR with manual chest compressions, according to guidelines, would improve 4-hour survival after out-of-hospital cardiac arrest (OHCA).
We could not identify any significant differences in outcome between the two groups.

Paper III. Despite women having several adverse characteristics associated with bad outcome after CA, female gender is considered being an independent predictor for early survival. This is however no longer seen after the initial phase, when male survival is significantly higher. The reason for this difference is not known. This has previously been shown in register based studies. This is, to our best knowledge, the first analysis based on a population from a randomized controlled trial. We aimed to identify gender differences in survival after OHCA.
Female gender was an independent predictor for early survival, but this difference was no longer seen at hospital discharge or after 6 months. 

Place, publisher, year, edition, pages
Uppsala: Uppsala universitet, 2016. 46 p.
National Category
Medical and Health Sciences
Research subject
Anaesthesiology and Intensive Care
Identifiers
urn:nbn:se:uu:diva-303994 (URN)
Presentation
2016-10-20, Akademiska sjukhuset, lärarrummet, ing 70, Akademiska sjukhuset, Uppsala, 14:20
Opponent
Supervisors
Available from: 2016-09-29 Created: 2016-09-28 Last updated: 2016-09-29Bibliographically approved

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