Sex difference in the association between type of bystander CPR and clinical outcomes in patients with out of hospital cardiac arrest

Junyoung Kwak; Ki Ok Ahn; Paul S Chan

doi:10.1016/j.resplu.2022.100342

Sex difference in the association between type of bystander CPR and clinical outcomes in patients with out of hospital cardiac arrest

Resusc Plus. 2022 Dec 23:13:100342. doi: 10.1016/j.resplu.2022.100342. eCollection 2023 Mar.

Authors

Junyoung Kwak¹, Ki Ok Ahn¹, Paul S Chan²

Affiliations

¹ Department of Emergency Medicine, Myongji Hospital and Hanyang University College of Medicine, Goyang-si, South Korea.
² Saint Luke's Mid America Heart Institute and the University of Missouri-Kansas City, MO, USA.

Abstract

Background: A recent study suggested that women with out-of-hospital cardiac arrest have a smaller survival benefit with bystander cardiopulmonary resuscitation than men. We evaluated whether this weaker association between bystander cardiopulmonary resuscitation and survival in women is related to dispatcher-assisted vs unassisted bystander cardiopulmonary resuscitation.

Methods: In a national registry in the Republic of Korea, we identified adult patients with out-of-hospital cardiac arrest during 2013-2018. The main exposure was type of bystander cardiopulmonary resuscitation (categorized as none, dispatcher-assisted, and unassisted). The primary outcome was favourable neurological survival. Multivariable logistic regression evaluated for an interaction between sex and type of bystander cardiopulmonary resuscitation.

Results: Of 93,245 patients with out-of-hospital cardiac arrest, there were 31,578 (33.9%) women and 61,667 (66.1%) men. Overall, both types of bystander cardiopulmonary resuscitation were associated with favourable neurological survival (unassisted: adjusted OR, 1.81 [95% CI: 1.66-1.98]; dispatcher-assisted: adjusted OR, 1.44 [95% CI: 1.33-1.56]). When unassisted cardiopulmonary resuscitation was administered, the association between bystander cardiopulmonary resuscitation and favourable neurological survival was similar between women and men: adjusted ORs of 1.59 (95% CI: 1.30-1.95) in women and 1.88 (95% CI: 1.71-2.08) in men; interaction p = 0.65). In contrast, when dispatcher-assisted cardiopulmonary resuscitation was administered, the association differed by sex: adjusted ORs of 1.08 (95% CI: 0.90-1.92) in women and 1.55 (95% CI: 1.42-1.69) in men; interaction p < 0.0002).

Conclusions: Dispatcher-assisted cardiopulmonary resuscitation was associated with favourable neurological survival in men but not in women whereas unassisted bystander cardiopulmonary resuscitation was associated with favourable neurological survival in women and men.

Keywords: Bystander cardiopulmonary resuscitation; Out-of-hospital cardiac arrest; Patient’s sex.