Abstract 45: Gender Disparity in Resuscitation Efforts and Outcomes in Out-of-Hospital Cardiac Arrest

Abstract

Objectives The aim of this study was to investigate the association between gender and cardiopulmonary resuscitation (CPR) efforts and outcomes in out-of-hospital cardiac arrests (OHCA). Methods We used a nationwide OHCA cohort database of emergency medical service (EMS) run sheets from 2008 and followed it with a retrospective medical record review. We extracted cases involving patients over the age of 20 years with presumed cardiac etiology. Potential predictors were collected using the Utstein style. The primary outcome was the use of resuscitation efforts, such as basic life support (BLS), by a bystander or an EMS provider, application of an automatic external defibrillator (AED) by an EMS provider, and advanced cardiac life support (ACLS) by emergency department (ED) physicians. Secondary outcomes related to the effect of the resuscitation on factors such as survival upon admission and discharge. Univariate and multivariate logistic regression models were applied by gender to calculating odds ratios (ORs) and 95% confidence intervals (95% CIs), with adjustment for potential predictors. Results The total number of eligible patients was 13,922. Of these, 5,158 patients (37.0%) were female. Females were significantly older (73.4 vs. 63.7) and had a lower probability of having a shockable rhythm (3.4% vs. 5.4%). Compared to males, females were less likely to receive BLS support (70.8% vs. 77.5%), AED (9.6% vs. 14.3%), and ACLS at the ED (42.2% vs. 49.2%). Survival to admission and to discharge for female patients, compared with male patients, were 11.8% vs. 12.3% ( p =0.43) and 3.1% vs. 1.8% ( p <0.001), respectively. Adjusted ORs (95% CIs) for BLS, AED, and ACLS use in female patients, compared with male patients were 0.91 (0.84-0.99), 0.77 (0.68-0.86), and 0.98 (0.91-1.06), respectively. Adjusted ORs for survival to admission and to discharge were 1.32 (1.17-1.48) and 0.82 (0.63-1.05), respectively. Conclusions Considering resuscitation efforts and hospital outcomes by gender, females were less likely to have received BLS or AED than were males. Gender influenced survival at admission to the hospital, but was not associated with survival at discharge.