Sex Disparities in Receipt of Bystander Interventions for Students Who Experienced Cardiac Arrest in Japan

Satoshi Matsui,Tomotaka Sobue,Yuri Kitamura,Masahiko Nitta,Taku Iwami,Junya Sado,Ken Nakata,Tetsuhisa Kitamura,Kosuke Kiyohara,Mamoru Ayusawa

doi:10.1001/jamanetworkopen.2019.5111

Abstract

Bystander interventions are a factor for improving survival of out-of-hospital cardiac arrest (OHCA), but it is hypothesized that girls and women experiencing OHCA may be less likely to receive bystander interventions than boys and men. To investigate sex disparities in receiving public-access automated external defibrillator (AED) pad application and bystander-initiated cardiopulmonary resuscitation (CPR) among students who experienced OHCA in school settings. This nationwide cohort study used the Stop and Prevent Cardiac Arrest, Injury, and Trauma in Schools (SPIRITS) database to link databases from 2 nationally representative registries-the Injury and Accident Mutual Aid Benefit System of the Japan Sport Council and the All-Japan Utstein Registry of the Fire and Disaster Management Agency. Students from elementary schools (ages 6-12 years), junior high schools (ages 12-15 years), high schools (ages 15-21 years), and technical colleges (ages 15-21 years) who experienced nontraumatic OHCA involving attempted resuscitation by emergency medical service personnel or bystanders in school settings from April 1, 2008, to December 31, 2015, were included. Data analysis was performed from January 5, 2019, to April 11, 2019. Sex and school level. Application of public-access AED pads or initiation of CPR by a bystander. A total of 232 students who experienced OHCA with nontraumatic causes in school settings (mean [SD] age, 14.5 [2.9] years; 175 [75.4%] male) were included. In multivariable analysis of the full cohort of students who experienced OHCA, female sex was associated with significantly lower odds of receiving public-access AED pad application compared with male sex (36 of 57 female students [63.2%] received AED pad application vs 141 of 175 male students [80.6%]; adjusted odds ratio [OR], 0.44; 95% CI, 0.20-0.97; P = .04). In the subgroup analysis of students who experienced OHCA in high schools or technical schools, female sex was associated with significantly lower odds of receiving public-access AED pad application compared with male sex (10 of 18 female students [55.6%] vs 84 of 101 male students [83.2%]; adjusted OR, 0.26; 95% CI, 0.08-0.87; P = .03). Among the full cohort, 48 of 57 female students (84.2%) and 151 of 175 male students (86.3%) received CPR from bystanders (adjusted OR, 0.81; 95% CI, 0.30-2.22), and there were no significant differences in receiving bystander-initiated CPR between sexes, irrespective of school level. Among students who experienced OHCA in schools in Japan, female sex was associated with lower odds of receiving public-access AED pad application compared with male sex.

Highlights

Out-of-hospital cardiac arrest (OHCA) is an important public health issue in resource-rich countries,[1,2,3,4] and the survival rate of OHCA remains low.[5,6,7] Pediatric patients who experience OHCA accounted for only 3% of all patients who experience OHCA in Japan.[8,9,10] OHCA and sudden OHCA-associated death among children have significant negative impacts on a community in terms of life-years lost, health care costs for survivors, and emotional burden for family members.[11]
In multivariable analysis of the full cohort of students who experienced OHCA, female sex was associated with significantly lower odds of receiving public-access automated external defibrillator (AED) pad application compared with male sex (36 of 57 female students [63.2%] received AED pad application vs 141 of 175 male students [80.6%]; adjusted odds ratio [odds ratios (ORs)], 0.44; 95% CI, 0.20-0.97; P = .04)
In the subgroup analysis of students who experienced OHCA in high schools or technical schools, female sex was associated with significantly lower odds of receiving public-access AED pad application compared with male sex (10 of 18 female students [55.6%] vs 84 of 101 male students [83.2%]; adjusted OR, 0.26; 95% CI, 0.08-0.87; P = .03)

Summary

Introduction

Out-of-hospital cardiac arrest (OHCA) is an important public health issue in resource-rich countries,[1,2,3,4] and the survival rate of OHCA remains low.[5,6,7] Pediatric patients who experience OHCA accounted for only 3% of all patients who experience OHCA in Japan.[8,9,10] OHCA and sudden OHCA-associated death among children have significant negative impacts on a community in terms of life-years lost, health care costs for survivors, and emotional burden for family members.[11]. As recommended in the cardiopulmonary resuscitation (CPR) guidelines,[1,2,3] bystanders performing CPR and using a public-access automated external defibrillator (AED) are important factors for improving survival outcomes in OHCAs. Previous studies have reported that women experiencing OHCA in public locations were less likely to receive bystander-initiated CPR compared with men,[12,13,14] and girls aged 12 to 17 years who experienced OHCA witnessed by nonfamily members were less likely to receive bystander-initiated CPR than boys.[15] El-Assaad et al[16] reported that children aged 2 to years experiencing OHCAs were less likely to receive AED pad application than children aged to 18 years. Schoolchildren spend most of their active hours of the day in schools, but to our knowledge, no clinical studies have been conducted to assess sex disparities in receiving public-access AED pad application and bystander-initiated CPR in school settings

Results

Discussion

Conclusion