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Association of gender to outcome after out-of-hospital cardiac arrest – a report from the International Cardiac Arrest Registry

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Abstract

Introduction

Previous studies have suggested an effect of gender on outcome after out-of-hospital cardiac arrest (OHCA), but the results are conflicting. We aimed to investigate the association of gender to outcome, coronary angiography (CAG) and adverse events in OHCA survivors treated with mild induced hypothermia (MIH).

Methods

We performed a retrospective analysis of prospectively collected data from the International Cardiac Arrest Registry. Adult patients with a non-traumatic OHCA and treated with MIH were included. Good neurological outcome was defined as a cerebral performance category (CPC) of 1 or 2.

Results

A total of 1,667 patients, 472 women (28%) and 1,195 men (72%), met the inclusion criteria. Men were more likely to receive bystander cardiopulmonary resuscitation, have an initial shockable rhythm and to have a presumed cardiac cause of arrest. At hospital discharge, men had a higher survival rate (52% vs. 38%, P <0.001) and more often a good neurological outcome (43% vs. 32%, P <0.001) in the univariate analysis. When adjusting for baseline characteristics, male gender was associated with improved survival (OR 1.34, 95% CI 1.01 to 1.78) but no longer with neurological outcome (OR 1.24, 95% CI 0.92 to 1.67). Adverse events were common; women more often had hypokalemia, hypomagnesemia and bleeding requiring transfusion, while men had more pneumonia. In a subgroup analysis of patients with a presumed cardiac cause of arrest (n = 1,361), men more often had CAG performed on admission (58% vs. 50%, P = 0.02) but this discrepancy disappeared in an adjusted analysis.

Conclusions

Gender differences exist regarding cause of arrest, adverse events and outcome. Male gender was independently associated with survival but not with neurological outcome.

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Abbreviations

CAG:

coronary angiography

CI:

confidence interval

COPD:

chronic obstructive pulmonary disease

CPC:

cerebral performance category

CPR:

cardiopulmonary resuscitation

DNR order:

do-not-resuscitate order

ICU:

intensive care unit

INTCAR:

International Cardiac Arrest Registry

IQR:

interquartile range

MIH:

mild induced hypothermia

OHCA:

out-of-hospital cardiac arrest

OR:

odds ratio

PCI:

percutaneous coronary intervention

ROSC:

return of spontaneous circulation

STEMI:

ST-elevation myocardial infarction

VF:

ventricular fibrillation

VT:

ventricular tachycardia

WLST:

withdrawal of life-sustaining therapy

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Acknowledgements

Funding: Swedish Research Council, Region Skåne (Sweden), National Health Service (Sweden), Thure Carlsson Foundation, Hans-Gabriel and Alice Trolle-Wachtmeister Foundation for Medical Research. Grant support from the European Union Interreg IV A.

Author information

Authors and Affiliations

  1. Department of Clinical Sciences, Lund University, 22184, Lund, Sweden

    Viktor Karlsson, Josef Dankiewicz, Niklas Nielsen & Hans Friberg

  2. Department of Anaesthesiology and Intensive Care, Skåne University Hospital, Lund, 22185, Sweden

    Josef Dankiewicz & Hans Friberg

  3. Department of Anaesthesiology and Intensive Care, Helsingborg Hospital, 25187, Helsingborg, Sweden

    Niklas Nielsen

  4. Sarver Heart Center, University of Arizona, 1501 N Campbell Ave, Tucson, AZ, 85724, USA

    Karl B Kern

  5. Minneapolis Heart Institute Foundation, Abbot Northwestern Hospital, 920 E 28th Street 100, Minneapolis, MN, 55407, USA

    Michael R Mooney & Barbara T Unger

  6. Department of Critical Care Services and Neuroscience Institute, Maine Medical Center, 22 Bramhall Street, Portland, ME, 04102, USA

    Richard R Riker & David B Seder

  7. Department of Surgical Sciences/Anaesthesiology and Intensive Care, Uppsala University, Akademiska sjukhuset, 75185, Uppsala, Sweden

    Sten Rubertsson

  8. Department of Anesthesia and Intensive Care, Centre Hospitalier de Luxembourg, 4, rue Barblé, L-1210, Luxembourg, Luxembourg

    Pascal Stammet

  9. Department of Anaesthesiology, Surgical ICU Ullevål, Oslo University Hospital, Oslo, Norway

    Kjetil Sunde

  10. Department of Anaesthesiology and Intensive Care, Stavanger University Hospital, 4068, Stavanger, Norway

    Eldar Søreide

  11. Department of Clinical Medicine, University of Bergen, Jonas Lies veg 87, 5021, Bergen, Norway

    Eldar Søreide

Authors
  1. Viktor Karlsson
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  2. Josef Dankiewicz
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  3. Niklas Nielsen
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  4. Karl B Kern
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  6. Richard R Riker
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  7. Sten Rubertsson
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  8. David B Seder
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  9. Pascal Stammet
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  10. Kjetil Sunde
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  11. Eldar Søreide
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  12. Barbara T Unger
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  13. Hans Friberg
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Corresponding author

Correspondence to Hans Friberg.

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Competing interests

The authors declare that they have no competing interests.

Authors’ contributions

VK, JD and HF contributed to study design, data collection, data analysis and manuscript preparation. NN, KBK, DBS, RRR, MRM, BTU, PS, ES, KS and SR contributed to data collection and manuscript preparation. All authors read and approved the final manuscript.

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Karlsson, V., Dankiewicz, J., Nielsen, N. et al. Association of gender to outcome after out-of-hospital cardiac arrest – a report from the International Cardiac Arrest Registry. Crit Care 19, 182 (2015). https://doi.org/10.1186/s13054-015-0904-y

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