Elsevier

Resuscitation

Volume 49, Issue 1, April 2001, Pages 15-23
Resuscitation

Is there a difference between women and men in characteristics and outcome after in hospital cardiac arrest?

https://doi.org/10.1016/S0300-9572(00)00342-7Get rights and content

Abstract

Aim: To describe the characteristics and outcome among patients suffering from an in-hospital cardiac arrest in women and men. Methods: All patients who suffered an in-hospital cardiac arrest during a 4 year period in Sahlgrenska Hospital Göteborg, Sweden, where the cardiopulmonary resuscitation (CPR) team was called, were recorded and described prospectively in terms of characteristics and outcome. Results: There were 557 patients suffering in-hospital cardiac arrest in whom the CPR-team was alerted. Among them, 217 (39%) were women. Women differed from men having a lower prevalence of earlier myocardial infarction, angina pectoris, renal disease and a higher prevalence of rheumatic disease. In terms of aetiology of the cardiac arrest, 47% men and 48% women were judged to have had a confirmed or possible AMI. More men than women were found in ventricular fibrillation/ventricular tachycardia (VF/VT) (57 vs. 41%; P<0.001), whereas more women were found in pulseless electrical activity (30 vs. 15%; P<0.0001). Cerebral performance categories (CPC)-score at discharge did not differ between men and women. Among women, 36.4% survived to discharge as compared with 38.0% among men (NS). Survival from VF/VT was 64.3% in women and 52.7% in men (NS). When correcting for dissimilarities at baseline, the adjusted odd ratio for being discharged alive from hospital among women as compared with men was 1.66 (95% confidence limit 1.06–2.62; P=0.028). Conclusion: Thirty nine percent of patients suffering in-hospital cardiac arrest for whom the CPR-team was alerted, were women. Women were less frequently found in VF/VT than men. After correcting for dissimilarities at baseline, female gender was associated with a small improvement in survival.

Zusammenfassung

Objectivo: descrever as caracterı́sticas e resultados das paragens cardı́acas intra-hospitalares em homens e mulheres. Método: registaram-se e descreveram-se prospectivamente todos os casos de paragem cardı́aca intra-hospitalar, para os quais fois chamada a equipa de reanimação, durante um perı́odo de 4 anos no Hospital Sahlgrenska em Gotemburgo. Resultados: a equipa de reanimação foi chamada para 557 doentes que tiveram paragem cárdio respiratória (PCR). Destes 217 (39%) eram mulheres. As mulheres distinguiram-se dos homens por terem uma menor prevalência de enfarte do miocárdio precoce, angina de peito, e doença renal e uma maior prevalência de doenças reumáticas. Em termos etiológicos 47% dos homens e 48% das mulheres foram classificados como tendo enfarte do miocárdio confirmado ou possı́vel. Foram encontrados em fibrilhação ventricular/taquicardia ventricular (FV/TV) sem pulso mais homens do que mulheres (57 vs 41%; P<0.001) ao passo que havia mais mulheres em actividade eléctrica sem pulso (30 vs 15%, P< 0.001). As classificação do desempenho cerebral (CDC) á data da alta não diferiu entre homens e mulheres. Á data da alta 36.4% das mulheres e 38% dos homens (não significativo) tinham sobrevivido. Á FV/TV sobreviveram 64.3% das mulheres e 52.7% dos homens. Feitas as correcções para o estadio base, a “odd ratio” ajustada para sobrevida á data da alta das mulheres em comparação com os homens era de 1.66 (limites de confiança de 95% 1.06–2.62, P=0.028). Conclusão: Dos doentes com paragem cárdio-respiratória para os quais foi activada a equipa de reanimação 39% eram mulheres. As mulheres tiveram menos FV/TV do que os homens. Feitas que foram as correcções para a situação basal, as mulheres tiveram uma sobrevida ligeiramente melhor.

Introduction

During recent years, there has been an increased interest in the characteristics and outcome among patients suffering from in-hospital cardiac arrest [1], [2], [3]. Our earlier work has shown a relatively high chance of survival after in-hospital cardiac arrest [4].

A large proportion of in-hospital cardiac arrests are caused by an ischaemic event. Many earlier studies have highlighted the differences between men and women in terms of characteristics and outcome, when suffering from an ischaemic event [5], [6], [7], [8], [9]. This study compares men and women in terms of characteristics and outcome, when suffering from an in-hospital cardiac arrest. The hypothesis was that they differed in terms of age, earlier history, initial arrhythmia and rate of survival.

Section snippets

Patients and methods

Between November 1, 1994 and December 31, 1998, all patients suffering from a suspected cardiac arrest where the cardiopulmonary resuscitation (CPR) team was called, were evaluated prospectively. Patients in whom the suspected arrest occurred either prior to hospital admission or in the emergency room were excluded. For each case, one case record form was filled in by the cardiologist in the CPR team and one by a nurse on the ward, where the arrest took place. Further clinical data were

Results

In all, there were 557 patients suffering in-hospital cardiac arrest for whom the CPR-team was alerted during the time of the survey. Among them, 217 (39%) were women compared with men, in terms of characteristics and outcome.

Discussion

A number of studies have reported sex differences in the frequency, management and natural history of coronary artery diseases. The overall incidence of sudden cardiac death is lower in women [13], as is the proportion of deaths associated with coronary artery disease which occur as sudden cardiac death [13]. Women who present with acute myocardial infarction, cardiac arrest or sudden cardiac death are also less likely to have pre-existing coronary artery disease.

Women suffering cardiac arrest

Conclusion

Among patients suffering in-hospital cardiac arrest, for whom the CPR-team was called, 39% were women. They differed from men by being less frequently found in VF/VT and more frequently found in PEA. When correcting for dissimilarities at baseline, female sex was associated with a higher chance of survival.

Acknowledgements

This study was supported by grants from The Swedish Heart and Lung Foundation and The Laerdal Foundation, Norway.

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