Gender differences and survival after an out-of-hospital cardiac arrest: a systematic review and meta-analysis
- 1 April 2021
- journal article
- review article
- Published by Springer Science and Business Media LLC in Internal and Emergency Medicine
- Vol. 16 (3), 765-775
- https://doi.org/10.1007/s11739-020-02552-4
Abstract
Patients who experience out-of-hospital cardiac arrest (OHCA) have unacceptably high mortality rates. It remains unclear whether gender has an association with survival in this regard. Hence, we aimed to investigate the association between gender and survival by conducting a systematic review and meta-analysis. The databases of PubMed, Embase, and Cochrane Database of Systematic Reviews were searched from inception to 17 March, 2020. Studies assessing the association between gender and survival to discharge or 30-day survival after OHCA were included. Two reviewers independently assessed the eligibility of the identified studies. The random-effects model was used to pool data, and the outcome was reported as odds ratios (ORs) and 95% confidence intervals, as the relative measure of association. Twenty-three eligible studies enrolling 897,805 patients were included in this systematic review. Overall, women were older and less likely to experience arrest in public places. When arrest occurred, women had less initial shockable rhythm, were less likely to be witnessed by bystanders, and were less likely provided with CPR compared with men. After admission, women underwent less coronary angiography, percutaneous coronary angiography, and targeted temperature management therapy. Eleven studies with ORs were pooled, showing a significant survival benefit in women (OR = 1.08, p < 0.05, I-2 = 52.3%). In the subgroup analysis, both premenopausal women (< 50 years) (OR = 1.42, p < 0.001, I-2 = 0%) and postmenopausal women (>= 50 years) (OR = 1.07, p < 0.05, I-2 = 16.4%) had higher odds of survival compared with age-matched men. Despite the unfavorable factors, the pooled results showed a significant survival benefit in women after OHCA, especially in premenopausal women.Funding Information
- National Key Research and Development Project (No. 2016YFC1301100)
This publication has 52 references indexed in Scilit:
- Exploring gender differences and the “oestrogen effect” in an Australian out-of-hospital cardiac arrest populationResuscitation, 2013
- A trend in epidemiology and outcomes of out-of-hospital cardiac arrest by urbanization level: A nationwide observational study from 2006 to 2010 in South KoreaResuscitation, 2013
- Females of childbearing age have a survival benefit after out-of-hospital cardiac arrestResuscitation, 2013
- Survival advantage from ventricular fibrillation and pulseless electrical activity in women compared to men: the Oregon Sudden Unexpected Death StudyJournal of Interventional Cardiac Electrophysiology, 2012
- Global incidences of out-of-hospital cardiac arrest and survival rates: Systematic review of 67 prospective studiesResuscitation, 2010
- Estrogen Is Renoprotective via a Nonreceptor-dependent Mechanism after Cardiac Arrest In VivoAnesthesiology, 2010
- Estradiol after Cardiac Arrest and Cardiopulmonary Resuscitation is Neuroprotective and Mediated through Estrogen Receptor-βJournal of Cerebral Blood Flow & Metabolism, 2008
- Regional Variation in Out-of-Hospital Cardiac Arrest Incidence and OutcomeJAMA, 2008
- Pathways to ischemic neuronal cell death: are sex differences relevant?Journal of Translational Medicine, 2008
- Sex differences in the mechanism of Met5-enkephalin-induced cardioprotection: role of PI3K/AktAmerican Journal of Physiology-Heart and Circulatory Physiology, 2008