Elsevier

Resuscitation

Volume 194, January 2024, 110060
Resuscitation

Clinical paper
Gender-related differences in adults concerning frequency, survival and treatment quality after out-of-hospital cardiac arrest (OHCA): An observational cohort study from the German resuscitation registry

https://doi.org/10.1016/j.resuscitation.2023.110060Get rights and content

Abstract

Background

In Germany approximately 20,500 women and 41,000 men were resuscitated after out-of-hospital cardiac arrest (OHCA) each year. We are currently experiencing a discussion about the possible undersupply of women in healthcare. The aim of the present study was to examine the prevalence of OHCA in Germany, as well as the outcome and quality of resuscitation care for both women and men.

Methods

We present a cohort study from the German Resuscitation Registry (2006–2022). The quality of care was assessed for both EMS and hospital care based on risk-adjusted survival rates with the endpoints: “hospital admission with return of spontaneous circulation” (ROSCadmission) for all patients and ”discharge with favourable neurological recovery“ (CPC1/2discharge) for all admitted patients. Risk adjustment was performed using logistic regression analysis (LRA). If sex was significantly associated with survival, a matched-pairs-analysis (MPA) followed to explore the frequency of guideline adherence.

Results

58,798 patients aged ≥ 18 years with OHCA and resuscitation were included (men = 65.2%, women = 34.8%). In the prehospital phase the male gender was associated with lower ROSCadmission-rate (LRA: OR = 0.79, CI = 0.759–0.822). A total of 27,910 patients were admitted. During hospital care, men demonstrated a better prognosis (OR = 1.10; CI = 1.015–1.191). MPA revealed a more intensive therapy for men both during EMS and hospital care. Looking at the complete chain of survival, LRA revealed no difference for men and women concerning CPC1/2discharge (n = 58,798; OR = 0.95; CI = 0.888–1.024).

Conclusion

In Germany, 80% more men than women experience OHCA. The prognosis for CPC1/2discharge remains low (men = 10.5%, women = 7.1%), but comparable after risk adjustment. There is evidence of undersupply of care for women during hospital treatment, which could be associated with a worse prognosis. Further investigations are required to clarify these findings.

Section snippets

Background

Cardiovascular diseases are among the leading causes of death in Germany and worldwide. Sudden cardiac arrest in the prehospital environment of Germany (OHCA, Out-of-Hospital Cardiac Arrest) holds a significant position, with an incidence of over 130 patients/100,000 inhabitants per year. Only approximately half of OHCA patients are reached by emergency medical services in time for resuscitation to commence.1, 2 Sudden cardiac death is most often attributed to coronary heart disease or

Method

An observational cohort study – based on the STROBE statement20 – from the German Resuscitation Registry was conducted including data from 2006 to 2022.21, 22, 23, 24, 25, 26, 27, 28 A positive approval was obtained from the ethics committee of Kiel University (ref. D592/21), after the internal scientific advisory board had approved the study protocol (ref. AZ 2021_11, unpublished). The datasets originated from 54 emergency medical services systems, which represent a population of 11 million

Results

According to the inclusion and exclusion criteria, a total of 58,798 patients were included in the study, with a CPR incidence of 74.5 / 100,000 inhabitants / year and a male patient proportion of 65.4% and a female proportion of 34.6%.

Analysing the association of various variables on “hospital admission with ROSC” or “good neurological recovery,” the regression analysis showed that increasing age, longer response times, more severe preexisting conditions, collapse in nursing homes, trauma as

Survival up to “hospital admission with ROSC” as a quality indicator for EMS care

Since the abovementioned factors influence both survival and treatment, multivariate binary logistic regression analysis with all 58,798 patients was conducted to compare adjusted survival rates. First, we looked at “hospital admission with ROSC”, and male sex was associated with reduced survival probability (Fig. 1; n = 58,798; OR 0.79; CI 0.759–0.822; p < 0.001).

To analyse whether this difference may be associated with the quality of EMS care, we performed a matched-pairs analysis with 15,880

Survival after “hospital admission” up to “discharge with good neurological recovery (CPC1/2) a quality indicator for hospital care after CPR.26

After EMS CPR a total of 27,910 patients were admitted to a hospital (18,743 men and 9,167 women). Regression analysis revealed a slightly better prognosis for men concerning CPC ½ at discharge (Fig. 2; OR 1.1; CI 1.015 1.191; p = 0.021).

Regarding hospital treatment in the raw data and in the matched-pairs analysis, men received more coronary angiography (CORO) and targeted temperature management (TTM) than women (Table 2: CORO: 35.3 vs. 30.9%; OR 1.22; CI 1.11–1.33) (TTM: 30.5 vs. 28.2%; OR

Discussion

The study reports on 58,798 adult patients (men = 65.2%, women = 34.8%) with an CPR-incidence of 74.5/100,000 inhabitants/year from the German Resuscitation Registry who were resuscitated by emergency physicians and rescue services. These services cover a population of 11 million inhabitants, making this study the most comprehensive one from Germany to date. In the prehospital phase the male gender was – risk adjusted – associated with a lower hospital admission rate with ROSC. A total of

Conclusion

In Germany, many more men than women with OHCA are resuscitated by EMS services. Since OHCA has different characteristics for women and men (OHCA of women less frequently in public, less frequent lay resuscitation, less frequent ventricular fibrillation, older age, more frequent respiratory cause), gender-specific measures for prevention and appropriate therapy seem necessary.

Binary logistic regression analysis revealed that men showed a higher mortality in the prehospital phase after CPR than

Author contributions

AP, PR, JW, JTG, SS, RL and MF were involved in study design, data collection, analysis, interpretation, and manuscript writing. BB, JB and SR were involved in data collection, analysis, interpretation, and manuscript writing. All authors read and approved the final manuscript.

CRediT authorship contribution statement

Bastian Böckler: Writing – original draft, Methodology, Formal analysis, Data curation. Achim Preisner: Writing – original draft, Methodology, Investigation, Formal analysis, Data curation, Conceptualization. Janina Bathe: Writing – original draft, Formal analysis, Data curation. Stefan Rauch: Writing – original draft, Formal analysis, Data curation. Patrick Ristau: Writing – review & editing, Project administration, Formal analysis, Data curation. Jan Wnent: Writing – review & editing, Project

Declaration of competing interest

The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: MF, JTG, JW, SS are members of the steering committee of the GRR. MF and JTG are co-founder of the GRR. MF is 1st chairman of agswn. JTG is spokesman for the DGAI Emergency Medicine Working Group. JTG is member of the Editorial Board of Resuscitation. All other authors have no conflict of interest.

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