Wulfran Bougouin1, Hazrije Mustafic2, Eloi Marijon3, Mohammad Hassan Murad4, Florence Dumas5, Anna Barbouttis6, Patricia Jabre7, Frankie Beganton8, Jean-Philippe Empana2, David S Celermajer9, Alain Cariou10, Xavier Jouven3. 1. Paris Descartes University, France; Paris Cardiovascular Research Center - INSERM U970 (PARCC), France; Intensive Care Unit, Cochin Hospital, Paris, France; Paris Sudden Death Expertise Center, Paris, France. Electronic address: wulfran.bougouin@gmail.com. 2. Paris Descartes University, France; Paris Cardiovascular Research Center - INSERM U970 (PARCC), France; Paris Sudden Death Expertise Center, Paris, France. 3. Paris Descartes University, France; Paris Cardiovascular Research Center - INSERM U970 (PARCC), France; Paris Sudden Death Expertise Center, Paris, France; Cardiology Department, European Georges Pompidou Hospital, Paris, France. 4. Division of Preventive Medicine, Mayo Clinic, Rochester, MN 55905, USA. 5. Paris Descartes University, France; Paris Cardiovascular Research Center - INSERM U970 (PARCC), France; Paris Sudden Death Expertise Center, Paris, France; Emergency Department, Cochin Hospital, Paris, France. 6. Paris Cardiovascular Research Center - INSERM U970 (PARCC), France. 7. Paris Descartes University, France; Paris Cardiovascular Research Center - INSERM U970 (PARCC), France; Paris Sudden Death Expertise Center, Paris, France; SAMU de Paris, Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France. 8. Paris Cardiovascular Research Center - INSERM U970 (PARCC), France; Paris Sudden Death Expertise Center, Paris, France. 9. Sydney Medical School, Australia. 10. Paris Descartes University, France; Paris Cardiovascular Research Center - INSERM U970 (PARCC), France; Intensive Care Unit, Cochin Hospital, Paris, France; Paris Sudden Death Expertise Center, Paris, France.
Abstract
BACKGROUND: Conflicting results exist regarding the impact of gender on early survival after sudden cardiac arrest (SCA). We aimed to assess the association between female gender and early SCA survival. METHODS: We searched Embase, MEDLINE, EBM Reviews, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews (between 1948 and January 2014) for studies evaluating the association between gender and survival after SCA. Two independent reviewers selected studies of any design or language. Pooled odds-ratios (OR) and 95% confidence intervals (CIs) were estimated using a random-effects model. Additional sensitivity analyses and meta-regression were carried out to explore heterogeneity. RESULTS: Thirteen studies were included involving 409,323 patients. Women were more likely to present with SCA at home, less likely to have witnessed SCA, had a lower frequency of initial shockable rhythm but were more likely to receive bystander CPR. After adjustment for these differences, women were more likely to survive at hospital discharge (OR 1.1, 95% CI 1.03-1.20, p=0.006, I(2)=61%). This association persisted in multiple sensitivity analyses. CONCLUSION: This meta-analysis of observational studies demonstrates that women have increased odds of survival after SCA. Further studies are needed to address mechanisms explaining this discrepancy.
BACKGROUND: Conflicting results exist regarding the impact of gender on early survival after sudden cardiac arrest (SCA). We aimed to assess the association between female gender and early SCA survival. METHODS: We searched Embase, MEDLINE, EBM Reviews, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews (between 1948 and January 2014) for studies evaluating the association between gender and survival after SCA. Two independent reviewers selected studies of any design or language. Pooled odds-ratios (OR) and 95% confidence intervals (CIs) were estimated using a random-effects model. Additional sensitivity analyses and meta-regression were carried out to explore heterogeneity. RESULTS: Thirteen studies were included involving 409,323 patients. Women were more likely to present with SCA at home, less likely to have witnessed SCA, had a lower frequency of initial shockable rhythm but were more likely to receive bystander CPR. After adjustment for these differences, women were more likely to survive at hospital discharge (OR 1.1, 95% CI 1.03-1.20, p=0.006, I(2)=61%). This association persisted in multiple sensitivity analyses. CONCLUSION: This meta-analysis of observational studies demonstrates that women have increased odds of survival after SCA. Further studies are needed to address mechanisms explaining this discrepancy.
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