Association of Bystander and First‐Responder Efforts and Outcomes According to Sex: Results From the North Carolina HeartRescue Statewide Quality Improvement Initiative
Background The Institute of Medicine has called for actions to understand and target sex‐related differences in care and outcomes for out‐of‐hospital cardiac arrest patients. We assessed changes in bystander and first‐responder interventions and outcomes for males versus females after statewide effo...
| Main Authors: | , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Wiley
2018-09-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.118.009873 |
| _version_ | 1819178681007865856 |
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| author | Carolina Malta Hansen Kristian Kragholm Matthew E. Dupre David A. Pearson Clark Tyson Lisa Monk Thomas D. Rea Monique A. Starks Darrell Nelson James G. Jollis Bryan McNally Claire M. Corbett Christopher B. Granger |
| author_facet | Carolina Malta Hansen Kristian Kragholm Matthew E. Dupre David A. Pearson Clark Tyson Lisa Monk Thomas D. Rea Monique A. Starks Darrell Nelson James G. Jollis Bryan McNally Claire M. Corbett Christopher B. Granger |
| author_sort | Carolina Malta Hansen |
| collection | DOAJ |
| description | Background The Institute of Medicine has called for actions to understand and target sex‐related differences in care and outcomes for out‐of‐hospital cardiac arrest patients. We assessed changes in bystander and first‐responder interventions and outcomes for males versus females after statewide efforts to improve cardiac arrest care. Methods and Results We identified out‐of‐hospital cardiac arrests from North Carolina (2010–2014) through the CARES (Cardiac Arrest Registry to Enhance Survival) registry. Outcomes for men versus women were examined through multivariable logistic regression analyses adjusted for (1) nonmodifiable factors (age, witnessed status, and initial heart rhythm) and (2) nonmodifiable plus modifiable factors (bystander cardiopulmonary resuscitation and defibrillation before emergency medical services), including interactions between sex and time (ie, year and year2). Of 8100 patients, 38.1% were women. From 2010 to 2014, there was an increase in bystander cardiopulmonary resuscitation (men, 40.5%–50.6%; women, 35.3%–51.8%; P for each <0.0001) and in the combination of bystander cardiopulmonary resuscitation and first‐responder defibrillation (men, 15.8%–23.0%, P=0.007; women, 8.5%–23.7%, P=0.004). From 2010 to 2014, the unadjusted predicted probability of favorable neurologic outcome was higher and increased more for men (men, from 6.5% [95% confidence interval (CI), 5.1–8.0] to 9.7% [95% CI, 8.1–11.3]; women, from 6.3% [95% CI, 4.4–8.3] to 7.4% [95% CI, 5.5–9.3%]); while adjusted for nonmodifiable factors, it was slightly higher but with a nonsignificant increase for women (from 9.2% [95% CI, 6.8–11.8] to 10.2% [95% CI, 8.0–12.5]; men, from 5.8% [95% CI, 4.6–7.0] to 8.4% [95% CI, 7.1–9.7]). Adding bystander cardiopulmonary resuscitation and defibrillation before EMS (modifiable factors) did not substantially change the results. Conclusions Bystander and first‐responder interventions increased for men and women, but outcomes improved significantly only for men. Additional strategies may be necessary to improve survival among female cardiac arrest patients. |
| first_indexed | 2024-12-22T21:46:25Z |
| format | Article |
| id | doaj.art-e844aaed060b4003923a528b9ac5d24b |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-12-22T21:46:25Z |
| publishDate | 2018-09-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-e844aaed060b4003923a528b9ac5d24b2022-12-21T18:11:29ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802018-09-0171810.1161/JAHA.118.009873Association of Bystander and First‐Responder Efforts and Outcomes According to Sex: Results From the North Carolina HeartRescue Statewide Quality Improvement InitiativeCarolina Malta Hansen0Kristian Kragholm1Matthew E. Dupre2David A. Pearson3Clark Tyson4Lisa Monk5Thomas D. Rea6Monique A. Starks7Darrell Nelson8James G. Jollis9Bryan McNally10Claire M. Corbett11Christopher B. Granger12Duke Clinical Research Institute Duke University Durham NCDuke Clinical Research Institute Duke University Durham NCDuke Clinical Research Institute Duke University Durham NCCarolinas Medical Center Charlotte NCDuke Clinical Research Institute Duke University Durham NCDuke Clinical Research Institute Duke University Durham NCDepartment of Medicine University of Washington Seattle WADuke Clinical Research Institute Duke University Durham NCWFU Health Sciences Winston‐Salem NCDuke Clinical Research Institute Duke University Durham NCEmory University School of Medicine Atlanta GANew Hanover Regional Medical Center Wilmington NCDuke Clinical Research Institute Duke University Durham NCBackground The Institute of Medicine has called for actions to understand and target sex‐related differences in care and outcomes for out‐of‐hospital cardiac arrest patients. We assessed changes in bystander and first‐responder interventions and outcomes for males versus females after statewide efforts to improve cardiac arrest care. Methods and Results We identified out‐of‐hospital cardiac arrests from North Carolina (2010–2014) through the CARES (Cardiac Arrest Registry to Enhance Survival) registry. Outcomes for men versus women were examined through multivariable logistic regression analyses adjusted for (1) nonmodifiable factors (age, witnessed status, and initial heart rhythm) and (2) nonmodifiable plus modifiable factors (bystander cardiopulmonary resuscitation and defibrillation before emergency medical services), including interactions between sex and time (ie, year and year2). Of 8100 patients, 38.1% were women. From 2010 to 2014, there was an increase in bystander cardiopulmonary resuscitation (men, 40.5%–50.6%; women, 35.3%–51.8%; P for each <0.0001) and in the combination of bystander cardiopulmonary resuscitation and first‐responder defibrillation (men, 15.8%–23.0%, P=0.007; women, 8.5%–23.7%, P=0.004). From 2010 to 2014, the unadjusted predicted probability of favorable neurologic outcome was higher and increased more for men (men, from 6.5% [95% confidence interval (CI), 5.1–8.0] to 9.7% [95% CI, 8.1–11.3]; women, from 6.3% [95% CI, 4.4–8.3] to 7.4% [95% CI, 5.5–9.3%]); while adjusted for nonmodifiable factors, it was slightly higher but with a nonsignificant increase for women (from 9.2% [95% CI, 6.8–11.8] to 10.2% [95% CI, 8.0–12.5]; men, from 5.8% [95% CI, 4.6–7.0] to 8.4% [95% CI, 7.1–9.7]). Adding bystander cardiopulmonary resuscitation and defibrillation before EMS (modifiable factors) did not substantially change the results. Conclusions Bystander and first‐responder interventions increased for men and women, but outcomes improved significantly only for men. Additional strategies may be necessary to improve survival among female cardiac arrest patients.https://www.ahajournals.org/doi/10.1161/JAHA.118.009873bystander cardiopulmonary resuscitationcardiac arrestcardiopulmonary resuscitationfirst responderwomen |
| spellingShingle | Carolina Malta Hansen Kristian Kragholm Matthew E. Dupre David A. Pearson Clark Tyson Lisa Monk Thomas D. Rea Monique A. Starks Darrell Nelson James G. Jollis Bryan McNally Claire M. Corbett Christopher B. Granger Association of Bystander and First‐Responder Efforts and Outcomes According to Sex: Results From the North Carolina HeartRescue Statewide Quality Improvement Initiative Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease bystander cardiopulmonary resuscitation cardiac arrest cardiopulmonary resuscitation first responder women |
| title | Association of Bystander and First‐Responder Efforts and Outcomes According to Sex: Results From the North Carolina HeartRescue Statewide Quality Improvement Initiative |
| title_full | Association of Bystander and First‐Responder Efforts and Outcomes According to Sex: Results From the North Carolina HeartRescue Statewide Quality Improvement Initiative |
| title_fullStr | Association of Bystander and First‐Responder Efforts and Outcomes According to Sex: Results From the North Carolina HeartRescue Statewide Quality Improvement Initiative |
| title_full_unstemmed | Association of Bystander and First‐Responder Efforts and Outcomes According to Sex: Results From the North Carolina HeartRescue Statewide Quality Improvement Initiative |
| title_short | Association of Bystander and First‐Responder Efforts and Outcomes According to Sex: Results From the North Carolina HeartRescue Statewide Quality Improvement Initiative |
| title_sort | association of bystander and first responder efforts and outcomes according to sex results from the north carolina heartrescue statewide quality improvement initiative |
| topic | bystander cardiopulmonary resuscitation cardiac arrest cardiopulmonary resuscitation first responder women |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.118.009873 |
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