Dadon Ziv, Fridel Tal, Einav Sharon
Jesselson Integrated Heart Center, Jerusalem, Israel.
Faculty of Medicine Hebrew University, Jerusalem, Israel.
Resusc Plus. 2022 Jul 27;11:100280. doi: 10.1016/j.resplu.2022.100280. eCollection 2022 Sep.
The relationship between sex and cardiopulmonary resuscitation (CPR) outcomes remains unclear. Particularly, questions remain regarding the potential contribution of unmeasured confounders. We aimed to examine the differences in the quality of chest compression delivered to men and women.
Prospective study of observational data recorded during consecutive resuscitations occurring in a single tertiary center (Feb-1-2015 to Dec-31-2018) with real-time follow-up to hospital discharge. The studied variables included time in CPR, no-flow-time and fraction, compression rate and depth and release velocity. The primary study endpoint was the unadjusted association between patient sex and the chest compression quality (depth and rate). The secondary endpoint was the association between the various components of chest compression quality, sex, and survival to hospital discharge/neurologically intact survival.
Overall 260 in-hospital resuscitations (57.7% male patients) were included. Among these 100 (38.5%) achieved return of spontaneous circulation (ROSC) and 35 (13.5%) survived to hospital discharge. Female patients were significantly older. Ischemic heart disease and ventricular arrhythmias were more prevalent among males. Compression depth was greater in female vs male patients (54.9 ± 11.3 vs 51.7 ± 10.9 mm; = 0.024). Other CPR quality-metrics were similar. The rates of ROSC, survival to hospital discharge and neurologically intact survival did not differ between males and females. Univariate analysis revealed no association between sex, quality metrics and outcomes.
Women received deeper chest compressions during in-hospital CPR. Our findings require corroboration in larger cohorts but nonetheless underscore the need to maintain high-quality CPR in all patients using real-time feedback devices. Future studies should also include data on ventilation rates and volumes which may contribute to survival outcomes.
性别与心肺复苏（CPR）结果之间的关系仍不明确。特别是，关于未测量混杂因素的潜在影响仍存在疑问。我们旨在研究对男性和女性进行胸外按压的质量差异。
对在单个三级中心（2015年2月1日至2018年12月31日）进行的连续复苏过程中记录的观察数据进行前瞻性研究，并实时随访至出院。研究变量包括心肺复苏时间、无血流时间及比例、按压速率、深度和释放速度。主要研究终点是患者性别与胸外按压质量（深度和速率）之间的未调整关联。次要终点是胸外按压质量的各个组成部分、性别与出院存活/神经功能完好存活之间的关联。
共纳入260例院内复苏患者（男性患者占57.7%）。其中100例（38.5%）实现自主循环恢复（ROSC），35例（13.5%）存活至出院。女性患者年龄显著更大。缺血性心脏病和室性心律失常在男性中更为普遍。女性患者的按压深度大于男性（54.9±11.3 vs 51.7±10.9毫米；P = 0.024）。其他心肺复苏质量指标相似。男性和女性之间的ROSC率、出院存活率和神经功能完好存活率没有差异。单因素分析显示性别、质量指标与结果之间无关联。
在院内心肺复苏期间，女性接受的胸外按压更深。我们的研究结果需要在更大的队列中得到证实，但尽管如此，强调了使用实时反馈设备对所有患者维持高质量心肺复苏的必要性。未来的研究还应纳入可能有助于存活结果的通气速率和容量数据。
