Kwak Junyoung, Ok Ahn Ki, Chan Paul S
Department of Emergency Medicine, Myongji Hospital and Hanyang University College of Medicine, Goyang-si, South Korea.
Saint Luke's Mid America Heart Institute and the University of Missouri-Kansas City, MO, USA.
Resusc Plus. 2022 Dec 23;13:100342. doi: 10.1016/j.resplu.2022.100342. eCollection 2023 Mar.
A recent study suggested that women with out-of-hospital cardiac arrest have a smaller survival benefit with bystander cardiopulmonary resuscitation than men. We evaluated whether this weaker association between bystander cardiopulmonary resuscitation and survival in women is related to dispatcher-assisted vs unassisted bystander cardiopulmonary resuscitation.
In a national registry in the Republic of Korea, we identified adult patients with out-of-hospital cardiac arrest during 2013-2018. The main exposure was type of bystander cardiopulmonary resuscitation (categorized as none, dispatcher-assisted, and unassisted). The primary outcome was favourable neurological survival. Multivariable logistic regression evaluated for an interaction between sex and type of bystander cardiopulmonary resuscitation.
Of 93,245 patients with out-of-hospital cardiac arrest, there were 31,578 (33.9%) women and 61,667 (66.1%) men. Overall, both types of bystander cardiopulmonary resuscitation were associated with favourable neurological survival (unassisted: adjusted OR, 1.81 [95% CI: 1.66-1.98]; dispatcher-assisted: adjusted OR, 1.44 [95% CI: 1.33-1.56]). When unassisted cardiopulmonary resuscitation was administered, the association between bystander cardiopulmonary resuscitation and favourable neurological survival was similar between women and men: adjusted ORs of 1.59 (95% CI: 1.30-1.95) in women and 1.88 (95% CI: 1.71-2.08) in men; interaction p = 0.65). In contrast, when dispatcher-assisted cardiopulmonary resuscitation was administered, the association differed by sex: adjusted ORs of 1.08 (95% CI: 0.90-1.92) in women and 1.55 (95% CI: 1.42-1.69) in men; interaction p < 0.0002).
Dispatcher-assisted cardiopulmonary resuscitation was associated with favourable neurological survival in men but not in women whereas unassisted bystander cardiopulmonary resuscitation was associated with favourable neurological survival in women and men.
最近一项研究表明，院外心脏骤停女性接受旁观者心肺复苏后的生存获益低于男性。我们评估了女性旁观者心肺复苏与生存之间较弱的关联是否与调度员协助的旁观者心肺复苏和非协助的旁观者心肺复苏有关。
在韩国的一个全国性登记处，我们确定了2013年至2018年期间的院外心脏骤停成年患者。主要暴露因素是旁观者心肺复苏的类型（分为无、调度员协助和非协助）。主要结局是良好的神经功能存活。多变量逻辑回归评估了性别与旁观者心肺复苏类型之间的相互作用。
在93245例院外心脏骤停患者中，有31578例（33.9%）女性和61667例（66.1%）男性。总体而言，两种类型的旁观者心肺复苏均与良好的神经功能存活相关（非协助：调整后的比值比，1.81[95%置信区间：1.66 - 1.98]；调度员协助：调整后的比值比，1.44[95%置信区间：1.33 - 1.56]）。当进行非协助心肺复苏时，女性和男性旁观者心肺复苏与良好神经功能存活之间的关联相似：女性调整后的比值比为1.59（95%置信区间：1.30 - 1.95），男性为1.88（95%置信区间：1.71 - 2.08）；相互作用p = 0.65）。相比之下，当进行调度员协助的心肺复苏时，关联因性别而异：女性调整后的比值比为1.08（95%置信区间：0.90 - 1.92），男性为1.55（95%置信区间：1.42 - 1.69）；相互作用p < 0.0002）。
调度员协助的心肺复苏与男性良好的神经功能存活相关，但与女性无关，而非协助的旁观者心肺复苏与女性和男性的良好神经功能存活均相关。
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