Westmead Applied Research Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.
School of Public Health and Preventive Medicine, Monash University, Victoria, Australia.
Resuscitation. 2024 Jun;199:110224. doi: 10.1016/j.resuscitation.2024.110224. Epub 2024 Apr 27.
To assess whether bystander cardiopulmonary resuscitation (CPR) differed by patient sex among bystander-witnessed out-of-hospital cardiac arrests (OHCA).
This study is a retrospective analysis of paramedic-attended OHCA in New South Wales (NSW) between January 2017 to December 2019 (restricted to bystander-witnessed cases). Exclusions included OHCA in aged care, medical facilities, with advance care directives, from non-medical causes. Multivariate logistic regression examined the association of patient sex with bystander CPR. Secondary outcomes were OHCA recognition, bystander AED application, initial shockable rhythm, and survival outcomes.
Of 4,491cases, females were less likely to receive bystander CPR in private residential (Adjusted Odds ratio [AOR]: 0.82, 95%CI: 0.70-0.95) and public locations (AOR: 0.58, 95%CI:0.39-0.88). OHCA recognition during the emergency call was lower for females arresting in public locations (84.6% vs 91.6%, p = 0.002) and this partially explained the association of sex with bystander CPR (∼44%). This difference in recognition was not observed in private residential locations (p = 0.2). Bystander AED use was lower for females (4.8% vs 9.6%, p < 0.001); however, after adjustment for location and other covariates, this relationship was no longer significant (AOR: 0.83, 95%CI: 0.60-1.12). Females were less likely to be in an initial shockable rhythm (AOR: 0.52, 95%CI: 0.44-0.61), but more likely to survive the event (AOR: 1.34, 95%CI: 1.15-1.56). There was no sex difference in survival to hospital discharge (AOR: 0.96, 95%CI: 0.77-1.19).
OHCA recognition and bystander CPR differ by patient sex in NSW. Research is needed to understand why this difference occurs and to raise public awareness of this issue.
评估旁观者目击的院外心脏骤停（OHCA）中，旁观者心肺复苏（CPR）是否因患者性别而异。
本研究是对新南威尔士州（NSW）2017 年 1 月至 2019 年 12 月期间接受护理人员治疗的 OHCA 的回顾性分析（仅限于旁观者目击病例）。排除标准包括老年护理、医疗设施、有预先护理指示、非医疗原因的 OHCA。多变量逻辑回归检查了患者性别与旁观者 CPR 的关联。次要结局是 OHCA 识别、旁观者 AED 应用、初始可电击节律和生存结局。
在 4491 例病例中，女性在私人住宅（调整后优势比 [AOR]：0.82，95%CI：0.70-0.95）和公共场所（AOR：0.58，95%CI：0.39-0.88）接受旁观者 CPR 的可能性较小。在公共场所发生 OHCA 的女性中，紧急呼救期间的 OHCA 识别率较低（84.6%对 91.6%，p=0.002），这部分解释了性别与旁观者 CPR 的关联（约 44%）。在私人住宅场所没有观察到这种识别差异（p=0.2）。女性旁观者 AED 使用率较低（4.8%对 9.6%，p<0.001）；然而，在调整位置和其他协变量后，这种关系不再显著（AOR：0.83，95%CI：0.60-1.12）。女性更有可能处于初始可电击节律（AOR：0.52，95%CI：0.44-0.61），但更有可能在事件中存活（AOR：1.34，95%CI：1.15-1.56）。在医院出院时的生存率方面，性别无差异（AOR：0.96，95%CI：0.77-1.19）。
在 NSW，OHCA 识别和旁观者 CPR 因患者性别而异。需要研究为什么会出现这种差异，并提高公众对此问题的认识。
