院外心脏骤停时除颤操作中的性别差异
Gender Differences in Defibrillator Practices in Out-of-Hospital Cardiac Arrest.
作者信息
Thompson Kathryn, Smith Jeffrey, Tanski Mary, Neth Matthew R, Sahni Ritu, Kennel Jamie, Jui Jonathan, Newgard Craig D, Daya Mohamud R, Lupton Joshua R
机构信息
Department of Emergency Medicine, Oregon Health & Science University, Portland, Oregon.
Oregon Health & Science University and Oregon Institute of Technology, Portland, Oregon.
出版信息
Prehosp Emerg Care. 2025;29(5):586-592. doi: 10.1080/10903127.2024.2394590. Epub 2024 Sep 17.
OBJECTIVES
Disparities remain in survival after out-of-hospital cardiac arrest (OHCA) for women compared to men. Our objective was to evaluate differences in automated external defibrillator (AED) use before Emergency Medical Services (EMS) arrival and time from arrival to initial EMS defibrillation by EMS-assessed gender (women or men).
METHODS
This was a secondary analysis of adult non-traumatic, EMS-treated OHCA cases in the Portland Cardiac Arrest Epidemiologic Registry from 2018 to 2021. Emergency Medical Services-witnessed cardiac arrests were excluded and the primary outcomes were pre-EMS AED application and the time from EMS arrival to first defibrillation among patients in a shockable rhythm at first rhythm assessment without pre-EMS AED application. We examined pre-EMS AED application rates overall and separately for law enforcement, in cases where they were on-scene before EMS without a lay bystander AED applied, and lay responders, in cases where law enforcement had not applied an AED. We used multivariable logistic and linear regressions to adjust for potential confounders, including age, arrest location, witness status, bystander CPR, year, and time from dispatch to EMS arrival. We accounted for clustering by county of arrest using a mixed-effects approach.
RESULTS
Of the 3,135 adult, EMS-treated non-traumatic OHCAs that were not witnessed by EMS, 3,049 had all variables for analysis, of which 1,011 (33.2%) were women. The adjusted odds (adjusted odds ratio [95% CI]) for any pre-EMS placement of an AED was significantly higher for men compared to women (1.40 [1.05-1.86]). These odds favoring men remained when examining law enforcement AED application (1.89 [1.16-3.07]), but not lay bystander AED application (1.19 [0.83-1.71]). Among patients still in arrest on EMS arrival, with a shockable initial EMS rhythm, and without pre-EMS AED application, the time from EMS arrival on-scene to initial defibrillation was significantly longer for women compared to men (+0.81 min [0.22-1.41 min]).
CONCLUSIONS
Women with OHCA received lower rates of pre-EMS AED application and delays in initial EMS defibrillation compared to men.
目的
与男性相比，院外心脏骤停（OHCA）女性患者的生存率仍存在差异。我们的目的是评估紧急医疗服务（EMS）到达前自动体外除颤器（AED）的使用差异，以及根据EMS评估的性别（女性或男性）从EMS到达至首次除颤的时间差异。
方法
这是对2018年至2021年波特兰心脏骤停流行病学登记处中接受EMS治疗的成年非创伤性OHCA病例的二次分析。排除由EMS目击的心脏骤停病例，主要结局为EMS到达前AED的应用情况，以及在首次心律评估时为可除颤心律且未在EMS到达前应用AED的患者从EMS到达至首次除颤的时间。我们分别检查了总体以及执法人员（在EMS到达前且无旁观者AED应用的现场情况下）和非执法人员旁观者（在执法人员未应用AED的情况下）的EMS到达前AED应用率。我们使用多变量逻辑回归和线性回归来调整潜在的混杂因素，包括年龄、骤停地点、目击者状态、旁观者心肺复苏、年份以及从调度至EMS到达的时间。我们采用混合效应方法考虑了按骤停县进行的聚类分析。
结果
在3135例接受EMS治疗的成年非创伤性OHCA病例中，排除由EMS目击的病例后，3049例具有全部分析变量，其中1011例（33.2%）为女性。与女性相比，男性在EMS到达前应用AED的调整后比值（调整后比值比[95%置信区间]）显著更高（1.40[1.05 - 1.86]）。在检查执法人员应用AED时，这种有利于男性的比值仍然存在（1.89[1.16 - 3.07]），但非执法人员旁观者应用AED时则不然（1.19[0.83 - 1.71]）。在EMS到达时仍处于心脏骤停状态、初始EMS心律为可除颤心律且未在EMS到达前应用AED的患者中，与男性相比，女性从EMS到达现场至首次除颤的时间显著更长（+0.81分钟[从0.22 - 1.41分钟]）。
结论
与男性相比，OHCA女性患者接受EMS到达前AED应用的比例较低，且初始EMS除颤存在延迟。
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