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Critical Care Medicine:
doi: 10.1097/CCM.0b013e3181d8ca43
Feature Articles

Women of child-bearing age have better inhospital cardiac arrest survival outcomes than do equal-aged men*

Topjian, Alexis A. MD; Localio, A. Russell PhD; Berg, Robert A. MD; Alessandrini, Evaline A. MD, MSCE; Meaney, Peter A. MD, MPH; Pepe, Paul E. MD, MPH; Larkin, G. Luke MD, MPH, MS; Peberdy, Mary Ann MD; Becker, Lance B. MD; Nadkarni, Vinay M. MD, MS; for the American Heart Association National Registry of Cardiopulmonary Resuscitation Investigators

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Abstract

Objectives: Estrogen and progesterone improve neurologic outcomes in experimental models of cardiac arrest and stroke. Our objective was to determine whether women of child-bearing age are more likely than men to survive to hospital discharge after in-hospital cardiac arrest.

Design: Prospective, observational study.

Setting: Five hundred nineteen hospitals in the National Registry of Cardiopulmonary Resuscitation database.

Patients: Patients included 95,852 men and women 15–44 yrs and 56 yrs or older with pulseless cardiac arrests from January 1, 2000 through July 31, 2008.

Measurements and Main Results: Patients were stratified a priori by gender and age groups (15–44 yrs and ≥56 yrs). Fixed-effects regression conditioning on hospital was used to examine the relationship between age, gender, and survival outcomes. The unadjusted survival to discharge rate for younger women of child-bearing age (15–44 yrs) was 19% (940/4887) vs. 17% (1203/7025) for younger men (p = .013). The adjusted hospital discharge difference between these younger women and men was 2.8% (95% confidence interval, 1.0% to 4.6%; p = .002), and these younger women also had a 2.6% (95% confidence interval, 0.9% to 4.3%; p = .002) absolute increase in favorable neurologic outcome. For older women compared with men (≥56 yrs), there were no demonstrable differences in discharge rates (18% vs. 18%; adjusted difference, −0.1%; 95% confidence interval, −0.9% to 0.6%; p = .68) or favorable neurologic outcome (14% vs. 14%; adjusted difference, −0.1%; 95% confidence interval, −0.7% to 0.5%; p = .74).

Conclusions: Women of child-bearing age were more likely than comparably aged men to survive to hospital discharge after in-hospital cardiac arrest, even after controlling for etiology of arrest and other important variables.

© 2010 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins

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