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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

doi: 10.1097/CCM.0b013e3181d8ca43
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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.

From Department of Anesthesia and Critical Care Medicine (AAT, RAB, PAM, VMN), The Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, PA; Department of Biostatics and Epidemiology (ARL), University of Pennsylvania School of Medicine, Philadelphia, PA; Division of Emergency Medicine (EAA), Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Emergency Medicine (PEP), University of Texas Southwestern Medical Center, Parkland Health Hospital System, Dallas, TX; Emergency Medicine Section (GLL), Surgery Department, Yale School of Medicine, New Haven, CT; Department of Emergency Medicine and Internal Medicine (MAP), Virginia Commonwealth University, Richmond, VA; Department of Emergency Medicine and Center for Resuscitation Science (LBB), University of Pennsylvania, Philadelphia, PA.

National Registry of Cardiopulmonary Resuscitation Investigators: Mary Mancini, RN PhD; Emilie Allen, BSN; Elizabeth Hunt, MD; Joseph Ornato, MD; Scott Braithwaite, MD; Graham Nichol, MD; John Gosbee, MD; Greg Mears, MD; Kathy Duncan, RN; William Kaye, MD; Tanya Lane Truitt, RN, MS; Jerry Potts, PhD; Brian Eigel, PhD; Paul Chan, MD; Tim Mader, MD; David Magid; Karl Kern, MD; Sam Warren, MD; Thomas Noel, MD; Jane Wigginton, MD; and Scott Carey.

The Edna G. Kynett Foundation FOCUS Junior Faculty Investigator Award provided funding for design of the study and data analysis.

Dr. Becker has received grant/research support from Philips Medical Systems, Laerdal Medical, NIH, Cardiac Science, and BeneChill. He consulted for Philips Medical Systems, NIH Data Safety Monitoring Board and Protocol Review Committee, and Gaymar Industries. He received patents from Hypothermia Induction and Reperfusion Therapies. He is a special government employee. He has received ownership, equity, and royalties from Cold Core Therapeutics, Inc. He is a member of the American Heart Association. He received speaker honoraria from Zoll Medical, Medtronics, and multiple universities. The remaining authors have not disclosed any potential conflicts of interest.

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