Abstract 11005: The Revision of American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Provides Clinical Benefit in Women With Out-of-hospital Cardiac Arrest Undergoing Prehospital Defibrillation
Backgrounds: Women are older and have a lower incidence of ventricular fibrillation/pulseless ventricular tachycardia than men when rescuers encounter a victim of sudden adult cardiac arrest. We assessed the hypothesis that the revision of American Heart Association (AHA) Guidelines for Cardiopulmonary Resuscitation (CPR) and Emergency Cardiovascular Care has a major impact on sex differences of improved survival of patients (pts) with out-of-hospital cardiac arrest (OHCA) through a prehospital defibrillation procedure.
Methods and Results:From January 1, 2005 through December 31, 2010, we conducted a prospective, population-based, observational study involving consecutive OHCA pts in whom resuscitation was attempted by emergency responders across Japan. A total of 670,313 pts were included in the present study and 118,777 pts had a cardiac arrest witnessed by bystanders. Among these pts, the AHA guidelines (G)2005 were aimed at 63,138 pts, G2000 were aimed at 17,836 pts, and the remaining 37,803 pts were within a transitional period for revision from G2000 to G2005. After the technique of Greedy matching for clinical characteristics was used to minimize the effect of selection bias, prehospital defibrillation based on G2005 showed better outcomes in women on return of spontaneous circulation (32% vs 27%, P=0.0145) and 1-month rate of survival with minimal neurologic impairment (20% vs 15%, P=0.0008) than men (Figure A and B). A clinical improvement of outcome in women undergoing prehospital defibrillation was remarkable as the guidelines were revised (Figure C [20% vs 26% vs 32%, P=0.0011] and D [11% vs 12% vs 20%, P<0.0001]).
Conclusions:The G2005 provide an incremental efficiency of prehospital defibrillation for OHCA women compared to men. Our findings may help to explain the missing link between clinical changes for the better in women and revised AHA guidelines although the frequency and quality of chest compression are contributing factors for outcome.
- © 2012 by American Heart Association, Inc.