The impact of time to defibrillation on return of spontaneous circulation in out-of-hospital cardiac arrest patients with recurrent shockable rhythms.

OBJECTIVE: Optimal timing for subsequent defibrillation attempts for Out-of-hospital cardiac arrest (OHCA) patients with recurrent VF/pVT is uncertain. We investigated the relationship between VF/pVT duration and return of spontaneous circulation (ROSC) in OHCA patients with recurrent shockable rhythms. METHODS: We analyzed data from the Salt Lake City Fire Department (SLCFD) spanning from 2012 to 2023. The implementation of rhythm-filtering technology since 2011 enabled real-time rhythm interpretation during CPR, with local protocols allowing early defibrillation for recurrent/refractory VF/pVT cases. We included patients experiencing four or five episodes of VF and pVT rhythms and employed generalized estimating equation (GEE) regression analysis to examine the association between VF/pVT durations preceding recurrent defibrillation and return of spontaneous circulation (ROSC). RESULTS: Analysis of 622 appropriate shocks showed that patients achieving ROSC had significantly shorter median VF/pVT duration than those who did not achieve ROSC (0.83 minutes vs. 1.2 minutes, p = 0.004). Adjusted analysis of those with 4 VF/pVT episodes (N = 142) revealed that longer VF/pVT durations were associated with lower odds of achieving ROSC (odds ratio: 0.81, 95% CI: 0.72-0.93, p = 0.005). Every one-minute delay in intra-arrest defibrillation is predicted to decrease the likelihood of achieving ROSC by 19%. CONCLUSION: Every one-minute increase in intra-arrest VF/pVT duration was associated with a statistically significant 19% decrease in the chance of achieving ROSC. This highlights the importance of reducing time to shock in managing recurrent VF/pVT. The findings suggest reevaluating the current recommendations of two minutes intervals for rhythm check and shock delivery.

Examining the association between ethnicity and out-of-hospital cardiac arrest interventions in Salt Lake City, Utah.

Aims: Previous research has reported racial disparities in out-of-hospital cardiac arrest (OHCA) interventions, including bystander CPR and AED use. However, studies on other prehospital interventions are limited. The primary objective of this study was to investigate race/ethnic disparities in out-of-hospital cardiac arrest (OHCA) interventions: EMS response times, medication administration, and decisions for intra-arrest transport. The secondary objective was to evaluate differences in the provision of Bystander CPR (CPR) and application of AED. Methods: We retrospectively analyzed data from the Salt Lake City Fire Department (2010-2023). We included adults 18 years or older with EMS-treated OHCA. Race/ethnicity was categorized as White people, Asian people, Black people, Hispanic people, and others. We employed multivariable regression analysis to evaluate the association between race/ethnicity and the outcomes of interest. Results: Unadjusted analyses revealed no significant differences across ethnic groups in EMS response, medication administration, bystander CPR, or intra-arrest transport decisions. However, significant ethnic disparities were observed in Automated External Defibrillator (AED) utilization, Black people having the lowest rate (6.5%) and Asian people the highest (21.8%). The adjusted analysis found no significant association between race/ethnicity and all OHCA intervention measures, nor between race/ethnicity and survival outcomes. Conclusions: Our multivariable analysis found no statistically significant association between race/ethnicity and EMS response time, epinephrine administration, antiarrhythmic medication use, bystander CPR, AED intervention, or intra-arrest transport. These results imply regional variations in ethnic disparities in OHCA may not be consistent across all areas, warranting further research into disparities in other regions and additional influential factors like neighborhood conditions and socioeconomic status.

Epidemiology and outcome of out-of-hospital cardiac arrest in Salt Lake City: Sex-based investigations.

Objectives: Prior research indicates sex disparities in the incidence and outcomes of out-of-hospital cardiac arrest (OHCA). This study investigates the presence of such differences in Salt Lake City, Utah. Methods: We analyzed data from the Salt Lake City Fire Department (2008‒2023). We included adults with non-traumatic OHCA. We calculated the annual incidence of OHCA and examined sex-specific survival outcomes using multivariable logistic regression, adjusting for OHCA characteristics known to be associated with survival. Results: The annual incidence of OHCA was 76 per 100,000 person-years. Among the 894 OHCA cases included in the analysis, 67.5% were males, 37.3% achieved return of spontaneous circulation (ROSC), and 13.6% survived hospital discharge. Unadjusted analysis revealed that males had significantly higher OHCA in public locations (43.9% vs. 28.6%), witnessed arrests (54.5% vs. 47.8%), and shockable rhythms (33.3% vs. 22.9%). Males also showed higher rates of ROSC (37.5% vs. 36.9%), hospital discharge survival (14.5% vs. 11.7%), and neurologically intact survival. After adjusting for the OHCA characteristics, there was no significant differences between males and females in ROSC, survival to hospital discharge, and favorable neurological function with adjusted odds ratios (male vs. female) of 0.92 (95% confidence interval [CI] 0.73‒1.16), 0.85 (95% CI 0.59‒1.22), and 0.92 (95% CI 0.62‒1.40), respectively. Conclusion: Approximately, 128 adults suffer OHCA in Salt Lake City annually. Males initially showed higher crude survival rates, but after adjusting for OHCA characteristics, no significant sex differences in survival outcomes were found. Enhancing OHCA characteristics could benefit both sexes. Investigations into the relationship between sex- and region-specific factors influencing OHCA outcomes are needed.

One-year survival after out-of- hospital cardiac arrest: Sex-based survival analysis in a Canadian population.

Objective: We investigated sex differences in 1-year survival in a cohort of patients who survived out-of-hospital cardiac arrest (OHCA) to hospital discharge. We hypothesized that female sex is associated with higher 1-year posthospital discharge survival. Methods: A retrospective analysis of linked data (2011-2017) from clinical databases in British Columbia (BC) was conducted. We used Kaplan-Meier curves, stratified by sex, to display survival up to 1-year, and the log-rank test to test for significant sex differences. This was followed by multivariable Cox proportional hazards analysis to investigate the association between sex and 1-year mortality. The multivariable analysis adjusted for variables known to be associated with survival, including variables related to OHCA characteristics, comorbidities, medical diagnoses, and in-hospital interventions. Results: We included 1278 hospital-discharge survivors; 284 (22.2%) were female. Females had a lower proportion of OHCA occurring in public locations (25.7% vs. 44.0%, P < 0.001), a lower proportion with a shockable rhythm (57.7% vs. 77.4%, P < 0.001), and fewer hospital-based acute coronary diagnoses and interventions. One-year survival for females and males was 90.5% and 92.4%, respectively (log-rank P = 0.31). Unadjusted (hazard ratio [HR] males vs. females 0.80, 95% confidence interval [CI] 0.51-1.24, P = 0.31) and adjusted (HR males vs. females 1.14, 95% CI 0.72-1.81, P = 0.57) models did not detect differences in 1-year survival by sex. Conclusion: Females have relatively unfavorable prehospital characteristics in OHCA and fewer hospital-based acute coronary diagnoses and interventions. However, among survivors to hospital discharge, we found no significant difference between males and females in 1-year survival, even after adjustment.

Provision of bystander CPR for out-of-hospital cardiac arrest in the Middle East: a retrospective gender-based analysis.

BACKGROUND: Previous studies conducted in North America, Europe, and East Asia (Liu et al., EClinicalMedicine 44:101293, 2022; Matsui et al., JAMA Netw Open 2:e195111, 2019; Awad et al., J Am Coll Emerg Physicians Open 4:e12957, 2023; Yoon et al., Prehosp Emerg Care :1-7, 2022) reported gender disparities in the provision of bystander CPR for patients with out-of-hospital cardiac arrest (OHCA). However, it remains unknown whether similar disparities exist in the Middle Eastern and Gulf regions. The primary objective of this study is to evaluate gender differences in the provision of bystander CPR for patients with OHCA in Qatar. METHODS: Retrospective analysis of data obtained from Hamad Medical Corporation OHCA registry in the State of Qatar (2016-2022). We included adults with non-traumatic and EMS-attended OHCA. We used multilevel logistic regression to examine the association between gender and provision of bystander CPR. RESULTS: In total, 4283 patients were included. Of those, 3414 (79.7%) were males, 1639 (38.3%) arrested in public locations, and 1463 (34.2%) received bystander CPR. Unadjusted comparisons showed that females were significantly older than males (mean age: 62.2 vs. 52.7). Females had a lower proportion of OHCA occurring in public locations (15.1% vs. 44.2%) and a lower proportion of shockable rhythm (11.9 vs. 27.5%). Regarding the outcome variable (provision of bystander CPR), the unadjusted analysis showed that the proportion of females who received bystander CPR was lower than that of males (29.2% vs. 35.4%, p < 0.001). However, after adjustment, we found no significant difference in provision of bystander CPR by gender (adjusted OR female vs. male 0.99, 95% CI 0.84-1.20, p = 0.97). In the subgroup who arrested in public locations, the analysis revealed females had greater odds of receiving bystander CPR (adjusted OR female vs. male 1.47, 95% CI 1.10-1.82, p = 0.04). CONCLUSIONS: Overall, bystander CPR was less common in female gender; after adjustment for other covariates, including arrest location, we found no significant gender differences in provision of bystander CPR. We also observed that females were found to have a lower incidence of cardiac arrest in public locations. Nevertheless, if females were to experience cardiac arrest in a public location, they would be more likely to receive CPR. Further research is required to explain the observed differences in provision of bystander CPR.

Predictors of neurological outcome after out-of-hospital cardiac arrest: sex-based analysis: do males derive greater benefit from hypothermia management than females?

BACKGROUND: Previous studies of the effect of sex on after out-of-hospital cardiac arrest (OHCA) outcomes focused on survival to hospital discharge and 1-month survival. Studies on the effect of sex on neurological function after OHCA are still limited. The objective of this study was to identify the predictors of favorable neurological outcome and to examine the association between sex as a biological variable and favorable neurological outcome OHCA. METHODS: Retrospective analyses of clustered data from the Resuscitation Outcomes Consortium multi-center randomized controlled trial (2011-2015). We included adults with non-traumatic OHCA and EMS-attended OHCA. We used multilevel logistic regression to examine the association between sex and favorable neurological outcomes (modified Rankin Scale) and to identify the predictors of favorable neurological outcome. RESULTS: In total, 22,416 patients were included. Of those, 8109 (36.2%) were females. The multilevel analysis identified the following variables as significant predictors of favorable neurological outcome: younger age, shorter duration of EMS arrival to the scene, arrest in public location, witnessed arrest, bystander CPR, chest compression rate (CCR) of 100-120 compressions per minute, induction of hypothermia, and initial shockable rhythm. Two variables, insertion of an advanced airway and administration of epinephrine, were associated with poor neurological outcome. Our analysis showed that males have higher crude rates of survival with favorable neurological outcome (8.6 vs. 4.9%, p < 0.001). However, the adjusted rate was not significant. Further analyses showed that hypothermia had a significantly greater effect on males than females. CONCLUSIONS: Males had significantly higher crude rates of survival with favorable neurological outcome. However, the adjusted rate was not statistically significant. Males derived significantly greater benefit from hypothermia management than females, but this can possibly be explained by differences in arrest characteristics or in-hospital treatment. In-depth confirmatory studies on the hypothermia effect size by sex are required.

The effect of sex and age on return of spontaneous circulation and survival to hospital discharge in patients with out of hospital cardiac arrest: A retrospective analysis of a Canadian population.

OBJECTIVES: We evaluated the effect of sex and age on out-of-hospital cardiac arrest (OHCA) outcomes in a Canadian population. METHODS: This study was a retrospective analysis of the British Columbia (BC) Cardiac Arrest Registry (2011-16). We included adult, non-traumatic, EMS-treated OHCA. We stratified the cohort into four groups by age and sex: younger females (18-47 years of age), younger males (18-47 years of age), older females, and older males (>53 years old). We used logistic regression to examine the effect of sex and interaction effect of sex and age on ROSC and survival to hospital discharge. RESULTS: We included 8115 patients; 31.4% were females. Females had a lower proportion of OHCA in public locations, bystander witnessed arrests, and with initial shockable rhythms. Overall, females had greater adjusted odds of ROSC (OR 1.29, 95% CI 1.15-1.42, p < 0.001). The ROSC advantage was significant in females with non-shockable rhythms (OR 1.48, 95% CI 1.24-1.78, p < 0.001) and females of premenopausal age. However, there was no significant difference in survival to hospital discharge between females and males overall or by sex-age groups. Both younger females and younger males have higher odds of survival to hospital discharge compared to older females and males. Older females had the lowest survival rate among all other sex-age groups. CONCLUSIONS: Female sex was associated with ROSC but not survival to hospital discharge. In the post-arrest phase, females, specifically those in the older age group, had a higher death rate, demonstrating the need for sex- and age-specific research in pre-and-post-OHCA care.

Premenopausal-aged females have no neurological outcome advantage after out-of-hospital cardiac arrest: A multilevel analysis of North American populations.

AIM: We investigated the impact of premenopausal age on neurological function at hospital discharge in patients with out-of-hospital cardiac arrest (OHCA). We hypothesized that premenopausal-aged females (18-47 years of age) with OHCA would have a higher probability of survival with favourable neurological function at hospital discharge compared with males of the same age group, older males, and older females (>53 years of age). METHODS: Retrospective analyses of data from the Resuscitation Outcomes Consortium multi-center randomized controlled trial (June 2011-May 2015). We included adults with non-traumatic OHCA treated by emergency medical service. We stratified the cohort into four groups by age and sex: premenopausal-aged females (18-47 years of age), older females (≥53 years old), younger males (18-47 years of age), and older male. We used multilevel logistic regression to examine the association between age-sex and favourable neurological outcomes (modified Rankin Scale ≤ 3). RESULTS: In total, 23,725 patients were included: 1050 (4.5%) premenopausal females; 1930 (8.1%) younger males; 7569 (31.9%) older females; and 13,176 (55.5%) older males. The multilevel analysis showed no difference in neurological outcome between younger males and younger females (OR 0.95, 95% CI 0.69-1.32, p = 0.75). Both older females (OR 0.36, 95% CI 0. 0.26-0.48, p < 0.001) and older males (OR 0.52, 95% CI 0.39-0.69, p < 0.001) had a significantly lower odds of favourable neurological outcome than younger females. Among all groups, older females had the worst outcomes. CONCLUSIONS: We did not detect an association between premenopausal age and survival with good neurological outcome, suggesting females sex hormones do not impact OHCA outcomes. Our findings are not in line with results from other studies. Studies that rigorously evaluate menopausal status are required to definitively assess the impact of female sex hormones on outcomes.

Sex differences in out-of-hospital cardiac arrest interventions within the province of British Columbia, Canada.

INTRODUCTION: Out-of-hospital cardiac arrest (OHCA) is common among females and males alike; however, previous studies reported differences in outcomes between sexes in different regions. To investigate possible explanations for this disparity, we examined sex differences in resuscitation interventions in the province of British Columbia (BC). METHODS: We performed an observational analysis of the BC Cardiac Arrest Registry (2011-16). We included adults with non-traumatic and EMS-treated OHCA. We examined sex differences in bystander CPR, chest compression rate, and intra-arrest transport using chi-square tests, student's t-test, multivariable linear and logistic regressions. RESULTS: In total, 7398 patients were eligible for the bystander CPR analysis; 31% were female. More males received bystander CPR (54% vs. 50%); however, male sex was not associated with bystander CPR after adjustment for confounders (adjusted OR male vs. female: 1.07, 95% CI 0.96, 1.18). There was no difference in the chest compression rate for males and females in unadjusted or adjusted analyses. Among subjects who did not achieve prehospital ROSC (n = 5225, 32% females), 64% were pronounced dead at the scene with the remaining transported to hospital. Males more often underwent intra-arrest transport than females (36.7% vs. 34.0%). After adjustment, males had 1.2 greater odds of being transported to hospital than females (95% CI 1.04, 1.37). CONCLUSIONS: We did not detect an association between sex and bystander CPR or chest compression rate. In those who did not achieve prehospital ROSC, males had 1.2-fold greater odds of being transported to hospital compared to females.

Public access defibrillators: Gender-based inequities in access and application.

AIM: While public access automated external defibrillator (AED) programs appear to improve outcomes in out-of-hospital cardiac arrest (OHCA) it is unclear if men and women benefit equally. We examined gender-based differences in OHCA location to determine what proportion were potentially eligible for public access AED application, and if patient gender was associated with AED utilization. METHODS: We analyzed data from the Resuscitation Outcomes Consortium registry (2011-2015). We compared differences in OHCA locations by gender. We fit multivariate logistic regression models, restricted to public location OHCAs and public-location cases with bystander intervention, to calculate the association between gender and public access AED application. RESULTS: Among 61 473 cases, 34% were female and 50% had bystander resuscitation. The incidence of public OHCA was 8.8% for women and 18% for men (risk difference 9.2%, 95% CI 8.7-9.7%). Women had significantly fewer OHCAs on roadways, in public buildings, places of recreation, and farms, but more in homes, non-acute healthcare facilities, and residential institutions. Female gender was associated with a lower odds of AED application in public OHCA (adjusted OR 0.76, 95% CI 0.64-0.90) and public-location cases with bystander interventions (adjusted OR 0.83, 95% CI 0.71-0.99). CONCLUSION: Women had fewer OHCA in public locations that may have public access AEDs. Even among public location OHCA with bystander interventions, women were less likely to have public access AED applied. Initiatives to optimize AED locations and to engage the public with gender-specific resuscitation training may improve outcomes in women with OHCA.

Reliability of Canadian Emergency Department Triage and Acuity Scale (CTAS) in Saudi Arabia.

BACKGROUND: The Canadian Emergency Department Triage and Acuity Scale (CTAS) is an integral part of the Canadian emergency medicine triaging system. There is growing interest and implementation of CTAS worldwide. However, little is known about its reliability outside Canada. The aim of this study was to determine the reliability agreement of CTAS in a tertiary care emergency center in Saudi Arabia. METHODS: Ten triage nurses (five senior and five junior nurses) utilized CTAS guidelines to independently assign a triage level for 160 real case-based scenarios. Quadratic weighted kappa statistics were used to measure raters' agreements. RESULTS: Raters provided 1600 triage category assignments to case scenarios for analysis. Intra-rater agreement was similar for both senior and junior nurses; for senior nurses (SN1) kappa 0.871 95 % CI (0.840-0.897), and for junior nurses (SN2) kappa 0.871 95 % CI (0.839-0.898). Inter-rater agreement for the SN1 versus SN2 nurses had statistically meaningful agreement across different triage levels (weighted kappa = 0.770) 95 % CI (0.742-0.797). CONCLUSIONS: CTAS has good reliability among emergency department (ED) triage nurses in King Abdulaziz Medical City (KAMC), Saudi Arabia. The findings suggest that CTAS might be a reliable instrument when applied in countries outside Canada.

Panoramic radiographic examination: a survey of 271 edentulous patients.

The aim of this study was to quantify the frequency of positive radiographic findings in edentulous arches. Panoramic radiographs from 271 patients who were edentulous in one or both arches were evaluated for the presence of retained root fragments, impacted teeth, foreign bodies, radiolucencies, radiopacities, mental foramina at or near the crest of the residual alveolar ridge, and maxillary sinus proximity to the crest of the residual alveolar ridge. One or more of these radiographic observations were found in 51.7% of the examined films. The most frequent finding (30.6%) was close approximation of the maxillary sinus to the crest of the ridge. These results underscore the importance of panoramic examination of edentulous patients in detecting potential problems before complete denture treatment. However, prescribing such an examination in patients seeking replacement dentures requires a thorough patient history and clinical examination.