Gender differences in the provision of key post-arrest interventions for out-of-hospital cardiac arrest (OHCA) patients—protocol for a systematic review

Cardiovascular disease (CVD) is the leading global cause of mortality, accounting for 17.9 million deaths per year in 2015, a number that is expected to reach more than 23.6 million by 2030 [1]. Although traditionally perceived to primarily affect men, recent research suggests that CVD has a pronounced effect on women’s health [2]. In fact, CVD is the primary cause of death among women and more women than men die of CVD each year [3]. Cardiac arrest remains the leading cause of CVD mortality, accounting for more than 50% of all CVD-related deaths [4]. Each year in Canada, an estimated 40,000 cardiac arrests will occur, 85% of which occur outside of a hospital setting [5]. Emergency medical services (EMS) treat 52.1 out-of-hospital cardiac arrests (OHCA) per 100,000 population; however, survival-to-discharge rates remain low [6, 7].

In the hopes of improving OHCA survival rates, the American Heart Association (AHA) International Liaison Committee of Resuscitation adopted a chain of survival concept as a guideline for the management and treatment of OHCA [8]. The chain consists of four links: need to call 911, early initiation of cardiopulmonary resuscitation (CPR), early defibrillation, and early delivery of advanced life support. In 2010, a fifth link representing early post-resuscitation care was added, emphasizing the importance of early access to quality post-resuscitation interventions including: cardiology and/or neurology consultation(s), coronary angiography, coronary artery bypass grafting (CABG), electrophysiological testing (ET), implantable cardiac defibrillator (ICD), neuroprognostication no earlier than 72 h post-arrest, percutaneous coronary intervention (PCI), and targeted temperature management (TTM) [9, 10]. Evidence has shown that implementation of optimized post-arrest care significantly contributes to increased survival and functional outcomes in OHCA patients [11].

Gender differences have been reported in OHCA survival [12‐20]. A recent systematic review and meta-analysis found that overall survival among women was higher than men [12]; however, multiple studies have found that female OHCA patients are less likely to survive to hospital discharge [13, 17, 18, 20] despite being more likely to survive to hospital admission [14‐17, 19]. With gender differences in the provision of care after myocardial infarction (MI) being well-established [21‐25], this discrepancy in OHCA survival may be due to gender differences in post-arrest care. The objective of this systematic review is to systematically review the evidence on gender differences in the provision of post-arrest care.

This systematic review was designed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement [26], and this protocol follows the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) and checklist (Additional file 1) [27, 28]. This protocol is registered with PROSPERO as CRD42012003096.

The goal of this review is to determine if there are differences in the provision of post-arrest care between men and women. Based on existing published literature, we will analyze data extracted from studies on OHCA patients who survived to hospital admission. Study inclusion criteria include a number of key evidence-based interventions and gender stratification.

To our knowledge, this systematic review is the first to address the association between patient gender and the provision of post-arrest care. We anticipate that the results of this review may point to gaps in the published literature that specifically examines gender differences in care in this patient population.