Sex Hormones Examined as Future EMS Tool

DALLAS, TEXAS -- EMS Expo and Firehouse Central opened Wednesday with some surprising information about the effects of estrogen on cardiac arrest patients and victims of traumatic head injuries.

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The female hormone estrogen might be in paramedics' pharmacological protocols in the next five to 10 years, predicted Paul Pepe and Jane Wigginton, both physicians at the University of Texas Southwestern Medical Center at Dallas.

In their keynote presentation during EMS Expo in Dallas, Pepe and Wigginton said women of child-bearing age have dramatically better outcomes from cardiac arrests and traumatic head injuries than menopausal women and men. They attribute the improved survival rates to the presences of estrogen.

"The effects of estrogen are profound and irrefutable," said Pepe to an audience of several hundreds of people gathered for the opening ceremony of EMS Expo, which in the future will be called EMS World Expo after a rebranding of EMS Magazine, and EMS Expo which was also announced during the ceremony.

In the keynote presentation, which was called "Sex, Drugs and R&R (Reanimation & Resuscitation)," Pepe and Wigginton explained the significant outcome differences between men and women in cardiac arrest. They discussed a study, which was done on nearly 10,000 patients, that strongly implies a very real and profound female sex hormonal effect on the favorable outcomes.

"The great thing about estrogen is it's safe, it's inexpensive, it's easy to use and it is effective," Pepe said.

Estrogen therapies are most effective when administered as soon after the cardiac event or traumatic injury as possible, the presenters said. Even after 10 to 12 hours, when a patient has been transferred to a Level I trauma center and is given estrogen, the outcomes are predictably better, Wigginton said.

That's why there's a very strong likelihood estrogen will find its way into a paramedic's drug kit, Pepe said.

The conclusion was reached by looking at the study's 9,445 cardiac patients and examining the outcomes.

Pepe and Wigginton said about 4,000 of the heart patients were women and the remaining approximately 5,000 were men. All of the cardiac patients studied received the identical prehospital cardiac event care and the women who were menopausal had virtually identical outcomes.

Childbearing-aged women with cardiac arrests and the exact same prehospital care had a 14.2 percent likelihood of being discharged from the hospital, compared to 10.1 percent for males, Pepe said. That may not seem like much, but even a 2 percent increase in survivability after cardiac arrest, with an average of 1,000 arrests daily, would mean 20 more people daily surviving and having productive lives.

"That's huge," Pepe said, noting that the number would be even higher on a global level.

Pepe and Wigginton backed up their conclusion with convincing data. In fact, the data is so convincing, a federal study of prehospital estrogen therapy is on a fast track.

When it comes to traumatic brain injuries, estrogen also has a very positive effect on the outcome as well.

Wigginton said in a study of laboratory rats, which had induced strokes, the ischemia of the brain was much less on those who were injected with estrogen within minutes of the stroke than those that were injected with a placebo.

In a series of rat brain cross sections, Wigginton showed the dramatic difference between health brain tissue of the rat that received estrogen and that of one that received a placebo of water.

In humans, Wigginton said some head trauma patients were found to have higher levels of estrogen than normal, suggesting that the body makes estrogen to combat the effects of the trauma.

"It backs up the theory that nature knows what's good," Wigginton said.

Conversely, patients with high levels of testosterone do worse than those with progesterone, Wigginton said.

There's also evidence that estrogen can help with spinal cord injuries as well, Pepe said. Wigginton added that burn patients have also shown better outcomes after receiving a single dose of estrogen.

Estrogen delivered within the first 15 minutes after a burn in laboratory rats have increased the survival rate, Wigginton said, noting that helps stop the inflammation of the brain and lungs.

The prevalence of estrogen in the medical field makes it a safe and known therapy, Pepe said, noting that it's given to cancer patients and as a hormone replacement therapy. In the scheme of hospital care and costs, Pepe said it's cheap at about $135 per dose.

When considering the cost of a day in intensive care, which can be up to $10,000 per day, anything to save even one day is worth it in an economic sense, Pepe said.