Melissa A Vogelsong1, Teresa May2, Sachin Agarwal3, Tobias Cronberg4, Josef Dankiewicz5, Allison Dupont6, Hans Friberg7, Robert Hand8, John McPherson9, Michael Mlynash10, Michael Mooney11, Niklas Nielsen12, Andrea O'Riordan10, Nainesh Patel13, Richard R Riker2, David B Seder2, Eldar Soreide14, Pascal Stammet15, Wei Xiong16, Karen G Hirsch10. 1. Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, CA, United States. Electronic address: mvoge@stanford.edu. 2. Department of Critical Care Services, Maine Medical Center, Portland, ME, United States. 3. Department of Neurology, Columbia University Medical Center/New York Presbyterian Hospital, New York City, NY, United States Tobias Cronberg - Department of Clinical Sciences, Neurology, Lund University, Skåne University Hospital, Lund, Sweden. 4. Department of Clinical Sciences, Neurology, Lund University, Skåne University Hospital, Lund, Sweden. 5. Department of Cardiology, Skåne University Hospital, Lund, Sweden. 6. Department of Cardiology, Northside Cardiovascular Institute, Atlanta, GA, United States. 7. Department of Clinical Sciences, Intensive and Perioperative Care, Lund University, Skåne University Hospital, Malmö, Sweden. 8. Deceased. 9. Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, TN, United States. 10. Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, United States. 11. Department of Cardiology, Minneapolis Heart Institute, Abbot North-Western Hospital, Minneapolis, MN, United States. 12. Department of Anesthesiology and Intensive Care, Helsingborg Hospital, Helsingborg, Sweden, Department of Clinical Sciences, Lund University, Lund, Sweden. 13. Department of Cardiology, Lehigh Valley Health Network, Allentown, PA, United States. 14. Critical Care and Anaesthesiology Research Group, Stavanger University Hospital, Stavanger, Norway, Department Clinical Medicine, University of Bergen, Bergen, Norway. 15. Medical and Health Department, Luxembourg Fire and Rescue Corps, Luxembourg, Luxembourg. 16. Department of Neurology, Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH, United States.
Abstract
AIM: Previous studies evaluating the relationship between sex and post-resuscitation care and outcomes following out-of-hospital cardiac arrest (OHCA) are conflicting. We investigated the association between sex and outcomes as well as neurodiagnostic testing in a prospective multicenter international registry of patients admitted to intensive care units following OHCA. METHODS: OHCA survivors enrolled in the International Cardiac Arrest Registry (INTCAR) from 2012-2017 were included. We assessed the independent association between sex and survival to hospital discharge, good neurologic outcome (Cerebral Performance Category 1 or 2), neurodiagnostic testing, and withdrawal of life-sustaining therapy (WLST). RESULTS: Of 2,407 eligible patients, 809 (33.6%) were women. Baseline characteristics differed by sex, with less bystander CPR and initial shockable rhythms among women. Women were less likely to survive to hospital discharge, however significance abated following adjusted analysis (30.1% vs 42.7%, adjusted OR 0.85, 95% CI 0.67-1.08). Women were less likely to have good neurologic outcome at discharge (21.4% vs 34.0%, adjusted OR 0.74, 95% CI 0.57-0.96) and at six months post-arrest (16.7% vs 29.4%, adjusted OR 0.73, 95% CI 0.54-0.98) that persisted after adjustment. Neuroimaging (75.5% vs 74.3%, p=0.54) and other neurophysiologic testing (78.8% vs 78.6%, p=0.91) was similar across sex. Women were more likely to undergo WLST (55.6% vs 42.8%, adjusted OR 1.35, 95% CI 1.09-1.66). CONCLUSIONS: Women with cardiac arrest have lower odds of good neurologic outcomes and higher odds of WLST, despite comparable rates of neurodiagnostic testing and after controlling for baseline differences in clinical characteristics and cardiac arrest features.
AIM: Previous studies evaluating the relationship between sex and post-resuscitation care and outcomes following out-of-hospital cardiac arrest (OHCA) are conflicting. We investigated the association between sex and outcomes as well as neurodiagnostic testing in a prospective multicenter international registry of patients admitted to intensive care units following OHCA. METHODS: OHCA survivors enrolled in the International Cardiac Arrest Registry (INTCAR) from 2012-2017 were included. We assessed the independent association between sex and survival to hospital discharge, good neurologic outcome (Cerebral Performance Category 1 or 2), neurodiagnostic testing, and withdrawal of life-sustaining therapy (WLST). RESULTS: Of 2,407 eligible patients, 809 (33.6%) were women. Baseline characteristics differed by sex, with less bystander CPR and initial shockable rhythms among women. Women were less likely to survive to hospital discharge, however significance abated following adjusted analysis (30.1% vs 42.7%, adjusted OR 0.85, 95% CI 0.67-1.08). Women were less likely to have good neurologic outcome at discharge (21.4% vs 34.0%, adjusted OR 0.74, 95% CI 0.57-0.96) and at six months post-arrest (16.7% vs 29.4%, adjusted OR 0.73, 95% CI 0.54-0.98) that persisted after adjustment. Neuroimaging (75.5% vs 74.3%, p=0.54) and other neurophysiologic testing (78.8% vs 78.6%, p=0.91) was similar across sex. Women were more likely to undergo WLST (55.6% vs 42.8%, adjusted OR 1.35, 95% CI 1.09-1.66). CONCLUSIONS:Women with cardiac arrest have lower odds of good neurologic outcomes and higher odds of WLST, despite comparable rates of neurodiagnostic testing and after controlling for baseline differences in clinical characteristics and cardiac arrest features.
Authors: David O Alao; Nada A Mohammed; Yaman O Hukan; Maitha Al Neyadi; Zia Jummani; Emad H Dababneh; Arif A Cevik Journal: Resusc Plus Date: 2022-03-19