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Influence of sex on survival, neurologic outcomes, and neurodiagnostic testing after out-of-hospital cardiac arrest

Vogelsong, Melissa A. ; May, Teresa ; Agarwal, Sachin ; Cronberg, Tobias LU ; Dankiewicz, Josef LU orcid ; Dupont, Allison ; Friberg, Hans LU ; Hand, Robert ; McPherson, John and Mlynash, Michael , et al. (2021) In Resuscitation 167. p.66-75
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 to 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 2407 eligible... (More)

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 to 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 2407 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.

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publishing date
type
Contribution to journal
publication status
published
subject
keywords
Cardiac arrest, Gender, Neurodiagnostic testing, Outcomes, Sex, Withdrawal
in
Resuscitation
volume
167
pages
10 pages
publisher
Elsevier
external identifiers
  • scopus:85113791410
  • pmid:34363853
ISSN
0300-9572
DOI
10.1016/j.resuscitation.2021.07.037
language
English
LU publication?
yes
id
cc493afd-b16a-44d5-a8fe-7c1910747ba7
date added to LUP
2021-09-17 14:56:48
date last changed
2024-04-20 12:26:51
@article{cc493afd-b16a-44d5-a8fe-7c1910747ba7,
  abstract     = {{<p>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 to 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 2407 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.</p>}},
  author       = {{Vogelsong, Melissa A. and May, Teresa and Agarwal, Sachin and Cronberg, Tobias and Dankiewicz, Josef and Dupont, Allison and Friberg, Hans and Hand, Robert and McPherson, John and Mlynash, Michael and Mooney, Michael and Nielsen, Niklas and O'Riordan, Andrea and Patel, Nainesh and Riker, Richard R. and Seder, David B. and Soreide, Eldar and Stammet, Pascal and Xiong, Wei and Hirsch, Karen G.}},
  issn         = {{0300-9572}},
  keywords     = {{Cardiac arrest; Gender; Neurodiagnostic testing; Outcomes; Sex; Withdrawal}},
  language     = {{eng}},
  pages        = {{66--75}},
  publisher    = {{Elsevier}},
  series       = {{Resuscitation}},
  title        = {{Influence of sex on survival, neurologic outcomes, and neurodiagnostic testing after out-of-hospital cardiac arrest}},
  url          = {{http://dx.doi.org/10.1016/j.resuscitation.2021.07.037}},
  doi          = {{10.1016/j.resuscitation.2021.07.037}},
  volume       = {{167}},
  year         = {{2021}},
}