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.

中文翻译：

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院外心脏骤停后性别对生存、神经系统结果和神经诊断测试的影响

目的

先前评估性与复苏后护理与院外心脏骤停 (OHCA) 后结局之间关系的研究是相互矛盾的。我们在一项前瞻性多中心国际登记处调查了性别与结果以及神经诊断测试之间的关联，这些登记处是 OHCA 后入住重症监护病房的患者。

方法

纳入了 2012 年至 2017 年在国际心脏骤停登记处 (INTCAR) 登记的 OHCA 幸存者。我们评估了性别与生存与出院、良好的神经系统结果（脑功能分类 1 或 2 类）、神经诊断测试和停止维持生命治疗 (WLST) 之间的独立关联。

结果

在 2407 名符合条件的患者中，809 名 (33.6%) 是女性。基线特征因性别而异，女性的旁观者 CPR 和初始电击节律较少。女性出院后存活的可能性较小，但经过调整分析后显着性降低（30.1% vs 42.7%，调整后 OR 0.85，95% CI 0.67–1.08）。女性在出院时（21.4% 对 34.0%，调整后 OR 0.74，95% CI 0.57–0.96）和逮捕后 6 个月（16.7% 对 29.4%，调整后 OR 0.73，95% CI）不太可能有良好的神经系统结果0.54–0.98），调整后仍然存在。神经影像学（75.5% 对 74.3%，p = 0.54）和其他神经生理学测试（78.8% 对 78.6%，p = 0.91）在不同性别中相似。女性更有可能接受 WLST（55.6% 对 42.8%，调整后 OR 1.35，95% CI 1.09–1.66）。

结论

尽管神经诊断测试的比率相当，并且在控制了临床特征和心脏骤停特征的基线差异后，心脏骤停女性获得良好神经系统结果的几率较低，而 WLST 的几率较高。