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

Authors

Melissa A. Vogelsong, Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, CA, United States. Electronic address: mvoge@stanford.edu.
Teresa May, Department of Critical Care Services, Maine Medical Center, Portland, ME, United States.
Sachin Agarwal, 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.
Josef Dankiewicz, Department of Cardiology, Skåne University Hospital, Lund, Sweden.
Allison Dupont, Department of Cardiology, Northside Cardiovascular Institute, Atlanta, GA, United States.
Hans Friberg, Department of Clinical Sciences, Intensive and Perioperative Care, Lund University, Skåne University Hospital, Malmö, Sweden.
Robert Hand
John McPherson, Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, TN, United States.
Michael Mlynash, Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, United States.
Michael Mooney, Department of Cardiology, Minneapolis Heart Institute, Abbot North-Western Hospital, Minneapolis, MN, United States.
Niklas Nielsen, Department of Anesthesiology and Intensive Care, Helsingborg Hospital, Helsingborg, Sweden, Department of Clinical Sciences, Lund University, Lund, Sweden.
Andrea O'Riordan, Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, United States.
Nainesh C. Patel MD, Lehigh Valley Health NetworkFollow
Richard R. Riker, Department of Critical Care Services, Maine Medical Center, Portland, ME, United States.
David B. Seder, Department of Critical Care Services, Maine Medical Center, Portland, ME, United States.
Eldar Soreide, Critical Care and Anaesthesiology Research Group, Stavanger University Hospital, Stavanger, Norway, Department Clinical Medicine, University of Bergen, Bergen, Norway.
Pascal Stammet, Medical and Health Department, Luxembourg Fire and Rescue Corps, Luxembourg, Luxembourg.
Wei Xiong, Department of Neurology, Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH, United States.
Karen G. Hirsch, Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, United States.

Document Type

Article

Publication Date

10-1-2021

Publication Title

Resuscitation

E-ISSN

1873-1570

Department(s)

Cardiology Division

Keywords

Cardiac arrest, Gender, Neurodiagnostic testing, Outcomes, Sex, Withdrawal

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 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.

Volume

167

First Page

66

Last Page

75

DOI

10.1016/j.resuscitation.2021.07.037

PubMed ID

34363853

Recommended Citation

Vogelsong, M. A., May, T., Agarwal, S., Cronberg, T., Dankiewicz, J., Dupont, A., Friberg, H., Hand, R., McPherson, J., Mlynash, M., Mooney, M., Nielsen, N., O'Riordan, A., Patel, N. C., Riker, R. R., Seder, D. B., Soreide, E., Stammet, P., Xiong, W., & Hirsch, K. G. (2021). Influence of sex on survival, neurologic outcomes, and neurodiagnostic testing after out-of-hospital cardiac arrest. LVHN Scholarly Works. Retrieved from https://scholarlyworks.lvhn.org/research-historical-works/32
DOI: 10.1016/j.resuscitation.2021.07.037