Department of Emergency Medicine University of Colorado, School of Medicine Aurora CO.
Adult and Child Consortium for Health Outcomes Research and Delivery Science University of Colorado, School of Medicine Aurora CO.
J Am Heart Assoc. 2020 Feb 18;9(4):e014200. doi: 10.1161/JAHA.119.014200. Epub 2020 Feb 17.
Background Women have higher utilization of "do not attempt resuscitation" (DNAR) orders during treatment for critical illness. Occurrence of sex differences in the establishment of DNAR orders after resuscitation from in-hospital cardiac arrest is unknown. Whether differences in DNAR use by sex lead to disparities in survival remains unclear. Methods and Results We identified 71 820 patients with return of spontaneous circulation (ROSC) after in-hospital cardiac arrest from the Get With The Guidelines-Resuscitation registry. Multivariable models evaluated the association between de novo DNAR (anytime after ROSC, within 12 hours of ROSC, or within 72 hours of ROSC) by sex and the association between sex and survival to discharge accounting for DNAR. All models accounted for clustering of patients within hospital and adjusted for demographic and cardiac arrest characteristics. The cohort included 30 454 (42.4%) women, who were slightly more likely than male participants to establish DNAR orders anytime after ROSC (45.0% versus 43.5%; adjusted relative risk: 1.15 [95% CI, 1.10-1.20]; <0.0001). Of those with DNAR orders, women were more likely to be DNAR status within the first 12 hours (51.8% versus 46.5%; adjusted relative risk: 1.40 [95% CI, 1.30-1.52]; <0.0001) and within 72 hours after ROSC (75.9% versus 70.9%; adjusted relative risk: 1.35 [95% CI, 1.26-1.45]; <0.0001). However, no difference in survival to hospital discharge between women and men (34.5% versus 36.7%; adjusted relative risk: 1.00 [95% CI, 0.99-1.02]; =0.74) was appreciated. Conclusions In patients successfully resuscitated from in-hospital cardiac arrest, there was no survival difference between men and women while accounting for DNAR. However, women had a higher rate of DNAR status early after resuscitation (<12 and <72 hours) in comparison to men.
在治疗危急病症时，女性更倾向于下达“不进行复苏尝试”（DNAR）医嘱。但在院内心跳骤停复苏后建立 DNAR 医嘱时是否存在性别差异尚不清楚。DNAR 使用的性别差异是否会导致生存结果的差异也尚不清楚。
我们从 Get With The Guidelines-Resuscitation 注册研究中确定了 71820 例经院内复苏后恢复自主循环（ROSC）的患者。多变量模型评估了性别与复苏后任何时间（ROSC 后 12 小时内或 ROSC 后 72 小时内）新建立的 DNAR 之间的关联，以及性别与生存至出院之间的关联，同时考虑了 DNAR 的使用情况。所有模型均考虑了患者在医院内的聚类，并调整了人口统计学和心脏骤停特征。该队列纳入了 30454 例（42.4%）女性，与男性参与者相比，女性更有可能在任何时候建立 DNAR 医嘱（45.0%比 43.5%；调整后的相对风险：1.15[95%CI，1.10-1.20]；<0.0001）。在下达 DNAR 医嘱的患者中，女性在 ROSC 后 12 小时内（51.8%比 46.5%；调整后的相对风险：1.40[95%CI，1.30-1.52]；<0.0001）和 ROSC 后 72 小时内（75.9%比 70.9%；调整后的相对风险：1.35[95%CI，1.26-1.45]；<0.0001）更有可能被认定为 DNAR 状态。然而，女性和男性在出院时的生存率并无差异（34.5%比 36.7%；调整后的相对风险：1.00[95%CI，0.99-1.02]；=0.74）。
在成功复苏的院内心脏骤停患者中，在考虑 DNAR 的情况下，男性和女性之间的生存率没有差异。然而，与男性相比，女性在复苏后早期（<12 小时和<72 小时）更有可能被判定为 DNAR 状态。
