Awad Emad M, Humphries Karin H, Grunau Brian E, Norris Colleen M, Christenson Jim M
Faculty of Medicine, Experimental Medicine, University of British Columbia, 2775 Laurel Street, 10th Floor, Room 10117, Vancouver, BC, V5Z 1M9, Canada.
BC RESURECT: BC Resuscitation Research Collaborative, Vancouver, British Columbia, Canada.
Int J Emerg Med. 2022 Sep 5;15(1):43. doi: 10.1186/s12245-022-00447-z.
Previous studies of the effect of sex on after out-of-hospital cardiac arrest (OHCA) outcomes focused on survival to hospital discharge and 1-month survival. Studies on the effect of sex on neurological function after OHCA are still limited. The objective of this study was to identify the predictors of favorable neurological outcome and to examine the association between sex as a biological variable and favorable neurological outcome OHCA.
Retrospective analyses of clustered data from the Resuscitation Outcomes Consortium multi-center randomized controlled trial (2011-2015). We included adults with non-traumatic OHCA and EMS-attended OHCA. We used multilevel logistic regression to examine the association between sex and favorable neurological outcomes (modified Rankin Scale) and to identify the predictors of favorable neurological outcome.
In total, 22,416 patients were included. Of those, 8109 (36.2%) were females. The multilevel analysis identified the following variables as significant predictors of favorable neurological outcome: younger age, shorter duration of EMS arrival to the scene, arrest in public location, witnessed arrest, bystander CPR, chest compression rate (CCR) of 100-120 compressions per minute, induction of hypothermia, and initial shockable rhythm. Two variables, insertion of an advanced airway and administration of epinephrine, were associated with poor neurological outcome. Our analysis showed that males have higher crude rates of survival with favorable neurological outcome (8.6 vs. 4.9%, p < 0.001). However, the adjusted rate was not significant. Further analyses showed that hypothermia had a significantly greater effect on males than females.
Males had significantly higher crude rates of survival with favorable neurological outcome. However, the adjusted rate was not statistically significant. Males derived significantly greater benefit from hypothermia management than females, but this can possibly be explained by differences in arrest characteristics or in-hospital treatment. In-depth confirmatory studies on the hypothermia effect size by sex are required.
既往关于性别对院外心脏骤停（OHCA）后结局影响的研究主要集中在出院生存率和1个月生存率。关于性别对OHCA后神经功能影响的研究仍然有限。本研究的目的是确定良好神经功能结局的预测因素，并探讨作为生物学变量的性别与OHCA良好神经功能结局之间的关联。
对复苏结局联盟多中心随机对照试验（2011 - 2015年）的聚类数据进行回顾性分析。我们纳入了非创伤性OHCA且有急救医疗服务（EMS）参与的成年患者。我们使用多水平逻辑回归来检验性别与良好神经功能结局（改良Rankin量表）之间的关联，并确定良好神经功能结局的预测因素。
总共纳入了22416例患者。其中，8109例（36.2%）为女性。多水平分析确定以下变量为良好神经功能结局的显著预测因素：年龄较小、EMS到达现场的时间较短、在公共场所发生心脏骤停、目睹心脏骤停、旁观者实施心肺复苏、每分钟100 - 120次按压的胸外按压速率（CCR）、诱导低温以及初始可电击心律。两个变量，即高级气道的插入和肾上腺素的使用，与不良神经功能结局相关。我们的分析表明，男性具有良好神经功能结局的粗生存率较高（8.6%对4.9%，p < 0.001）。然而，调整后的比率并不显著。进一步分析表明，低温对男性的影响显著大于女性。
男性具有良好神经功能结局的粗生存率显著较高。然而，调整后的比率在统计学上并不显著。男性从低温治疗中获得的益处显著大于女性，但这可能可以通过心脏骤停特征或院内治疗的差异来解释。需要对性别对低温效应大小进行深入的验证性研究。
