Department of Critical Care and Emergency Medicine, Japanese Red Cross Maebashi Hospital, Maebashi, Gunma, Japan.
Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore.
Crit Care. 2024 Oct 31;28(1):302. doi: 10.1186/s13054-024-05086-9.
Previous studies examining sex differences in patients undergoing extracorporeal cardiopulmonary resuscitation (ECPR) for out-of-hospital cardiac arrest (OHCA) have indicated that women have favorable outcomes; however, detailed evidence remains lacking. We aimed to investigate sex differences in the backgrounds and outcomes of patients undergoing ECPR for OHCA.
This study was a secondary analysis of the registry from the SAVE-J II study, a retrospective multicenter study conducted in Japan from 2013 to 2018. Adult patients without external causes who underwent ECPR for OHCA were included. The primary outcome was a favorable neurological outcome (Cerebral Performance Status 1 or 2) at hospital discharge. We used multilevel logistic regression to evaluate the association of sex differences, adjusting for center-level (hospital) and individual-level variables (patient background, cardiac arrest situation, and in-hospital intervention factors). For sensitivity analyses, we performed three models of multilevel logistic regression when selecting confounders.
Among the 1819 patients, 1523 (83.7%) were men, and 296 (16.3%) were women. The median age (61.0 vs. 58.0 years), presence of a witness (78.8% vs. 79.2%), and occurrence of bystander CPR (57.5% vs. 61.6%) were similar between groups. Women were more likely to present with an initial non-shockable rhythm (31.7% vs. 49.7%), as well as a non-shockable rhythm at hospital arrival (52.1% vs. 61.5%) and at ECMO initiation (48.1% vs. 57.1%). The proportion of favorable neurological outcomes was 12.3% in males and 15.9% in females (p = 0.10). Multilevel logistic regression analysis showed that the female sex was significantly associated with a favorable neurologic outcome at discharge (adjusted odds ratio: 1.60 [95% confidence interval: 1.05-2.43]; p = 0.03). This advantage in women was consistently observed in the sensitivity analyses.
The female sex is significantly associated with favorable neurological outcomes at hospital discharge in patients who received ECPR for OHCA.
先前研究表明，在因院外心脏骤停（OHCA）接受体外心肺复苏（ECPR）的患者中，女性存在有利的结局，但详细证据仍缺乏。我们旨在探究因 OHCA 接受 ECPR 的患者在背景和结局方面的性别差异。
这是 SAVE-J II 研究注册数据的二次分析，这是一项 2013 年至 2018 年在日本开展的回顾性多中心研究。纳入无外在原因导致的接受 ECPR 治疗的 OHCA 成年患者。主要结局为出院时的良好神经功能结局（脑功能状态 1 或 2）。我们使用多水平逻辑回归来评估性别差异的关联，调整中心水平（医院）和个体水平变量（患者背景、心脏骤停情况和院内干预因素）。在敏感性分析中，我们在选择混杂因素时进行了三种多水平逻辑回归模型。
在 1819 例患者中，1523 例（83.7%）为男性，296 例（16.3%）为女性。两组间的中位年龄（61.0 岁 vs. 58.0 岁）、目击者存在（78.8% vs. 79.2%）和旁观者心肺复苏（57.5% vs. 61.6%）相似。女性更可能出现初始非除颤性节律（31.7% vs. 49.7%）、到院时非除颤性节律（52.1% vs. 61.5%）和 ECMO 启动时非除颤性节律（48.1% vs. 57.1%）。男性的良好神经功能结局比例为 12.3%，女性为 15.9%（p=0.10）。多水平逻辑回归分析显示，女性的性别与出院时的良好神经结局显著相关（调整优势比：1.60[95%置信区间：1.05-2.43]；p=0.03）。在敏感性分析中也观察到女性具有这一优势。
在因 OHCA 接受 ECPR 的患者中，女性的性别与出院时的良好神经功能结局显著相关。
