Disparities in the treatment of cardiogenic shock: does sex matter?

Abstract

Objectives The use of extracorporeal life support for cardiogenic shock has significantly increased over the past decade. However, there are insufficient data for the presence of sex-associated outcomes differences. Our study assesses differences between male and female patients placed on venoarterial extracorporeal life support for cardiogenic shock from an international database. Methods This is a multi-center, retrospective study on 9888 adult patients on venoarterial extracorporeal life support for cardiogenic shock from the Extracorporeal Life Support Organization registry from 2011 to 2019. 1:1 nearest neighbor propensity score matching was performed. The primary endpoint was in-hospital mortality. Secondary endpoints include bleeding, infection, and other complications. Results There were 6747 (68%) male patients and 3141 (32%) female patients. Male patients were more likely to have history of myocardial infarction, coronary artery disease, diabetes, chronic kidney disease, and congestive heart failure. Female patients were more likely to be centrally cannulated. After propensity score matching, there was no difference seen in in-hospital mortality. In regards to complications, female patients were more likely to experience limb ischemia, whereas males were more likely to receive renal replacement therapy and have longer hospital stays. Multivariable logistic regression confirmed sex was not independently associated with mortality. Conclusion There was no difference in-hospital mortality between male and female patients receiving venoarterial extracorporeal life support for cardiogenic shock. Female patients were more likely to have limb ischemia as a complication. Varying cannulation approach for female patients should be further investigated.

Health Disparities in Extracorporeal Membrane Oxygenation Utilization and Outcomes: A Scoping Review and Methodologic Critique of the Literature*

“…Of citations identifying adverse outcomes, 8 (22%) used univariate (77–84) and 28 (78%) used multivariate analyses. Of multivariate analyses, diverse populations, compared with nondiverse/White patients, were independently associated with mortality (26, 27, 29, 30, 32, 35, 85–100), adverse neurologic outcomes (101), or prolonged ECMO duration (34). One study showed higher adjusted mortality in patients with Hispanic ethnicity compared with Asian (102).…”