Postresuscitation care and prognostication after cardiac arrest—Does sex matter?

Abstract

Summary Background There are conflicting results concerning sex-specific differences in the post-cardiac arrest period. We investigated the sex distribution of patients after successful cardiopulmonary resuscitation (CPR), differences in treatment, complications, outcome and sex-specific performance of biomarkers for prognostication of neurological outcome. Methods Prospective observational study including cardiac-arrest (CA) patients treated with mild therapeutic hypothermia (MTH) at 33 °C for 24 h or normothermia. We investigated common complications including pneumonia and acute kidney injury (AKI) and neuron-specific enolase, secretoneurin and tau protein as biomarkers of neurological outcome, which was assessed with the cerebral performance categories score at hospital discharge. Results Out of 134 patients 26% were female. Women were significantly older (73 years, interquartile range (IQR) 56–79 years vs. 62 years, IQR 53–70 years; p = 0.038), whereas men showed a significantly higher rate of pneumonia (29% vs. 6%; p = 0.004) and a trend towards higher rates of AKI (62% vs. 45%; p = 0.091). Frequency of MTH treatment was not significantly different (48% vs. 31%; p = 0.081). Female sex was not associated with neurological outcome in multivariable analysis (p = 0.524). There was no significant interaction of sex with prognostication of neurological outcome at 24, 48 and 72 h after CPR. At the respective time intervals pinteraction for neuron-specific enolase was 0.524, 0.221 and 0.519, for secretoneurin 0.893, 0.573 and 0.545 and for tau protein 0.270, 0.635, and 0.110. Conclusion The proportion of female patients was low. Women presented with higher age but had fewer complications during the post-CA period. Female sex was not associated with better neurological outcome. The performance of biomarkers is not affected by sex.

Increased risk of ventilator‐associated pneumonia in patients after cardiac arrest treated with mild therapeutic hypothermia

“…Among these are a higher rate of patients resuscitated from OHCA. Originally, the planning of this study together with the power calculation was targeted on the neuroprognostication by biomarkers 37,38 . The incidence of VAP was considered as secondary end‐point in the original protocol.…”

“…Originally, the planning of this study together with the power calculation was targeted on the neuroprognostication by biomarkers. 37,38 The incidence of VAP was considered as secondary end-point in the original protocol. According to the VAP definition, patients had to receive mechanical ventilation and survive for at least 48 h.…”