Sex differences in cardiac arrest survivors who receive therapeutic hypothermia

Greenberg, Marna Rayl; Ahnert, Amy M.; Patel, Nainesh C; Bennett, Courtney; Elliott, Nicole; Lundquist, M. Brayden; Miller, Andrew H.; Feiner, Ellina Cheskis; Kurt, Anita; Glenn-Porter, Bernadette; Scott, Mercedes; Burmeister, David B.

doi:10.1016/j.ajem.2014.02.004

Cited by 12 publications

(10 citation statements)

References 17 publications

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“…In contrast to the experimental study, a neuroprotective effect of endogenous estrogen might be attenuated or underestimated in the human TTM setting using clinical measures for neurological function [ 31 ]. Our study is comparable to four studies that included TTM-treated OHCA patients who were similar to our study subjects [ 13 – 16 ]. In all studies, female sex was not associated with neurological outcomes when other confounders were adjusted, but the authors did not analyze the impact of reproductive age on the outcome [ 13 – 16 ].…”

Section: Discussionsupporting

confidence: 86%

“…Importantly, these data did not include postresuscitation neurological outcomes. Although some studies enrolled these patients, they were not focused on interactions between patient sex and age [ 13 – 16 ]. Therefore, whether sex affects neurological outcomes after TTM and whether the specific sex advantage is age-specific remain unclear.…”

Section: Introductionmentioning

confidence: 99%

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The impact of sex and age on neurological outcomes in out-of-hospital cardiac arrest patients with targeted temperature management

Park

Lim

et al. 2017

Crit Care

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BackgroundThere are conflicting data regarding sex-based differences in the outcomes of out-of-hospital cardiac arrest (OHCA) patients, and whether the specific sex advantage is age-specific remains unclear. We assessed the impact of the interactions between sex and age on the neurological outcomes of OHCA patients receiving targeted temperature management (TTM).MethodsData collected from 2007 to 2012 for a multicenter, registry-based study of the Korean Hypothermia Network were analyzed. We used a multivariate logistic regression model with an interaction term (age × sex) as the final model for the outcomes. To evaluate the association between sex and outcome in specific age groups, all patients were divided into specific age subgroups, and the adjusted ORs and 95% CIs of good neurological outcomes for males were calculated for each age group. Finally, the ORs of a good neurological outcome for the specific age groups compared with the 50- to 59-year-old group were calculated for both sexes.ResultsIn the interaction analysis, age was a negative prognostic factor (OR, 0.95 [95% CI, 0.93-0.98]), whereas sex was not associated with neurological outcomes (OR, 3.74 [95% CI, 0.85–16.35]), and reproductive age in females (age, < 50 years) was also not associated with good neurological outcomes. After the patients were divided into five age groups, sex was not an independent predictor of neurological outcomes across all age groups. Patients of both sexes aged < 40 years had significantly better outcomes than patients in the 50- to 59-year-old group (males, OR, 4.03 [95% CI, 1.86–8.73]; females, OR, 10.34 [95% CI, 1.99–53.85]). Males aged ≥ 70 years had significantly poorer neurological outcomes than those in the 50- to 59-year-old group (OR, 0.15 [95% CI, 0.07–0.32]), but this outcome was not observed for females (OR, 0.78 [95% CI, 0.20–3.14]).ConclusionsSex did not influence the neurological outcomes of TTM-treated OHCA patients. In contrast to the outcomes in males, the neurological outcomes of females worsened from 18 to 59 years of age and then remained constant.

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Section: Discussionsupporting

confidence: 86%

Section: Introductionmentioning

confidence: 99%

The impact of sex and age on neurological outcomes in out-of-hospital cardiac arrest patients with targeted temperature management

Park

Lim

et al. 2017

Crit Care

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“…There has been ample evidence suggesting that women have worse outcomes across a variety of cardiovascular procedures/surgeries, including coronary artery bypass grafting surgery and primary PCI for ST‐segment elevation myocardial infarction (STEMI) . However, data regarding sex‐based differences in outcomes following cardiac arrest have been conflicting, with some studies showing worse survival among women and others showing comparable or even better survival in women . Given limited and contradictory published data, we sought to characterize sex‐based disparities and trends in presentation, treatment strategies, and in‐hospital clinical outcomes for all cardiac arrests, as well as for subgroups of VT/VF and PEA/asystole, in a large, national contemporary database from 2003 to 2012.…”

Section: Introductionmentioning

confidence: 99%

“…17 However, data regarding sex-based differences in outcomes following cardiac arrest have been conflicting, with some studies showing worse survival among women and others showing comparable or even better survival in women. [18][19][20][21][22][23] Given limited and contradictory published data, we sought to characterize sex-based disparities and trends in presentation, treatment strategies, and in-hospital clinical outcomes for all cardiac arrests, as well as for subgroups of VT/VF and PEA/ asystole, in a large, national contemporary database from 2003 to 2012. Our findings will further our understanding of mechanisms contributing to the cardiac arrest sex gap and may assist in the resolution of discrepant historical data.…”

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confidence: 99%

Sex‐Based Disparities in Incidence, Treatment, and Outcomes of Cardiac Arrest in the United States, 2003–2012

Kim

Looser

Swaminathan

et al. 2016

JAHA

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BackgroundRecent studies have shown improving survival after cardiac arrest. However, data regarding sex‐based disparities in treatment and outcomes after cardiac arrest are limited.Methods and ResultsWe performed a retrospective analysis of all patients suffering cardiac arrest between 2003 and 2012 using the Nationwide Inpatient Sample database. Annual rates of cardiac arrest, rates of utilization of coronary angiography/percutaneous coronary interventions/targeted temperature management, and sex‐based outcomes after cardiac arrest were examined. Among a total of 1 436 052 discharge records analyzed for cardiac arrest patients, 45.4% (n=651 745) were females. Women were less likely to present with ventricular tachycardia/ventricular fibrillation arrests compared with men throughout the study period. The annual rates of cardiac arrests have increased from 2003 to 2012 by 14.0% (P trend<0.001) and ventricular tachycardia/ventricular fibrillation arrests have increased by 25.9% (P trend<0.001). Women were less likely to undergo coronary angiography, percutaneous coronary interventions, or targeted temperature management in both ventricular tachycardia/ventricular fibrillation and pulseless electrical activity/asystole arrests. Over a 10‐year study period, there was a significant decrease in in‐hospital mortality in women (from 69.1% to 60.9%, P trend<0.001) and men (from 67.2% to 58.6%, P trend<0.001) after cardiac arrest. In‐hospital mortality was significantly higher in women compared with men (64.0% versus 61.4%; adjusted odds ratio 1.02, P<0.001), particularly in the ventricular tachycardia/ventricular fibrillation arrest cohort (49.4% versus 45.6%; adjusted odds ratio 1.11, P<0.001).ConclusionsWomen presenting with cardiac arrests are less likely to undergo therapeutic procedures, including coronary angiography, percutaneous coronary interventions, and targeted temperature management. Despite trends in improving survival after cardiac arrest over 10 years, women continue to have higher in‐hospital mortality when compared with men.

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“…In these studies, obesity has been associated with longer duration of time to reach target temperature; although in one study there was no difference in survival. [11,12,21,22] It is acknowledged that fewer obese patients presented with ventricular fibrillation than non-obese patients, which may affect the findings. Nevertheless, we show contemporary results of patients stratified by BMI with similar percentages of non-shockable rhythms, ventricular tachycardia, and similar achievement of target temperatures; obesity was associated with reduced survival.…”

Section: Discussionmentioning

confidence: 99%

The impact of body mass index on patient survival after therapeutic hypothermia after resuscitation

Breathett

Mehta

Yıldız

et al. 2016

The American Journal of Emergency Medicine

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OBJECTIVES Therapeutic hypothermia improves survival in patients following cardiac arrest; yet the impact of body mass index(BMI) on survival is lesser known. We hypothesized that non-obese patients would have greater survival post therapeutic hypothermia than obese patients. METHODS We retrospectively evaluated 164 patients who underwent therapeutic hypothermia following resuscitation for cardiac arrest from 1/2012-9/2014. Logistic regression analysis was used to assess for survival based upon BMI and comorbidities(odds ratio[OR], 95% confidence interval[CI]). RESULTS Forty-one percent of patients were obese. Obese patients presented less frequently with ventricular fibrillation(p=0.046) but had similar rates of pulseless electrical activity(p=0.479), and ventricular tachycardia(p=0.262) as non-obese patients. In multivariable analysis, BMI <30kg/m2, hypertension, presence of pacemaker/implantable cardioverter defibrillator(PM/ICD), high glomerular filtration rate(GFR), and low neuron-specific enolase(NSE) were all associated with increased survival post therapeutic hypothermia respectively: 0.36(0.16-0.78), 0.28(0.12-0.66), 0.23(0.08-0.62), 0.25(0.11-0.56), 0.37(0.14-0.96). Other comorbidities demonstrated no association with survival. CONCLUSIONS BMI ≥30kg/m2 compared to BMI <30kg/m2 was a significant risk factor for mortality post therapeutic hypothermia protocol. Absence of history of hypertension, lack of PM/ICD, high NSE, and renal disease had greater associations with death. Larger studies will be needed to validate these findings.

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Sex differences in cardiac arrest survivors who receive therapeutic hypothermia

Cited by 12 publications

References 17 publications

The impact of sex and age on neurological outcomes in out-of-hospital cardiac arrest patients with targeted temperature management

The impact of sex and age on neurological outcomes in out-of-hospital cardiac arrest patients with targeted temperature management

Sex‐Based Disparities in Incidence, Treatment, and Outcomes of Cardiac Arrest in the United States, 2003–2012

The impact of body mass index on patient survival after therapeutic hypothermia after resuscitation

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