Key result
Male sex was not associated with good 6-month neurological outcomes compared to female sex in out-of-hospital cardiac arrest patients after adjusting for resuscitation and in-hospital confounders.
Why the study?
Conflicting results exist regarding sex-based differences in OHCA outcomes, and no study had evaluated whether in-hospital interventions and courses are driven by sex.
Does male sex improve good neurological outcomes in adult out-of-hospital cardiac arrest patients treated with targeted temperature management?
Cohort (n=1,339)
Yes
Does male sex improve good neurological outcomes in adult out-of-hospital cardiac arrest patients treated with targeted temperature management?
While men appear to have better 6-month neurological outcomes after out-of-hospital cardiac arrest, this difference is entirely explained by baseline and resuscitation confounders, indicating no independent sex difference in outcomes.
Answers are grounded in this paper and cite their sources.
No sex difference in neurological outcomes after OHCA; hypothesis-generating and should not yet change practice.
Background: Conflicting results regarding sex-based differences in the outcomes of out-of-hospital cardiac arrest (OHCA) patients have been reported. Furthermore, no study has examined whether differences in in-hospital interventions and courses are driven by sex. This study evaluated the effect of sex on the in-hospital course as well as the survival rates and long-term neurological outcomes of OHCA patients treated with targeted temperature management. Methods: We retrospectively analyzed the Korean Hypothermia Network Prospective Registry composed of data collected from 22 hospitals in Korea between October 2015 and December 2018. To evaluate the effect of sex on patient outcomes, we created various multivariate logistic regression models. Regarding the difference in in-hospital courses, we compared daily total and SOFA sub-scores between the sexes and analyzed whether the decision regarding early cardiac interventions and limitations in in-hospital care were associated with sex. Results: The rate of good neurological outcomes after 6 months was higher in men (OR = 1.66, 95% CI: 1.26 2.17). However, when the results were adjusted using resuscitation variables and in-hospital variables were added, there was no significant difference between the two sexes (OR =1.22, 95% CI: 0.85 – 1.74; OR = 1.13, 95 CI: 0.76 – 1.68, respectively). There was no association between sex and outcome in patients of reproductive age and no interaction between age and sex. Regarding the in-hospital course, the daily total SOFA score was similar in both sexes whereas cardiovascular scores were higher in women on 2 and 3 days (on day 2, p = 0.006; on day 3, p = 0.017). The adjusted effect of sex was not associated with the clinician’s decision to perform early cardiac interventions except that men had more extracorporeal membrane oxygenation (ECMO) (OR=2.51, 95% CI: 1.11-5.66). The decision to discontinue life-sustaining treatment was determined by poor prognostic factors, not by sex. Conclusions: The findings suggested that men had more favorable 6-month neurological outcomes. However, after adjusting for confounders, there was no difference between the sexes. The results regarding in-hospital course were similar in men and women.
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Park et al. (2022) conducted a cohort in Out-of-hospital cardiac arrest (OHCA) (n=1,339). Male sex vs. Female sex was evaluated on Good neurological outcome (CPC 1 or 2) at 6 months (OR 1.10, 95% CI 0.74-1.64, p=0.626). Male sex was not associated with good 6-month neurological outcomes compared to female sex in out-of-hospital cardiac arrest patients after adjusting for resuscitation and in-hospital confounders.
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