Do Women Have a Higher Mortality Risk Than Men following ICU Admission after Out-of-Hospital Cardiac Arrest? A Retrospective Cohort Analysis.
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ABSTRACT: Purpose
previous studies showed that women have a higher mortality risk than men after out-of-hospital cardiac arrest (OHCA). This sex difference may disappear after adjustment for cardiac arrest characteristics. Most studies also included patients who were not admitted to the intensive care unit (ICU). We analyzed whether sex impacts the mortality of ICU-admitted OHCA patients.Methods
a retrospective cohort analysis of 1240 OHCA patients admitted to the ICU (310 women, 25%, AgeMedian 64.0 (IQR 53.8-73.0)) at an academic hospital in the Netherlands between 1 January 2007 and 31 December 2018. The primary outcome was 90-day mortality; the secondary outcome was a favorable cerebral performance category (CPC) score at ICU discharge and ICU length of stay (ICU LOS).Results
we found no association between sex and 90-day mortality (hazard ratio (HR) 0.867; 95% confidence interval (95% CI) 0.678-1.108) after adjusting for relevant cardiac arrest characteristics. Similarly, we found no difference for favorable CPC score (OR 1.117; 95% CI 0.777-1.608) or ICU LOS between sexes (Beta 0.428; 95% CI -0.442 to 1.298).Conclusions
after adjusting for cardiac arrest characteristics, we found no difference between women and men with respect to 90-day mortality, ICU LOS, and CPC score.
SUBMITTER: van Wees C
PROVIDER: S-EPMC8470772 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description: Not available
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Project description:Post-resuscitation hemodynamic instability following out-of-hospital cardiac arrest (OHCA) may occur from myocardial dysfunction underlying cardiogenic shock and/or inflammation-mediated distributive shock. Distinguishing the predominant shock subtype with widely available clinical metrics may have prognostic and therapeutic value.A two-hospital cohort was assembled of patients in shock following OHCA. Left ventricular ejection fraction (LVEF) was assessed via echocardiography or cardiac ventriculography within 1 day post arrest and used to delineate shock physiology. The study evaluated whether higher LVEF, indicating distributive-predominant shock physiology, was associated with neurocognitive outcome (primary endpoint), survival, and duration of multiple organ failures. The study also investigated whether volume resuscitation exhibited a subtype-specific association with outcome.Of 162 patients with post-resuscitation shock, 48% had normal LVEF (>?40%), consistent with distributive shock physiology. Higher LVEF was associated with less favorable neurocognitive outcome (OR 0.74, 95% CI 0.58-0.94 per 10% increase in LVEF; p?=?0.01). Higher LVEF also was associated with worse survival (OR 0.81, 95% CI 0.67-0.97; p?=?0.02) and fewer organ failure-free days (? = - 0.67, 95% CI - 1.28 to -?0.06; p?=?0.03). Only 51% of patients received a volume challenge of at least 30 ml/kg body weight in the first 6 h post arrest, and the volume received did not differ by LVEF. Greater volume resuscitation in the first 6 h post arrest was associated with favorable neurocognitive outcome (OR 1.59, 95% CI 0.99-2.55 per liter; p?=?0.03) and survival (OR 1.44, 95% CI 1.02-2.04; p?=?0.02) among patients with normal LVEF but not low LVEF.In post-resuscitation shock, higher LVEF-indicating distributive shock physiology-was associated with less favorable neurocognitive outcome, fewer days without organ failure, and higher mortality. Greater early volume resuscitation was associated with more favorable neurocognitive outcome and survival in patients with this shock subtype. Additional studies with repeated measures of complementary hemodynamic parameters are warranted to validate the clinical utility for subtyping post-resuscitation shock.
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Project description:ImportanceTherapeutic delivery of sodium nitrite during resuscitation improved survival in animal models of cardiac arrest, but efficacy has not been evaluated in clinical trials in humans.ObjectiveTo determine whether parenteral administration of sodium nitrite given by paramedics during resuscitation for out-of-hospital cardiac arrest improved survival to hospital admission.Design, setting, and participantsDouble-blind, placebo-controlled, phase 2 randomized clinical trial including 1502 adults in King County, Washington, with out-of-hospital cardiac arrest from ventricular fibrillation or nonventricular fibrillation. Patients underwent resuscitation by paramedics and were enrolled between February 8, 2018, and August 19, 2019; follow-up and data abstraction were completed by December 31, 2019.InterventionsEligible patients with out-of-hospital cardiac arrest were randomized (1:1:1) to receive 45 mg of sodium nitrite (n = 500), 60 mg of sodium nitrite (n = 498), or placebo (n = 499), which was given via bolus injection by the paramedics as soon as possible during active resuscitation.Main outcomes and measuresThe primary outcome was survival to hospital admission and was evaluated with 1-sided hypothesis testing. The secondary outcomes included out-of-hospital variables (rate of return of spontaneous circulation, rate of rearrest, and use of norepinephrine to support blood pressure) and in-hospital variables (survival to hospital discharge; neurological outcomes at hospital discharge; cumulative survival to 24 hours, 48 hours, and 72 hours; and number of days in the intensive care unit).ResultsAmong 1502 patients with out-of-hospital cardiac arrest who were randomized (mean age, 64 years [SD, 17 years]; 34% were women), 99% completed the trial. Overall, 205 patients (41%) in the 45 mg of sodium nitrite group and 212 patients (43%) in the 60 mg of sodium nitrite group compared with 218 patients (44%) in the placebo group survived to hospital admission; the mean difference for the 45-mg dose vs placebo was -2.9% (1-sided 95% CI, -8.0% to ∞; P = .82) and the mean difference for the 60-mg dose vs placebo was -1.3% (1-sided 95% CI, -6.5% to ∞; P = .66). None of the 7 prespecified secondary outcomes were significantly different, including survival to hospital discharge for 66 patients (13.2%) in the 45 mg of sodium nitrite group and 72 patients (14.5%) in the 60 mg of sodium nitrite group compared with 74 patients (14.9%) in the placebo group; the mean difference for the 45-mg dose vs placebo was -1.7% (2-sided 95% CI, -6.0% to 2.6%; P = .44) and the mean difference for the 60-mg dose vs placebo was -0.4% (2-sided 95% CI, -4.9% to 4.0%; P = .85).Conclusions and relevanceAmong patients with out-of-hospital cardiac arrest, administration of sodium nitrite, compared with placebo, did not significantly improve survival to hospital admission. These findings do not support the use of sodium nitrite during resuscitation from out-of-hospital cardiac arrest.Trial registrationClinicalTrials.gov Identifier: NCT03452917.
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