Previous studies examining sex differences in patients undergoing extracorporeal cardiopulmonary resuscitation (ECPR) for out-of-hospital cardiac arrest (OHCA) have indicated that women have favorable outcomes; however, detailed evidence remains lacking. We aimed to investigate sex differences in the backgrounds and outcomes of patients undergoing ECPR for OHCA. This study was a secondary analysis of the registry from the SAVE-J II study, a retrospective multicenter study conducted in Japan from 2013 to 2018. Adult patients without external causes who underwent ECPR for OHCA were included. The primary outcome was a favorable neurological outcome (Cerebral Performance Status 1 or 2) at hospital discharge. We used multilevel logistic regression to evaluate the association of sex differences, adjusting for center-level (hospital) and individual-level variables (patient background, cardiac arrest situation, and in-hospital intervention factors). For sensitivity analyses, we performed three models of multilevel logistic regression when selecting confounders. Among the 1819 patients, 1523 (83.7%) were men, and 296 (16.3%) were women. The median age (61.0 vs. 58.0 years), presence of a witness (78.8% vs. 79.2%), and occurrence of bystander CPR (57.5% vs. 61.6%) were similar between groups. Women were more likely to present with an initial non-shockable rhythm (31.7% vs. 49.7%), as well as a non-shockable rhythm at hospital arrival (52.1% vs. 61.5%) and at ECMO initiation (48.1% vs. 57.1%). The proportion of favorable neurological outcomes was 12.3% in males and 15.9% in females (p = 0.10). Multilevel logistic regression analysis showed that the female sex was significantly associated with a favorable neurologic outcome at discharge (adjusted odds ratio: 1.60 [95% confidence interval: 1.05–2.43]; p = 0.03). This advantage in women was consistently observed in the sensitivity analyses. The female sex is significantly associated with favorable neurological outcomes at hospital discharge in patients who received ECPR for OHCA.

中文翻译：

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院外心脏骤停体外心肺复苏的性别差异：日本全国多中心回顾性研究


先前检查接受体外心肺复苏 （ECPR） 的患者的性别差异的研究表明，女性预后良好;然而，仍然缺乏详细的证据。我们旨在调查接受 ECPR 治疗 OHCA 的患者背景和结局的性别差异。本研究是对 SAVE-J II 研究的登记处的二次分析，该研究是 2013 年至 2018 年在日本进行的一项回顾性多中心研究。纳入无外部原因且接受 ECPR 治疗 OHCA 的成年患者。主要结局是出院时良好的神经系统结局 （脑功能状态 1 或 2）。我们使用多水平 logistic 回归来评估性别差异的关联，调整中心水平 （医院） 和个人水平变量 （患者背景、心脏骤停情况和院内干预因素）。对于敏感性分析，我们在选择混杂因素时执行了三个多水平 logistic 回归模型。在 1819 例患者中，男性 1523 例 （83.7%），女性 296 例 （16.3%）。各组之间的中位年龄 （61.0 vs. 58.0 岁）、目击者在场 （78.8% vs. 79.2%） 和旁观者 CPR 的发生率 （57.5% vs. 61.6%） 相似。女性更可能出现初始不可电击心律 （31.7% vs. 49.7%），以及到达医院时 （52.1% vs. 61.5%） 和 ECMO 开始时 （48.1% vs. 57.1%） 时出现不可电击心律。良好的神经系统结果的比例在男性中为 12.3%，在女性中为 15.9% （p = 0.10）。多水平 logistic 回归分析显示，女性与出院时良好的神经系统结局显著相关 （调整后的比值比： 1.60 [95% 置信区间：1.05–2.43];p = 0.03）。在敏感性分析中一致观察到女性的这一优势。在接受 ECPR for OHCA 的患者中，女性与出院时良好的神经系统结局显著相关。