PMID- 38292453
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20240201
IS  - 2297-055X (Print)
IS  - 2297-055X (Electronic)
IS  - 2297-055X (Linking)
VI  - 10
DP  - 2023
TI  - Gender disparities in patients undergoing extracorporeal cardiopulmonary 
      resuscitation.
PG  - 1265978
LID - 10.3389/fcvm.2023.1265978 [doi]
LID - 1265978
AB  - INTRODUCTION: The use of venoarterial extracorporeal membrane oxygenation 
      (VA-ECMO) in extracorporeal cardiopulmonary resuscitation (eCPR) has emerged as a 
      treatment option for selected patients who are experiencing refractory cardiac 
      arrest (CA). In the light of increasing availability, the analyses of 
      outcome-relevant predisposing characteristics are of growing importance. We 
      evaluated the prognostic influence of gender in patients presenting with 
      out-of-hospital cardiac arrest (OHCA) treated with eCPR. METHODS: We 
      retrospectively analysed the data of 377 consecutive patients treated for OHCA 
      using eCPR in our cardiac arrest centre from January 2016 to December 2022. The 
      primary outcome was defined as the survival of patients until they were 
      discharged from the hospital, with a favourable neurological outcome [cerebral 
      performance category (CPC) score of </=2]. Statistical analyses were performed 
      using baseline comparison, survival analysis, and multivariable analyses. 
      RESULTS: Out of the 377 patients included in the study, 69 (21%) were female. 
      Female patients showed a lower prevalence rate of pre-existing coronary artery 
      disease (48% vs. 75%, p < 0.001) and cardiomyopathy (17% vs. 34%, p = 0.01) 
      compared with the male patients, while the mean age and prevalence rate of other 
      cardiovascular risk factors were balanced. The primary reason for CA differed 
      significantly (female: coronary event 45%, pulmonary embolism 23%, cardiogenic 
      shock 17%; male: coronary event 70%, primary arrhythmia 10%, cardiogenic shock 
      10%; p = 0.001). The prevalence rate of witnessed collapse (97% vs. 86%; 
      p = 0.016) and performance of bystander CPR (94% vs. 85%; p = 0.065) was higher 
      in female patients. The mean time from collapse to the initiation of eCPR did not 
      differ between the two groups (77 +/- 39 min vs. 80 +/- 37 min; p = 0.61). Overall, 
      female patients showed a higher percentage of neurologically favourable survival 
      (23% vs. 12%; p = 0.027) despite a higher prevalence of procedure-associated 
      bleeding complications (33% vs. 16%, p = 0.002). The multivariable analysis 
      identified a shorter total CPR duration (p = 0.001) and performance of bystander 
      CPR (p = 0.03) to be associated with superior neurological outcomes. The 
      bivariate analysis showed relevant interactions between gender and body mass 
      index (BMI). CONCLUSION: Our analysis suggests a significant survival benefit for 
      female patients who obtain eCPR, possibly driven by a higher prevalence of 
      witnessed collapse and bystander CPR. Interestingly, the impact of patient age 
      and BMI on neurologically favourable outcome was higher in female patients than 
      in male patients, warranting further investigation.
CI  - (c) 2024 Springer, Dreher, Reimers, Kaiser, Bahlmann, van der Schalk, Wohlmuth, 
      Gessler, Hassan, Wietz, Bein, Spangenberg, Willems, Hakmi and Tigges.
FAU - Springer, A
AU  - Springer A
AD  - Department of Cardiology and Critical Care, Asklepios Clinic St. Georg, Hamburg, 
      Germany.
FAU - Dreher, A
AU  - Dreher A
AD  - Department of Cardiology and Critical Care, Asklepios Clinic St. Georg, Hamburg, 
      Germany.
FAU - Reimers, J
AU  - Reimers J
AD  - Department of Cardiology and Critical Care, Asklepios Clinic St. Georg, Hamburg, 
      Germany.
FAU - Kaiser, L
AU  - Kaiser L
AD  - Department of Cardiology and Critical Care, Asklepios Clinic St. Georg, Hamburg, 
      Germany.
FAU - Bahlmann, E
AU  - Bahlmann E
AD  - Department of Cardiology and Critical Care, Asklepios Clinic St. Georg, Hamburg, 
      Germany.
FAU - van der Schalk, H
AU  - van der Schalk H
AD  - Department of Cardiology and Critical Care, Asklepios Clinic St. Georg, Hamburg, 
      Germany.
FAU - Wohlmuth, P
AU  - Wohlmuth P
AD  - Asklepios ProResearch, Hamburg, Germany.
FAU - Gessler, N
AU  - Gessler N
AD  - Department of Cardiology and Critical Care, Asklepios Clinic St. Georg, Hamburg, 
      Germany.
AD  - Asklepios ProResearch, Hamburg, Germany.
AD  - DZHK (German Centre for Cardiovascular Research), Partner Site 
      Hamburg/Kiel/Luebeck, Hamburg, Germany.
FAU - Hassan, K
AU  - Hassan K
AD  - Department of Cardiac Surgery, Asklepios Clinic St. Georg, Hamburg, Germany.
FAU - Wietz, J
AU  - Wietz J
AD  - Department of Emergency Medicine, Asklepios Clinic St. Georg, Hamburg, Germany.
FAU - Bein, B
AU  - Bein B
AD  - Department of Anaesthesiology and Critical Care, Asklepios Clinic St. Georg, 
      Hamburg, Germany.
FAU - Spangenberg, T
AU  - Spangenberg T
AD  - Department of Cardiology and Critical Care, Asklepios Clinic Altona, Hamburg, 
      Germany.
FAU - Willems, S
AU  - Willems S
AD  - Department of Cardiology and Critical Care, Asklepios Clinic St. Georg, Hamburg, 
      Germany.
AD  - DZHK (German Centre for Cardiovascular Research), Partner Site 
      Hamburg/Kiel/Luebeck, Hamburg, Germany.
AD  - Semmelweis-University, Budapest, Hungary.
FAU - Hakmi, S
AU  - Hakmi S
AD  - DZHK (German Centre for Cardiovascular Research), Partner Site 
      Hamburg/Kiel/Luebeck, Hamburg, Germany.
AD  - Department of Cardiac Surgery, Asklepios Clinic St. Georg, Hamburg, Germany.
FAU - Tigges, E
AU  - Tigges E
AD  - Department of Cardiology and Critical Care, Asklepios Clinic St. Georg, Hamburg, 
      Germany.
AD  - DZHK (German Centre for Cardiovascular Research), Partner Site 
      Hamburg/Kiel/Luebeck, Hamburg, Germany.
LA  - eng
PT  - Journal Article
DEP - 20240116
PL  - Switzerland
TA  - Front Cardiovasc Med
JT  - Frontiers in cardiovascular medicine
JID - 101653388
PMC - PMC10824923
OTO - NOTNLM
OT  - CPR
OT  - OHCA
OT  - VA-ECMO
OT  - eCPR
OT  - gender
COIS- The authors declare that the research was conducted in the absence of any 
      commercial or financial relationships that could be construed as a potential 
      conflict of interest.
EDAT- 2024/01/31 06:42
MHDA- 2024/01/31 06:43
PMCR- 2023/01/01
CRDT- 2024/01/31 04:11
PHST- 2023/07/25 00:00 [received]
PHST- 2023/11/30 00:00 [accepted]
PHST- 2024/01/31 06:43 [medline]
PHST- 2024/01/31 06:42 [pubmed]
PHST- 2024/01/31 04:11 [entrez]
PHST- 2023/01/01 00:00 [pmc-release]
AID - 10.3389/fcvm.2023.1265978 [doi]
PST - epublish
SO  - Front Cardiovasc Med. 2024 Jan 16;10:1265978. doi: 10.3389/fcvm.2023.1265978. 
      eCollection 2023.