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。

IF 8.8 1区 医学 Q1 CRITICAL CARE MEDICINE Critical Care Pub Date : 2024-10-31 DOI:10.1186/s13054-024-05086-9
Akira Kawauchi, Yohei Okada, Makoto Aoki, Akihiko Inoue, Toru Hifumi, Tetsuya Sakamoto, Yasuhiro Kuroda, Mitsunobu Nakamura
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引用次数: 0

摘要

背景:以往对因院外心脏骤停(OHCA)而接受体外心肺复苏(ECPR)的患者的性别差异进行的研究表明,女性患者的预后较好;然而,目前仍缺乏详细的证据。我们旨在调查因 OHCA 而接受 ECPR 的患者在背景和预后方面的性别差异:本研究是对 SAVE-J II 研究登记资料的二次分析,SAVE-J II 研究是 2013 年至 2018 年在日本进行的一项回顾性多中心研究。研究纳入了因 OHCA 而接受 ECPR 的无外因成人患者。主要结果是出院时的良好神经功能结果(脑功能状态 1 或 2)。我们使用多层次逻辑回归来评估性别差异的相关性,并对中心(医院)和个体水平变量(患者背景、心脏骤停情况和院内干预因素)进行了调整。为了进行敏感性分析,我们在选择混杂因素时进行了三种多层次逻辑回归模型:在 1819 名患者中,1523 名(83.7%)为男性,296 名(16.3%)为女性。两组患者的年龄中位数(61.0 岁 vs. 58.0 岁)、有目击者(78.8% vs. 79.2%)和旁观者心肺复苏发生率(57.5% vs. 61.6%)相似。女性更有可能出现初始非休克心律(31.7% 对 49.7%),以及到达医院时的非休克心律(52.1% 对 61.5%)和启动 ECMO 时的非休克心律(48.1% 对 57.1%)。男性和女性获得良好神经系统预后的比例分别为 12.3% 和 15.9%(P = 0.10)。多层次逻辑回归分析显示,女性与出院时良好的神经功能预后显著相关(调整后的几率比:1.60 [95% 置信区间:1.05-2.43];p = 0.03)。女性的这一优势在敏感性分析中也得到了证实:结论:女性与因 OHCA 而接受 ECPR 的患者出院时的良好神经功能预后有明显关系。
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Sex differences in extracorporeal cardiopulmonary resuscitation for out-of-hospital cardiac arrest: nationwide multicenter retrospective study in Japan.

Background: 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.

Methods: 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.

Results: 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.

Conclusions: The female sex is significantly associated with favorable neurological outcomes at hospital discharge in patients who received ECPR for OHCA.

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来源期刊
Critical Care
Critical Care 医学-危重病医学
CiteScore
20.60
自引率
3.30%
发文量
348
审稿时长
1.5 months
期刊介绍: Critical Care is an esteemed international medical journal that undergoes a rigorous peer-review process to maintain its high quality standards. Its primary objective is to enhance the healthcare services offered to critically ill patients. To achieve this, the journal focuses on gathering, exchanging, disseminating, and endorsing evidence-based information that is highly relevant to intensivists. By doing so, Critical Care seeks to provide a thorough and inclusive examination of the intensive care field.
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