Abstract 255: Sex Difference of Clinical Outcomes in Patients with Out-of-Hospital Cardiopulmonary Arrest: A Prospective Multicenter Observational Study

Abstract

OBJECTIVE: There is a strong interest in differences in the outcomes between men and women with out-of-hospital cardiopulmonary arrest (OHCA). The aim of this study is to examine the sex differences of clinical outcomes in patients with OHCA. METHODS: The Japan-Prediction of neurological Outcomes in patients Post cardiac arrest (J-POP) registry is a prospective, multicenter, cohort study to test whether regional cerebral oxygen saturation (rSO2) predicts neurological outcomes in OHCA. In this post-hoc analysis, OHCA were collected after excluding patients exposed to extracorporeal cardiopulmonary bypass from the J-POP registry. The primary outcome measure was a return of spontaneous circulation (ROSC) prior to hospital arrival, and secondary outcome measure was a 90-days neurological outcome. Results: Between May 2011 and July 2012, 1204 consecutive patients, age 72±15 years, 40.4% of women, were examined. Men were younger than women (70±15 vs. 75±15 years, p<0.001), with higher percentage of witness status (53.7% vs. 43.1%, p<0.001), and with higher percentage of rSO2 more than 40% at hospital arrival (12.1% vs. 7.0%, p<0.01), and tended to have higher percentage of cardiac etiology (57.6% vs. 52.4%, p=0.07). 118 (9.8%) patients achieved ROSC prior to hospital arrival. 90-day survival rate was 6.1% (n=73), and 90-day good neurological outcome rate was 3.5% (n=42). Men had higher chance of ROSC (11.7% vs. 7.0%, p<0.01), and good neurological outcome at 90 days (4.6% vs. 1.8%, p=0.01). Multivariate analysis adjusting for age (less than 75 y/o or not), witnessed, received CPR by bystander and etiology revealed that sex male was chosen as an independent predictor for ROSC prior to arrival (RR 1.59, 95%CIs 1.03-2.45). Mantel-Haenszel test adjusting for cardiac etiology also showed that men had higher rate of good neurological outcome (RR 2.47, 95%CIs 1.16-5.23). Conclusion: Our results demonstrate that men had significantly better chance of ROSC regardless of age, received BLS and etiology, and had better neurological prognosis after cardiogenic OHCA. Additional studies are needed to validate these observations for other potential genetic factors.