Abstract P398: Sex Differences in Stroke Frequency in Extracorporeal Cardio-Pulmonary Resuscitation for Refractory Cardiac Arrest

Abstract

Introduction: Extracorporeal cardio-pulmonary resuscitation (ECPR) is being used more frequently for refractory cardiac arrest (rCA). Stroke remains a key determinant of outcomes in patients receiving ECPR. No studies have yet analyzed sex differences in the frequency of stroke in patients with rCA treated with ECPR. Methods: Retrospective analysis of ECPR cases for rCA identified in the Extracorporeal Life Support Organization (ELSO) International Registry. Age, sex, race/ethnicity and vascular risk factors were included. Stroke was defined as “Ischemic Stroke” and “Intracranial Hemorrhage” as detected by neuroimaging. Statistical analysis: level of significance was set to p≤0.05. To assess sex differences comparative tests were used as appropriate. Results: From 1992 to 2020 a total of 7,460 adult cases of ECPR for rCA were identified; 2,276 (30%) women vs. 5,184 (69%) men; Mean age 50.3 years (±SD 17) in women vs. 54.7 years (±SD 14) in men, (p<0.001). There was no significant difference in hypertension, diabetes, and atrial fibrillation frequency between men and women. Coronary artery disease was more frequent in men than women, 960 (18.5%) vs. 333 (14.6%) respectively (p<0.001). Intracranial hemorrhage occurred in 165 (2.2%) patients in the overall cohort, more frequently in women than men, 69 (3.0%) vs. 96 (1.8%) respectively (p=0.013). Ischemic Stroke occurred in 367 (4.9%) of the overall cohort and more frequently in men than women, 272 (5.2%) vs. 95 (4.1%) respectively (p =0.049). In-hospital mortality occurred in 89 (92.7%) men and 59 (85.5%) women with intracranial hemorrhage (p=0.133), and in 226 (83%) men and 76 (80%) women with ischemic stroke (p=0.497). Conclusions: This is the first study evaluating sex-related differences in the frequency of stroke in patients with ECPR from the largest contemporary ELSO registry. Women were younger than men at the time of rCI and had more intracranial hemorrhages. Men were older and had more ischemic strokes. Morality was high when stroke was present. Our study has implications for future development of sex-targeted treatment strategies when implementing ECPR to reduce neurological complications and to improve outcome.