Multicenter Study on Sex-Based Differences in Patients Placed on Extracorporeal Life Support for Cardiogenic Shock

Abstract

<h3>Purpose</h3> The use of extracorporeal life support (ECLS) for patients in cardiogenic shock has significantly increased over the past decade. However, there are insufficient data for the presence of gender-associated differences in outcomes. Our study assesses differences between male and female patients placed on venoarterial ECLS (VA-ECLS) for cardiogenic shock at numerous centers worldwide. <h3>Methods</h3> This is a multicenter retrospective study conducted on 9888 patients from the Extracorporeal Life Support Organization database. We looked at adult patients (>18 years old) who were placed on VA-ECLS between January 1^st, 2011 and December 31^st, 2019 for cardiogenic shock. We only looked at patients' first ECLS runs, excluding subsequent ECLS runs for patients who received ECLS multiple times. The primary endpoint was in-hospital mortality. Patients who were transferred to outside hospitals after ECLS placement were excluded. Secondary endpoints include postoperative bleeding, infection, cardiac arrhythmia, cardiac arrest, limb ischemia, compartment syndrome, fasciotomy requirement, stroke, renal replacement therapy, and metabolic acidosis. <h3>Results</h3> There were 6747 male patients and 3141 female patients. In an unadjusted comparison, male patients were more likely to have prior myocardial infarction (29.5% vs 20.9%, p<0.001), coronary artery disease (23.1% vs 15.6%, p<0.001), diabetes (10.6% vs 9.2%, p=0.038), chronic kidney disease (7.7% vs 5.2%, p<0.001), and CHF (23.9% vs 21.4%, p=0.006). Female patients were more likely to be centrally cannulated (23% vs 18.5%, p<0.001). There was no difference in in-hospital mortality between male and female patients (57.2% vs 55.7%, p=0.169). Female patients were more likely to have limb ischemia as a complication (7.0% vs 4.6%, p<0.001), whereas male patients were more likely to require renal replacement therapy (43.5% vs 38.6%, p<0.001) and have arrhythmias (15.2 vs 13.1, p=0.008) after ECLS. There were no other differences in the secondary outcomes between male and female patients. <h3>Conclusion</h3> Compared with male patients, female patients were more likely to centrally cannulated and experience limb ischemia as a complication of ECLS, potentially due to their smaller vessel size. Varying cannulation approach based on biologic sex may be warranted to reduce ECLS complication rates in female patients.