Neurological prognostication by gender in out-of-hospital cardiac arrest patients receiving hypothermia treatment Público

Abstract

Aim To examine whether neurological recovery of out-of-hospital cardiac arrest (OHCA) patients receiving therapeutic hypothermia (TH) treatment is enhanced for women of childbearing age.

Methods A cross-sectional analysis was conducted using a nationwide surveillance database in Korea of OHCA with presumed cardiac etiology and 15 years or older that occurred and survived to admission between 2008 and 2012. The exposure and outcomes studied were TH treatment and neurological outcome at discharge. Patient characteristics between hypothermia-treated and non-treated groups were compared. Multivariate logistic regression was used to account for the patient characteristics. The association was examined for each stratum of gender, age (<45, 45-65, and >65 years old), and cardiac rhythm. Cardiac rhythms were considered in two different categorizations: 1) shockable/non-shockable rhythm, and 2) VF.VT/PEA/asystole.

Results Total 8,486 OHCA were analyzed. Crude analysis showed that women of childbearing ages treated with TH had enhanced neurological recovery than older aged women and all men. After adjusted, men had stronger association between TH and good neurological recovery than women. The highest association was found in men who are under 45 years of age and have shockable cardiac rhythm (OR=2.00 (1.26, 3.19)). The association between TH and neurological recovery was not statistically significant in all women. The magnitude of association decreased with age. Shockable rhythm was associated with better neurological recovery than non-shockable rhythms in all gender and age groups. Using VF.VT/PEA/asystole categorization of cardiac rhythms, men consistently showed higher ORs than women. In all gender and age groups, having PEA rhythm was associated with better neurological outcome than shockable rhythms (VF/VT) or asystole.

Conclusion The unadjusted association between TH and neurological recovery was the strongest in women of childbearing ages. After adjustment, men had a better neurological outcome than women across all ages. Shockable rhythms were associated with enhanced neurological recovery. Our results suggest that among out-of-hospital cardiac arrest patients, the effect of TH treatment on neurological recovery is greater for men, young ages, and having shockable cardiac rhythm.

Table of Contents

• Introduction 1
• Methods 4
• Results 10
• Discussion 14
• Conclusion 17
• Reference 19
• Tables and Figures 25 Figure 1. Mechanisms of neuroprotection by hypothermia treatment and proposed roles of sex hormones during reperfusion injury. 25 Figure 2. Inclusion criteria of OHCA from CAVAS database, 2008-2012. 26 Table 1. Cerebral Performance Category (CPC) Scale. 27 Table 2. Proportion of patients survived to discharge, stratified by gender, age and cardiac rhythm. 28 Figure 3. Type of therapeutic hypothermia treatment utilized by gender. 29 Table 3. Demographic, clinical characteristics, and risk factors of the study population, 2008-2012. 30 Table 4. Neurological outcome by age, gender, and cardiac rhythm. 32 Table 5. Multivariate association of hypothermia treatment and good neurological recovery. 33 Table 6. Adjusted odds ratio for good neurological recovery by therapeutic hypothermia treatment, stratified by gender, age and cardiac rhythm (shockable/non-shocakble rhythms). 34 Table 7. Adjusted odds ratio for good neurological recovery by therapeutic hypothermia treatment, stratified by gender, age and cardiac rhythm (VF.VT/PEA/asystole). 35

About this Master's Thesis

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School	Rollins School of Public Health
Department	Epidemiology
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health Health Sciences, Epidemiology
Palavra-chave	gender cardiac arrest hypothermia
Committee Chair / Thesis Advisor	McClellan, William, Emory University
Partnering Agencies	Emory University schools, faculty or affiliated programs Non-US governmental agency (e.g., Minister of Health in Haiti) University, college or educational institution (other than Emory)

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