title: Sex differences in cardiac arrest survivors who receive therapeutic hypothermia.
abstract: OBJECTIVE
  Sex differences have not been well defined for patients undergoing therapeutic hypothermia (TH). We aimed to determine sex differences in mortality and Cerebral Performance Category (CPC) scores at discharge among those receiving TH.
  
  
  METHODS
  This retrospective cohort study used data abstracted from an "ICE alert" database, an institutional protocol expediting mild TH for postarrest patients. Quality assurance variables (such as age, time to TH, CPC scores, and mortality) were reviewed and compared by sex. χ2 Test and Wilcoxon rank sum test were used. Stepwise logistic regression was used to assess the association between mortality and sex, while controlling for patient characteristics and clinical presentation of cardiac arrest.
  
  
  RESULTS
  Three hundred thirty subjects were analyzed, 198 males and 132 females. Subjects' mean age (SD) was 61.7 years (15.0); there was no significant sex difference in age. There were no statistically significant sex differences in history of coronary artery disease, congestive heart failure, arrhythmia, hypertension, chronic obstructive pulmonary disease, renal disease, type 1 and/or type 2 diabetes mellitus, or those previously healthy. Obesity (body mass index>35 kg/m2) was more likely in females (37, 28.0%) than males (35, 17.7%); P=.03. Females (64, 49.6%) were more likely than males (71, 36.8%) to have shock; P=.02. There was no difference in arrest to initiating hypothermia, but there was a significant difference in time to target temperature (in median minutes, interquartile range): male (440, 270) vs female (310, 270), P=.003. There was no statistical difference in CPC at discharge. Crude mortality was not different between sexes: male, 67.7%; female, 70.5%; P=.594. However, after controlling for differences in age, obesity, shock, and other variables, females were less likely to die (odds ratio, 0.46; 95% confidence interval, 0.23-0.92; P=.03) than males.
  
  
  CONCLUSIONS
  There is no statistically significant difference in CPC or crude mortality outcomes between sexes. After adjusting for confounders, females were 54% less likely to die than males.
authors.affiliation: Department of Emergency Medicine, Lehigh Valley Hospital and Health Network, Allentown, PA 18103. Electronic address: mrgdo@ptd.net.
authors.forename: Marna Rayl
authors.initials: MR
authors.lastname: Greenberg
authors.affiliation: Department of Medicine, Division of Cardiology, Lehigh Valley Hospital and Health Network, Allentown, PA 18103.
authors.forename: Amy M
authors.initials: AM
authors.lastname: Ahnert
authors.affiliation: Department of Medicine, Division of Cardiology, Lehigh Valley Hospital and Health Network, Allentown, PA 18103.
authors.forename: Nainesh C
authors.initials: NC
authors.lastname: Patel
authors.affiliation: Department of Medicine, Division of Cardiology, Lehigh Valley Hospital and Health Network, Allentown, PA 18103.
authors.forename: Courtney E
authors.initials: CE
authors.lastname: Bennett
authors.affiliation: Department of Emergency Medicine, Lehigh Valley Hospital and Health Network, Allentown, PA 18103.
authors.forename: Nicole
authors.initials: N
authors.lastname: Elliott
authors.affiliation: Department of Emergency Medicine, Lehigh Valley Hospital and Health Network, Allentown, PA 18103.
authors.forename: Mark
authors.initials: M
authors.lastname: Lundquist
authors.affiliation: Department of Emergency Medicine, Lehigh Valley Hospital and Health Network, Allentown, PA 18103.
authors.forename: Andrew
authors.initials: A
authors.lastname: Miller
authors.affiliation: Department of Medicine, Division of Cardiology, Lehigh Valley Hospital and Health Network, Allentown, PA 18103.
authors.forename: Ellina C
authors.initials: EC
authors.lastname: Feiner
authors.affiliation: Department of Emergency Medicine, Lehigh Valley Hospital and Health Network, Allentown, PA 18103.
authors.forename: Anita
authors.initials: A
authors.lastname: Kurt
authors.affiliation: Department of Emergency Medicine, Lehigh Valley Hospital and Health Network, Allentown, PA 18103.
authors.forename: Bernadette
authors.initials: B
authors.lastname: Glenn-Porter
authors.affiliation: Department of Medicine, Division of Cardiology, Lehigh Valley Hospital and Health Network, Allentown, PA 18103.
authors.forename: Mercedes
authors.initials: M
authors.lastname: Scott
authors.affiliation: Department of Emergency Medicine, Lehigh Valley Hospital and Health Network, Allentown, PA 18103.
authors.forename: David B
authors.initials: DB
authors.lastname: Burmeister
mesh_terms: D005260:Female; D006323:Heart Arrest / Q000401:mortality / Q000628:therapy*; D006801:Humans; D007036:Hypothermia, Induced / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D016019:Survival Analysis; D016896:Treatment Outcome