Postresuscitation care and prognostication after cardiac arrest-Does sex matter?

BACKGROUND: There are conflicting results concerning sex-specific differences in the post-cardiac arrest period. We investigated the sex distribution of patients after successful cardiopulmonary resuscitation (CPR), differences in treatment, complications, outcome and sex-specific performance of biomarkers for prognostication of neurological outcome. METHODS: Prospective observational study including cardiac-arrest (CA) patients treated with mild therapeutic hypothermia (MTH) at 33 °C for 24 h or normothermia. We investigated common complications including pneumonia and acute kidney injury (AKI) and neuron-specific enolase, secretoneurin and tau protein as biomarkers of neurological outcome, which was assessed with the cerebral performance categories score at hospital discharge. RESULTS: Out of 134 patients 26% were female. Women were significantly older (73 years, interquartile range (IQR) 56-79 years vs. 62 years, IQR 53-70 years; p = 0.038), whereas men showed a significantly higher rate of pneumonia (29% vs. 6%; p = 0.004) and a trend towards higher rates of AKI (62% vs. 45%; p = 0.091). Frequency of MTH treatment was not significantly different (48% vs. 31%; p = 0.081). Female sex was not associated with neurological outcome in multivariable analysis (p = 0.524). There was no significant interaction of sex with prognostication of neurological outcome at 24, 48 and 72 h after CPR. At the respective time intervals pinteraction for neuron-specific enolase was 0.524, 0.221 and 0.519, for secretoneurin 0.893, 0.573 and 0.545 and for tau protein 0.270, 0.635, and 0.110. CONCLUSION: The proportion of female patients was low. Women presented with higher age but had fewer complications during the post-CA period. Female sex was not associated with better neurological outcome. The performance of biomarkers is not affected by sex.

Increased risk of ventilator-associated pneumonia in patients after cardiac arrest treated with mild therapeutic hypothermia.

BACKGROUND: We aimed at investigating the incidence, characteristics and outcome of ventilator-associated pneumonia (VAP) in patients after cardiac arrest (CA) and its potential association with mild therapeutic hypothermia (MTH). We hypothesized, that MTH might increase the risk of VAP. METHODS: Prospective observational study including comatose adult patients after successful resuscitation from out-of-hospital or in-hospital CA with presumed cardiac cause admitted to ICU and treated with MTH at 33°C for 24 h or normothermia (NT) with treatment of fever ≥38°C by pharmacological means. The primary outcome measure was the development of VAP. VAP diagnosis included mechanical ventilation >48 h combined with clinical and radiologic criteria. For a microbiologically confirmed VAP (mcVAP), a positive respiratory culture was required. RESULTS: About 23% of 171 patients developed VAP, 6% presented with mcVAP. VAP was associated with increased ICU-LOS (9 (IQR 5-14) vs. 6 (IQR 3-9) days; p < .01), ventilator-dependent days (6 (IQR 4-9) vs. 4 (IQR 2-7) days; p < .01) and duration of antibiotic treatment (9 (IQR 5-13) vs. 5 (IQR 2-9) days; p < .01), but not with mortality (OR 0.88 (95% CI: 0.43-1.81); p = .74). Patients treated with MTH (47%) presented higher VAP (30% vs. 17%; p = .04) and mcVAP rates (11% vs. 2%; p = .03). MTH was associated with VAP in multivariable logistic regression analysis with an OR of 2.67 (95% CI: 1.22-5.86); p = .01. CONCLUSIONS: VAP appears to be a common complication in patients after CA, accompanied by more ventilator-dependent days, prolonged antibiotic treatment, and ICU-LOS. Treatment with MTH is significantly associated with development of VAP.