Sex Differences in In‐Hospital Mortality Among Patients Receiving Veno‐Arterial Extracorporeal Membrane Oxygenation and Extracorporeal Cardiopulmonary Resuscitation: A Propensity Score‐Matched Analysis
Background Veno‐arterial extracorporeal membrane oxygenation (VA‐ECMO) is used in cardiogenic shock, but sex‐specific outcomes remain unclear. This study investigated in‐hospital mortality differences by sex among patients receiving extracorporeal cardiopulmonary resuscitation (ECPR). Methods We ret...
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Wiley
2025-07-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
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| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.124.039541 |
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| author | Jung‐Chi Hsu Chen‐Hsu Pai Ling‐Yi Wei Chih‐Hsien Wang Nai‐Hsin Chi Shu‐Chien Huang Jeng‐Wei Chen Heng‐Wen Chou Ron‐Bin Hsu Nai‐Kuan Chou Hsi‐Yu Yu Lian‐Yu Lin Yih‐Sharng Chen |
| author_facet | Jung‐Chi Hsu Chen‐Hsu Pai Ling‐Yi Wei Chih‐Hsien Wang Nai‐Hsin Chi Shu‐Chien Huang Jeng‐Wei Chen Heng‐Wen Chou Ron‐Bin Hsu Nai‐Kuan Chou Hsi‐Yu Yu Lian‐Yu Lin Yih‐Sharng Chen |
| author_sort | Jung‐Chi Hsu |
| collection | DOAJ |
| description | Background Veno‐arterial extracorporeal membrane oxygenation (VA‐ECMO) is used in cardiogenic shock, but sex‐specific outcomes remain unclear. This study investigated in‐hospital mortality differences by sex among patients receiving extracorporeal cardiopulmonary resuscitation (ECPR). Methods We retrospectively reviewed adults with cardiogenic shock treated with VA‐ECMO at National Taiwan University Hospital between 2010 and 2021. After propensity score matching to improve comparability between groups, survival outcomes were assessed using Kaplan‐Meier estimates, and Cox proportional hazards models were used to evaluate the effect of sex on in‐hospital mortality. Results Of the 1329 patients (average age: 57.1±15.0 years; 953 men), 670 underwent VA‐ECMO for ECPR. Women in the VA‐ECMO group exhibited a lower prevalence of out‐of‐hospital cardiac arrest (6.7% versus 10.7%, P=0.031), a lower body mass index (24.0±4.4 versus 25.0±4.3, P<0.001), and lower rates of diabetes (26.2% versus 33.2%, P=0.017) and coronary artery disease (20.9% versus 28.6%, P=0.005) after propensity score matching. No discernible sex differences were observed in the baseline characteristics of the ECPR subgroup. Kaplan‐Meier analyses showed no significant sex differences in mortality for VA‐ECMO (log‐rank P=0.1), but significant disparities were noted for ECPR (log‐rank P=0.006). In the ECPR group, female patients exhibited higher mortality rates compared with men (hazard ratio, 1.37 [95% CI, 1.09–1.72]; P=0.007), independent of Survival After Veno‐Arterial ECMO score severity. Conclusions Women who underwent ECPR had higher in‐hospital mortality rates regardless of the severity of their Survival After Veno‐Arterial ECMO scores, despite the absence of significant sex differences in VA‐ECMO mortality. This emphasizes the necessity for sex‐based strategies in ECPR administration. |
| format | Article |
| id | doaj-art-a4fc37f3dd904deab809debbdb004249 |
| institution | Kabale University |
| issn | 2047-9980 |
| language | English |
| publishDate | 2025-07-01 |
| publisher | Wiley |
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| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj-art-a4fc37f3dd904deab809debbdb0042492025-08-20T03:58:49ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802025-07-01141310.1161/JAHA.124.039541Sex Differences in In‐Hospital Mortality Among Patients Receiving Veno‐Arterial Extracorporeal Membrane Oxygenation and Extracorporeal Cardiopulmonary Resuscitation: A Propensity Score‐Matched AnalysisJung‐Chi Hsu0Chen‐Hsu Pai1Ling‐Yi Wei2Chih‐Hsien Wang3Nai‐Hsin Chi4Shu‐Chien Huang5Jeng‐Wei Chen6Heng‐Wen Chou7Ron‐Bin Hsu8Nai‐Kuan Chou9Hsi‐Yu Yu10Lian‐Yu Lin11Yih‐Sharng Chen12Department of Internal Medicine National Taiwan University Hospital, Jinshan Branch New Taipei City TaiwanCardiovascular Center National Taiwan University Hospital Taipei TaiwanCardiovascular Center National Taiwan University Hospital Taipei TaiwanCardiovascular Center National Taiwan University Hospital Taipei TaiwanCardiovascular Center National Taiwan University Hospital Taipei TaiwanCardiovascular Center National Taiwan University Hospital Taipei TaiwanCardiovascular Center National Taiwan University Hospital Taipei TaiwanCardiovascular Center National Taiwan University Hospital Taipei TaiwanCardiovascular Center National Taiwan University Hospital Taipei TaiwanCardiovascular Center National Taiwan University Hospital Taipei TaiwanCardiovascular Center National Taiwan University Hospital Taipei TaiwanDivision of Cardiology, Department of Internal Medicine National Taiwan University Hospital and College of Medicine Taipei TaiwanCardiovascular Center National Taiwan University Hospital Taipei TaiwanBackground Veno‐arterial extracorporeal membrane oxygenation (VA‐ECMO) is used in cardiogenic shock, but sex‐specific outcomes remain unclear. This study investigated in‐hospital mortality differences by sex among patients receiving extracorporeal cardiopulmonary resuscitation (ECPR). Methods We retrospectively reviewed adults with cardiogenic shock treated with VA‐ECMO at National Taiwan University Hospital between 2010 and 2021. After propensity score matching to improve comparability between groups, survival outcomes were assessed using Kaplan‐Meier estimates, and Cox proportional hazards models were used to evaluate the effect of sex on in‐hospital mortality. Results Of the 1329 patients (average age: 57.1±15.0 years; 953 men), 670 underwent VA‐ECMO for ECPR. Women in the VA‐ECMO group exhibited a lower prevalence of out‐of‐hospital cardiac arrest (6.7% versus 10.7%, P=0.031), a lower body mass index (24.0±4.4 versus 25.0±4.3, P<0.001), and lower rates of diabetes (26.2% versus 33.2%, P=0.017) and coronary artery disease (20.9% versus 28.6%, P=0.005) after propensity score matching. No discernible sex differences were observed in the baseline characteristics of the ECPR subgroup. Kaplan‐Meier analyses showed no significant sex differences in mortality for VA‐ECMO (log‐rank P=0.1), but significant disparities were noted for ECPR (log‐rank P=0.006). In the ECPR group, female patients exhibited higher mortality rates compared with men (hazard ratio, 1.37 [95% CI, 1.09–1.72]; P=0.007), independent of Survival After Veno‐Arterial ECMO score severity. Conclusions Women who underwent ECPR had higher in‐hospital mortality rates regardless of the severity of their Survival After Veno‐Arterial ECMO scores, despite the absence of significant sex differences in VA‐ECMO mortality. This emphasizes the necessity for sex‐based strategies in ECPR administration.https://www.ahajournals.org/doi/10.1161/JAHA.124.039541extracorporeal cardiopulmonary resuscitationextracorporeal membrane oxygenationin‐hospital mortalityprognosissex difference |
| spellingShingle | Jung‐Chi Hsu Chen‐Hsu Pai Ling‐Yi Wei Chih‐Hsien Wang Nai‐Hsin Chi Shu‐Chien Huang Jeng‐Wei Chen Heng‐Wen Chou Ron‐Bin Hsu Nai‐Kuan Chou Hsi‐Yu Yu Lian‐Yu Lin Yih‐Sharng Chen Sex Differences in In‐Hospital Mortality Among Patients Receiving Veno‐Arterial Extracorporeal Membrane Oxygenation and Extracorporeal Cardiopulmonary Resuscitation: A Propensity Score‐Matched Analysis Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease extracorporeal cardiopulmonary resuscitation extracorporeal membrane oxygenation in‐hospital mortality prognosis sex difference |
| title | Sex Differences in In‐Hospital Mortality Among Patients Receiving Veno‐Arterial Extracorporeal Membrane Oxygenation and Extracorporeal Cardiopulmonary Resuscitation: A Propensity Score‐Matched Analysis |
| title_full | Sex Differences in In‐Hospital Mortality Among Patients Receiving Veno‐Arterial Extracorporeal Membrane Oxygenation and Extracorporeal Cardiopulmonary Resuscitation: A Propensity Score‐Matched Analysis |
| title_fullStr | Sex Differences in In‐Hospital Mortality Among Patients Receiving Veno‐Arterial Extracorporeal Membrane Oxygenation and Extracorporeal Cardiopulmonary Resuscitation: A Propensity Score‐Matched Analysis |
| title_full_unstemmed | Sex Differences in In‐Hospital Mortality Among Patients Receiving Veno‐Arterial Extracorporeal Membrane Oxygenation and Extracorporeal Cardiopulmonary Resuscitation: A Propensity Score‐Matched Analysis |
| title_short | Sex Differences in In‐Hospital Mortality Among Patients Receiving Veno‐Arterial Extracorporeal Membrane Oxygenation and Extracorporeal Cardiopulmonary Resuscitation: A Propensity Score‐Matched Analysis |
| title_sort | sex differences in in hospital mortality among patients receiving veno arterial extracorporeal membrane oxygenation and extracorporeal cardiopulmonary resuscitation a propensity score matched analysis |
| topic | extracorporeal cardiopulmonary resuscitation extracorporeal membrane oxygenation in‐hospital mortality prognosis sex difference |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.124.039541 |
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