Sex Differences in In-Hospital Mortality Among Patients Receiving Veno-Arterial Extracorporeal Membrane Oxygenation and Extracorporeal Cardiopulmonary Resuscitation: A Propensity Score-Matched Analysis.

Abstract

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.