Do Sex Differences Exist in the Establishment of "Do Not Attempt Resuscitation" Orders and Survival in Patients Successfully Resuscitated From In-Hospital Cardiac Arrest?
Do Sex Differences Exist in the Establishment of "Do Not Attempt Resuscitation" Orders and Survival in Patients Successfully Resuscitated From In-Hospital Cardiac Arrest?
复制标题
DOI：
10.1161/jaha.119.014200
复制
发表时间：
2020-02-18
影响因子：
5.4
通讯作者：
Chan, Paul S.
中科院分区：
文献类型：
--
作者：
Perman, Sarah M.;Beaty, Brenda L.;Chan, Paul S.
背景--在危重疾病的治疗过程中，女性对“不尝试复苏”(DNAR)命令的使用率较高。院内心脏骤停复苏后建立DNAR序列的性别差异尚不清楚。目前尚不清楚性别使用DNAR的差异是否会导致存活率的差异。方法和结果--我们根据指南-复苏登记从GET中确定了71820名住院心脏骤停后自主循环恢复(ROSC)的患者。多变量模型评估了性别与DNAR(ROSC后任何时间、ROSC后12小时内或ROSC后72小时内)之间的关联，以及性别与存活到出院之间的关联。所有模型都考虑了医院内患者的聚集，并根据人口统计和心脏骤停特征进行了调整。队列包括30454名女性(42.4%)，她们比男性参与者在ROSC后任何时候建立DNAR订单的可能性略高(45.0%比43.5%；调整后的相对风险：1.15[95%CI，1.101.20]；P
Background--Women have higher utilization of "do not attempt resuscitation" (DNAR) orders during treatment for critical illness. Occurrence of sex differences in the establishment of DNAR orders after resuscitation from in-hospital cardiac arrest is unknown. Whether differences in DNAR use by sex lead to disparities in survival remains unclear. Methods and Results--We identified 71 820 patients with return of spontaneous circulation (ROSC) after in-hospital cardiac arrest from the Get With The Guidelines-Resuscitation registry. Multivariable models evaluated the association between de novo DNAR (anytime after ROSC, within 12 hours of ROSC, or within 72 hours of ROSC) by sex and the association between sex and survival to discharge accounting for DNAR. All models accounted for clustering of patients within hospital and adjusted for demographic and cardiac arrest characteristics. The cohort included 30 454 (42.4%) women, who were slightly more likely than male participants to establish DNAR orders anytime after ROSC (45.0% versus 43.5%; adjusted relative risk: 1.15 [95% CI, 1.101.20]; P