35: Sex-based differences in the extracorporeal cardiopulmonary resuscitation population for out-of-hospital cardiac arrest in the Minneapolis metro area

Background: Women constitute nearly 40% out-of-hospital cardiac arrests (OHCA), receive less post-arrest evidence-based interventions. Aims: To identify presence of sex-based differences in utilization of extracorporeal cardiopulmonary resuscitation (ECPR) for refractory OHCA in the Minneapolis (MSP) metro area. Methods: Patients eligible for the Minnesota Resuscitation Consortium (MRC) ECPR protocol between 2013-2021 were identified in the Cardiac Arrest Registry to Enhance Survival (CARES) registry. Patients who presented to the University of Minnesota (UMN) and were eligible for the MRC protocol between 2014-2022 were identified. Arrest data, patient characteristics and mortality were compared between the sexes in both populations. Results: We identified 2790 OHCA patients through CARES of whom 685 (24.6%) were women. There were 443 referrals to UMN for ECPR, of whom 87 (19.6%) were women. Significantly more eligible women arrested than were referred for ECPR (p =0.02). In MSP, women were more likely to suffer cardiac arrest at home (59% vs 66%,p<0.01), less likely to receive bystander CPR (42% vs 35%,p<0.01) and have greater time to professional CPR (6.3 vs 5.4 mins,p<0.01). Among referrals for MRC protocol, there were no differences in arrest characteristics between the sexes. Multivariate analysis for neurologically favorable survival showed female sex was associated with decreased survival in the community (p=0.03) but trended towards increased survival in the UMN cohort (p=0.08). Conclusion: Women suffering from cardiac arrest have higher mortality in the community, are less likely to be referred for ECPR, however, have equal survival after ECPR. Fewer referral of women for ECPR warrants further investigation.