Stayin' Alive: Examining Gender-Based Differences in Bystander Cardiopulmonary Resuscitation for Out-of-Hospital Cardiac Arrest.

Abstract

Introduction: Many factors influence the likelihood of bystander cardiopulmonary resuscitation (BCPR) after out-of-hospital cardiac arrest (OHCA), but gender disparities in prehospital care remain under-examined, particularly in relation to the bystander's connection to the patient.

Objective: The objective of this study was to evaluate the association between gender and the likelihood of receiving BCPR in OHCA. The primary outcome of the study was to examine differences in BCPR rates among men and women who experienced OHCA. The secondary outcome was to investigate whether bystanders were more likely to provide CPR based on their relationship to the victim, comparing "true" layperson CPR to CPR administered by family members or friends and how these rates differed between men and women.

Methods: This retrospective prehospital chart review included all encounters from a single urban Emergency Medical Services (EMS) agency with a cardiac arrest prior to EMS arrival from January 1, 2017 through June 30, 2022 (n = 701). For each encounter, the presence or absence of BCPR was recorded, along with the relation of the bystander to the patient. "True" BCPR was defined as CPR performed by a layperson unknown to the patient. Patients were excluded if they exhibited signs of obvious death, were physically inaccessible to bystanders, had CPR initiated by trained facility staff or police, had a do not resuscitate (DNR) order present on EMS arrival, received CPR but were not in cardiac arrest, or were younger than 18 years old (n = 174). Odds ratios (OR) with 95% confidence intervals (CI) were used to evaluate data, with statistical significance defined at P < .05.

Results: The study examined 701 cardiac arrest encounters: 250 female (35.7%) and 451 male (64.3%). Overall, men (n = 123; 27.3%) were more likely to receive BCPR than women (n = 48; 19.2%); OR = 1.58; 95%CI, 1.08-2.30; P = .02. Among those who received BCPR, women were significantly more likely to have received it from someone they knew (83.3% versus 65.9%; OR = 2.59; 95%CI, 1.11-6.04; P = .03) while men were more likely to receive "true" layperson BCPR.

Conclusions: This study identifies significant gender disparities in prehospital BCPR and highlights an association between the bystander's relationship to the patient and the likelihood of intervention.