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

Published online by Cambridge University Press:  12 August 2025

Abagayle E. Bierowski Open the ORCID record for Abagayle E. Bierowski [Opens in a new window] ,
Julie A. Calabrese ,
Patrice J. Baptista ,
Paul C. Comber ,
Alexander Kuc ,
Aman Shah  and
Gerard Carroll
Abagayle E. Bierowski*
Affiliation:
Department of Emergency Medicine, Thomas Jefferson University, Philadelphia, PennsylvaniaUSA Sidney Kimmel Medical College, Philadelphia, PennsylvaniaUSA Department of Emergency Medicine, Cooper University Hospital, Camden, New JerseyUSA Cooper Medical School at Rowan University, Camden, New JerseyUSA
Julie A. Calabrese
Affiliation:
Department of Emergency Medicine, Cooper University Hospital, Camden, New JerseyUSA
Patrice J. Baptista
Affiliation:
Department of Emergency Medicine, Cooper University Hospital, Camden, New JerseyUSA Cooper Medical School at Rowan University, Camden, New JerseyUSA
Paul C. Comber
Affiliation:
Department of Emergency Medicine, Cooper University Hospital, Camden, New JerseyUSA Cooper Medical School at Rowan University, Camden, New JerseyUSA
Alexander Kuc
Affiliation:
Department of Emergency Medicine, Cooper University Hospital, Camden, New JerseyUSA Cooper Medical School at Rowan University, Camden, New JerseyUSA
Aman Shah
Affiliation:
Department of Emergency Medicine, Cooper University Hospital, Camden, New JerseyUSA Cooper Medical School at Rowan University, Camden, New JerseyUSA
Gerard Carroll
Affiliation:
Department of Emergency Medicine, Cooper University Hospital, Camden, New JerseyUSA Cooper Medical School at Rowan University, Camden, New JerseyUSA
*
Correspondence: Abagayle E. Bierowski, MD, MEHP Thomas Jefferson University Sidney Kimmel Medical College Department of Emergency Medicine Philadelphia, Pennsylvania 19107-5083 USA Emails: abby.bierowski@gmail.com; abagayle.bierowski@jefferson.edu
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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.

Keywords

CPRgender differencesgender disparityOHCAtrue bystander CPR

Information

Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 40 , Issue 4 , August 2025 , pp. 199 - 203
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Copyright
© The Author(s), 2025. Published by Cambridge University Press on behalf of World Association for Disaster and Emergency Medicine

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References

Benjamin, EJ, Virani, SS, Callaway, CW, et al. Heart disease and stroke statistics—2018 update: a report from the American Heart Association. Circulation. 2018;137(12):e67–492.CrossRefGoogle ScholarPubMed
Blewer, AL, McGovern, SK, Schmicker, RH, et al. Gender disparities among adult recipients of bystander cardiopulmonary resuscitation in the public. Circ Cardiovasc Qual Outcomes. 2018;11(8):e004710.CrossRefGoogle ScholarPubMed
Wissenberg, M, Lippert, FK, Folke, F, et al. Association of national initiatives to improve cardiac arrest management with rates of bystander intervention and patient survival after out-of-hospital cardiac arrest. JAMA. 2013;310(13):1377–1384.CrossRefGoogle ScholarPubMed
Bray, JE, Stub, D, Bernard, S, Smith, K. Exploring gender differences and the “oestrogen effect” in an Australian out-of-hospital cardiac arrest population. Resuscitation. 2013; 84(7):957–963.CrossRefGoogle Scholar
Herlitz, J, Engdahl, J, Svensson, L, Young, M, Angquist, KA, Holmberg, S. Is female sex associated with increased survival after out-of-hospital cardiac arrest? Resuscitation. 2004;60(2):197–203.CrossRefGoogle ScholarPubMed
Ahn, KO, Shin, SD, Hwang, SS. Sex disparity in resuscitation efforts and outcomes in out-of-hospital cardiac arrest. Am J Emerg Med. 2012;30(9):1810–1816.CrossRefGoogle ScholarPubMed
Swor, R, Khan, I, Domeier, R, Honeycutt, L, Chu, K, Compton, S. CPR training and CPR performance: do CPR-trained bystanders perform CPR? Acad Emerg Med. 2006;13(6):596–601.Google ScholarPubMed
Liu, N, Ning, Y, Eng Hock Ong, M, et al. Gender disparities among adult recipients of layperson bystander cardiopulmonary resuscitation by location of cardiac arrest in Pan-Asian communities: a registry-based study. eClinMed. 2022;44:101293.Google ScholarPubMed
Vesela, K, Franek, O. No gender differences found in bystander CPR in Prague. BMJ Open. 2018;8.CrossRefGoogle Scholar
Blom, MT, Oving, I, Berdowski, J, van Valkengoed, IGM, Bardai, A, Tan, HL. Women have lower chances than men to be resuscitated and survive out-of-hospital cardiac arrest. Eur Heart J. 2019;40(47):3824–3834.CrossRefGoogle ScholarPubMed
Jacobs, I, Nadkarni, V, Bahr, J, et al. Cardiac arrest and cardiopulmonary resuscitation outcome reports: update and simplification of the Ulstein templates for resuscitation registries: a statement for healthcare professionals from a task force of the International Liaison Committee on Resuscitation (American Heart Association, European Resuscitation Council, Australian Resuscitation Council, New Zealand Resuscitation Council, Heart and Stroke Foundation of Canada, InterAmerican Heart Foundation, Resuscitation Councils of Southern Africa). Circulation. 2004;110(21):3385–3397.CrossRefGoogle Scholar
Hasselqvist-Ax, I, Riva, G, Herlitz, J, et al. Early cardiopulmonary resuscitation in out-of-hospital cardiac arrest. N Engl J Med. 2015;372(24):2307–2315.CrossRefGoogle ScholarPubMed
Maurer, H, Masterson, S, Tjelmeland, IB, et al. When is a bystander not a bystander any more? A European survey. Resuscitation. 2019;136:78–84.CrossRefGoogle ScholarPubMed
Sasson, C, Magid, DJ, Chan, P, et al; CARES Surveillance Group. Association of neighborhood characteristics with bystander-initiated CPR. N Engl J Med. 2012;367(17):1607–1615.CrossRefGoogle Scholar
Sasson, C, Keirns, CC, Smith, DM, et al. Examining the contextual effects of neighborhood on out-of-hospital cardiac arrest and the provision of bystander cardiopulmonary resuscitation. Resuscitation. 2011;82(6):674–679.CrossRefGoogle ScholarPubMed
Root, ED, Gonzales, L, Persse, DE, Hinchey, PR, McNally, B, Sasson, C. A tale of two cities: the role of neighborhood socioeconomic status in spatial clustering of bystander CPR in Austin and Houston. Resuscitation. 2013;84(6):752–759.CrossRefGoogle Scholar