Females are less likely to receive bystander cardiopulmonary resuscitation in witnessed out-of-hospital cardiac arrest: An Australian perspective (Preprint)

Sonali Munot, Janet E Bray, Julie Redfern, Adrian Bauman, Simone Marschner, Christopher Semsarian, Alan Robert Denniss, Andrew Coggins, Paul M Middleton, Garry Jennings, Blake Angell, Saurabh Kumar, Pramesh Kovoor, Matthew Vukasovic, Jason C Bendall, T Evens, Clara K Chow

Research output: Other contributionDiscipline Preprint RepositoryResearch


Bystander cardiopulmonary resuscitation (CPR) plays a significant role in survival from out-of-hospital cardiac arrest (OHCA). This study aimed to assess whether bystander CPR differed by patient sex among bystander-witnessed arrests.

Data on all OHCAs attended by New South Wales (NSW) paramedics between January 2017 and December 2019 was obtained from the NSW Public Health Risks and Outcomes Registry (PHROR). This observational study was restricted to bystander-witnessed cases with presumed medical aetiology. OHCA from arrests in aged care, medical facilities, and cases with an advance care directive (do-not-resuscitate) were excluded. Multivariate logistic regression was used to examine the association of patient sex with bystander CPR. Secondary outcomes were OHCA recognition, bystander AED applied, initial shockable rhythm, and survival outcomes.

Among the 4,491 bystander-witnessed cases, females were less likely to receive bystander CPR in both private residential (Adjusted Odds ratio [AOR]: 0.82, 95%CI: 0.70-0.95) and public locations (AOR: 0.58, 95%CI:0.39-0.88). Recognition of OHCA in the emergency call was lower for females, particularly in those who arrested in public locations (84.6% vs 91.6%-males, p=0.002) and it partially explained the association of sex with bystander CPR (∼44%). There was no significant difference in OHCA recognition by sex for arrests in private residential locations (p=0.2). Females had lower rates of bystander AED use (4.8% vs 9.6%, p<0.001) however, after adjustment for arrest location and other covariates, this relationship was attenuated and no longer significant (AOR: 0.83, 95%CI: 0.60-1.12). Females were significantly less likely to record an initial shockable rhythm (AOR: 0.52, 95%CI: 0.44-0.61). Although females had greater odds of event survival (AOR: 1.34, 95%CI: 1.15 – 1.56), there was no sex difference in survival to hospital discharge (AOR: 0.96, 95%CI: 0.77-1.19).

OHCA recognition and bystander CPR provision differs by patient sex in NSW. Given their importance to patient outcomes, research is needed to understand why this difference occurs and to raise awareness of this issue to the public.
Original languageEnglish
PublishermedRxiv: the preprint server for health sciences
Number of pages27
Publication statusSubmitted - 21 Dec 2023
Externally publishedYes


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