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Background: Bystander cardiopulmonary resuscitation (BCPR) improves survival from out-of-hospital cardiac arrest (OHCA), yet BCPR rates remain low. It is unknown whether BCPR delivery disparities exist based on victim gender. We measured BCPR rates by gender in private and public environments, hypothesizing that females would be less likely than males to receive BCPR in public settings, with an associated difference in survival to hospital discharge. Methods and Results: We analyzed data from adult, non-traumatic OHCA events within the Resuscitation Outcomes Consortium registry (2011–2015). Using logistic regression, we modeled the likelihood of receiving BCPR by gender, including patient-level variables, stratified by location. A cohort of 19,331 OHCAs were assessed. Mean age was 64±17 years, and 63% (12,225/19,331) were male. Overall, 37% of OHCA victims received bystander CPR. In public locations, 39% (272/694) of females and 45% (1,170/2,600) of males received BCPR (p<0.01), whereas in private settings, 35% (2,198/6,328) of females and 36% (3,364/9,449) of males received BCPR (p=ns). Among public OHCAs, males had significantly increased odds of receiving BCPR compared to females (OR: 1.27, 95% CI: 1.05–1.53, p=0.01); this was not the case in the private setting (OR: 0.93, 95% CI: 0.87–1.01, p=ns). Controlling for site, age, and race, BCPR was significantly associated with survival to hospital discharge (OR:1.69, 95% CI: 1.54–1.85, p<0.01); in this model, males had 29% increased odds of survival compared to females (OR:1.29, 95% CI: 1.17–1.42, p<0.01). Conclusions: Males had an increased likelihood of receiving BCPR compared to females in public. BCPR improved survival to discharge, with greater survival among males compared to females.

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BACKGROUND In a departure from the previous strategy of immediate defibrillation, the 2005 resuscitation guidelines from the American Heart Association–International Liaison Committee on Resuscitation suggested that emergency medical service (EMS) personnel could provide 2 minutes of cardiopulmonary resuscitation (CPR) before the first analysis of cardiac rhythm. We compared the strategy of a brief period of CPR with early analysis of rhythm with the strategy of a longer period of CPR with delayed analysis of rhythm. METHODS We conducted a cluster-randomized trial involving adults with out-of-hospital cardiac arrest at 10 Resuscitation Outcomes Consortium sites in the United States and Canada. Patients in the early-analysis group were assigned to receive 30 to 60 seconds of EMS-administered CPR and those in the later-analysis group were assigned to receive 180 seconds of CPR, before the initial electrocardiographic analysis. The primary outcome was survival to hospital discharge with satisfactory functional status (a modified Rankin scale score of ≤3, on a scale of 0 to 6, with higher scores indicating greater disability). RESULTS We included 9933 patients, of whom 5290 were assigned to early analysis of cardiac rhythm and 4643 to later analysis. A total of 273 patients (5.9%) in the later-analysis group and 310 patients (5.9%) in the early-analysis group met the criteria for the primary outcome, with a cluster-adjusted difference of −0.2 percentage points (95% confidence interval, −1.1 to 0.7; P = 0.59). Analyses of the data with adjustment for confounding factors, as well as subgroup analyses, also showed no survival benefit for either study group. CONCLUSIONS Among patients who had an out-of-hospital cardiac arrest, we found no difference in the outcomes with a brief period, as compared with a longer period, of EMS-administered CPR before the first analysis of cardiac rhythm. (Funded by the National Heart, Lung, and Blood Institute and others; ROC PRIMED ClinicalTrials.gov number, NCT00394706.)