Gender Disparities Among Adult Recipients of Layperson Bystander Cardiopulmonary Resuscitation by Location of Cardiac Arrest in Pan-Asian Communities

Abstract

Background: Bystander cardiopulmonary resuscitation (BCPR) is a critical component of the ‘chain of survival’ in reducing mortality among out-of-hospital cardiac arrest (OHCA) victims. Inconsistent findings on gender disparities among adult recipients of layperson BCPR have been reported in the literature. We aimed to fill this knowledge gap by investigating the extent of gender disparities in a cross-national setting within Pan-Asian communities. Methods: We utilized data collected from the Pan-Asian Resuscitation Outcomes Study (PAROS), an international, multicenter, prospective study conducted between 2009 and 2018. We included all OHCA cases with non-traumatic arrest etiology transported by emergency medical services and excluded study sites that did not consistently collect information about the location of cardiac arrest. Logistic regression was used to analyze the association between gender and BCPR, stratified by location. Findings: We analyzed a cohort of 56,192 OHCA cases with an overall BCPR rate of 36.2% (20,329/56,192). At public locations, BCPR rate was 31.2% (631/2022) for female and 36.4% (3235/8892) for male OHCA victims; while at home, the rate was 38.3% (6838/17,842) for females and 35.1% (9625/27,436) for males. Controlling for country differences and several factors in multivariable logistic regression, we found females less likely to receive BCPR than males in public locations (odds ratio [OR]=0.89, 95% confidence interval [CI]: 0.70–0.99), but more likely to receive BCPR at home (OR=1.16, 95% CI: 1.11–1.21). Interpretation: In Pan-Asian communities, gender differences exist in adult recipients of BCPR and differ between home and public locations. Funding Statement: The study is supported by grants from the National Medical Research Council (NMRC/CSA/0049/2013) and Laerdal Foundation (20040). Declaration of Interests: MEH Ong reports funding from the ZOLL Medical Corporation for a study involving mechanical cardiopulmonary resuscitation devices; grants from the Laerdal Foundation, Laerdal Medical, and Ramsey Social Justice Foundation for funding of the Pan-Asian Resuscitation Outcomes Study; an advisory relationship with Global Healthcare SG, a commercial entity that manufactures cooling devices; and funding from Laerdal Medical on an observation program to their Community CPR raining Centre Research Program in Norway. MEH Ong has a licensing agreement and patent filed (Application no: 13/047,348) with ZOLL Medical Corporation for a study titled “Method of predicting acute cardiopulmonary events and survivability of a patient. NL and MEH Ong are the co-founders and scientific advisors of TIIM Healthcare, a commercial entity which develops real-time prediction and risk stratification solutions at triage. All other authors have no conflict of interest to declare. Ethics Approval Statement: The study was granted approval from SingHealth Centralised Institutional Review Board and Domain Specific Review Board with waiver of patient informed consent.