Association between bystander cardiopulmonary resuscitation initiation and patient’s sex: a systematic review and meta-analysis

Abstract Background and aim: The chain of survival, including cardiopulmonary resuscitation (CPR) and automated external defibrillation (AED), improves patients’ outcomes in case of cardiac arrest. Socioeconomic status, race, and gender appear to be associated with the likelihood of receiving resus- citation. The aim of this systematic review and meta-analysis was to evaluate the association between female sex and the odds of bystander CPR initiation and AED application in patients with cardiac arrest, compared with male individuals. Methods: The protocol of this systematic review was prospectively registered in PROSPERO (CRD42024512024). PubMed, Scopus, and Cochrane were searched for studies describing the association between patient sex and the initiation of bystander CPR or the application of AED pads. Results: Fifteen observational cohort studies were included, for a total of 499,854 patients. The analysis from adjusted estimates of the primary outcome showed substantial heterogeneity (I2 = 89%, very low certainty evidence) and was narratively summarised. Female sex was associated with reduced odds of AED pad application compared with males (OR 0.79; 95% CI 0.66–0.94; P = 0.008; I2 = 45%; moderate certainty evidence). Conclusions: The evidence regarding the association between bystander CPR initiation and patient’s sex is characterised by substantial hetero- geneity. Female sex appears to be associated with a lower probability of AED pad application compared with males.