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Sex modifies the association between bystander CPR and 30-day survival after out-of-hospital cardiac arrest:

Koichiro Shinozaki1, Nobuya Kitamura2, Takashi Tagami3

  • 1Department of Emergency and Critical Care Medicine, Kindai University Faculty of Medicine, Osaka, Japan; The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA.

The American Journal of Emergency Medicine
|August 18, 2026
PubMed

Insights

Bystander cardiopulmonary resuscitation (CPR) improves survival after out-of-hospital cardiac arrest (OHCA), but the effect differs significantly between men and women. Further research is needed to optimize resuscitation strategies for equitable care.

Area of Science:

  • Emergency Medicine
  • Cardiology
  • Public Health

Background:

  • Out-of-hospital cardiac arrest (OHCA) is a major global cause of death.
  • Bystander cardiopulmonary resuscitation (CPR) is crucial for improving survival rates.
  • The differential impact of bystander CPR on survival based on biological sex is not well understood.

Purpose of the Study:

  • To investigate whether biological sex modifies the association between bystander CPR and 30-day survival following OHCA.
  • To analyze the effect of sex on the effectiveness of bystander CPR in OHCA patients.

Main Methods:

  • A multicenter prospective cohort study involving 9081 adult OHCA patients in Japan (2019-2021).
  • Analysis of 30-day survival as the primary outcome, comparing patients who received bystander CPR versus those who did not.
  • Multivariable Cox proportional hazards models and formal interaction analyses were used to assess sex-specific effects.

Main Results:

  • Bystander CPR was associated with improved 30-day survival in men (aHR, 1.54) but not significantly in women (aHR, 1.33).
  • Formal interaction analysis revealed a significant effect modification by sex (interaction P < 0.001).
  • Crude survival rates were higher with bystander CPR for both sexes, and favorable neurological outcomes were also observed more frequently.

Conclusions:

  • Biological sex is a significant effect modifier in the association between bystander CPR and OHCA survival.
  • While bystander CPR benefits both sexes, the magnitude of its impact differs.
  • Further research into sex-specific mechanisms is essential for optimizing resuscitation strategies and ensuring equitable care.
Abstract

Keywords:
Cardiopulmonary resuscitationHeart arrestProspective studiesSex factorsSurvival analysis

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