O1001: Sex Differences in Bystander Cardiopulmonary Resuscitation and Outcomes in Pediatric Out of Hospital Cardiac Arrest: Do Pre- and Post-Pubertal Disparities Exist?

Background: Bystander cardiopulmonary resuscitation (BCPR) is associated with improved survival following pediatric out of hospital cardiac arrest (OHCA). Adult females are less likely to receive BCPR as compared to males. Whether sex disparities exist in BCPR pediatric OHCA is unknown. We hypothesized that post-pubescent female children would be less likely to receive BCPR as compared to their male counterparts.

Methods: A retrospective cohort study was conducted utilizing the Cardiac Arrest Registry to Enhance Survival (CARES) database of pediatric (
Results: Of 27,116 pediatric OHCAs, 15,994 (59%) were in males and 13,103 (48%) were under one year of age, with 12,536 (46%) having received BCPR. There was no difference in rates of BCPR by sex, with 4,856 (48%) of females and 7,192 (49%) of males receiving BCPR (p=0.06). However, more males received compression only BCPR (3,009 (24%)), while more females received conventional BCPR (1936 (22%)) (p=0.02). Males had more public OHCAs than females (2,058 (14%) vs. 1,079 (11%), p< 0.001). A higher proportion of males had a shockable rhythm (1,333 (7.7%) vs. 582 (5.7%), p< 0.001) and experienced bystander automated external defibrillator use than females (3,209 (22%) vs. 2,034 (20%), p< 0.001). Overall survival to hospital discharge (1,777 (12%) vs. 961 (9%), p< 0.001) and favorable neurological survival (1,474 (10%) vs. 806 (8%), p< 0.001) was higher in males vs. females, with no difference in outcomes following puberty. In multivariate analysis, prepubertal females were less likely to receive BCPR, with a shift at age 12-years (p=0.02) to receiving more BCPR compared to males (Figure 1).

Conclusion: Prepubertal females are less likely to receive BCPR for OHCA as compared to their male counterparts. However, this changes at puberty with post-pubertal females being more likely to receive BCPR compared to males. Interestingly, these data differ from the adult literature, in which females are less likely to receive BCPR.