Race, Gender, and Survival: a Scoping Review of Disparities in ICU Post-Resuscitation Care and Neurological Outcomes Following Out-of-Hospital Cardiac Arrest

Racial and ethnic disparities in healthcare are well documented, yet limited attention has been given to the intersection of race/ethnicity and gender in high-acuity critical care. Black women experience compounded inequities affecting access to and quality of intensive care unit (ICU) treatment following out-of-hospital cardiac arrest (OHCA). Because outcomes after OHCA are influenced by each link in the chain of survival, disparities in early intervention and subsequent clinical decision-making may contribute to differences in survival and neurological recovery. This study synthesizes evidence on disparities in ICU treatment and outcomes among Black women in the United States while examining how inequities across the chain of survival may influence post-resuscitation care, neurocritical care, and outcomes following OHCA. We conducted a scoping review, guided by the Arksey and O’Malley framework, to analyze peer-reviewed studies identified through electronic databases (e.g., PubMed, CINAHL, and ScienceDirect). Fifteen studies met inclusion criteria and were analyzed using thematic synthesis. Findings indicate persistent disparities, including lower bystander cardiopulmonary resuscitation (CPR) rates, delayed emergency response, reduced access to ICU interventions, and higher rates of early do-not-resuscitate (DNR) orders and withdrawal of life-sustaining therapies (WLST). These inequities may contribute to poorer outcomes and likely reflect a combination of systemic, institutional, and social factors, although relatively few studies directly examined Black women from an intersectional perspective. Addressing these disparities requires improved data disaggregation, culturally responsive care, and interdisciplinary interventions to promote equitable post-resuscitation care and outcomes.