Inequalities in early resuscitation after out-of-hospital cardiac arrest: sex, socioeconomic status and location

Background Out-of-hospital cardiac arrest (OHCA) has persistently low survival. Early bystander cardiopulmonary resuscitation (CPR) and timely automated external defibrillator (AED) use are critical links in the chain of survival. Therefore, the aim of this study was to examine the associations between sex, socioeconomic status (SES), and arrest location with bystander CPR, pre-EMS AED use, and one-year mortality within a Dutch OHCA cohort. Methods We performed a single-center retrospective cohort study of adults (≥18 years) with OHCA transported to the emergency department of an academic hospital (2018-2022). SES was derived from the SES score by Statistics Netherlands (CBS) and categorized as low, middle or high. Primary outcomes were bystander CPR (any chest compressions with/without ventilation before emergency medical services arrival) and pre-EMS AED use (AED applied before EMS arrival, irrespective of shock delivery). Secondary outcomes were one-year all-cause mortality and one-year cardiac mortality. Multivariable logistic regression provided odds ratios with 95% confidence intervals (CI). Results Among 565 patients, bystander CPR was less frequent for arrests at home than in public settings (OR 0.37, 95% CI 0.17-0.82). Pre-EMS AED use was less frequent in the middle SES category compared with the high SES category (OR 0.09, 95% CI 0.010.67), and more common in men than women (OR 2.78, 95% CI 1.07-7.21). No associations were observed for one-year cardiac mortality. One-year all-cause mortality was lower in patients with a shockable initial rhythm and higher following arrests occurring at home. Conclusions Sex, SES, and location-related disparities were observed in early resuscitation with lower pre-EMS AED use in women and the middle SES category and a trend in the lower SES category. These findings suggest that disparities in early resuscitation contribute to differences in outcomes and support the need for targeted strategies to increase bystander CPR and pre-EMS AED use, particularly for arrests occurring at home and among underrepresented groups.