Provision of bystander CPR for out-of-hospital cardiac arrest in the Middle East: a retrospective gender-based analysis

Emad Awad; Guillaume Alinier; Hassan Farhat; Niki Rumbolt; Adnaan Azizurrahman; Buthaina Mortada; Rakan Shami

doi:10.1186/s12245-023-00537-6

Provision of bystander CPR for out-of-hospital cardiac arrest in the Middle East: a retrospective gender-based analysis

Int J Emerg Med. 2023 Sep 26;16(1):63. doi: 10.1186/s12245-023-00537-6.

Authors

Emad Awad^{1

2

3}, Guillaume Alinier^{4

5

6

7}, Hassan Farhat^{4

8

9}, Niki Rumbolt¹⁰, Adnaan Azizurrahman¹⁰, Buthaina Mortada¹⁰, Rakan Shami¹⁰

Affiliations

¹ College of Health Science, University of Doha for Science and Technology, Doha, Qatar. emad.awad@alumni.ubc.ca.
² BC RESURECT: Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada. emad.awad@alumni.ubc.ca.
³ Department of Emergency Medicine, School of Medicine, University of Utah, Salt Lake, UT, USA. emad.awad@alumni.ubc.ca.
⁴ Hamad Medical Corporation Ambulance Service (HMCAS), Hamad Medical Corporation, Doha, Qatar.
⁵ School of Health and Social Work, University of Hertfordshire, Hatfield, UK.
⁶ Weill Cornell Medicine - Qatar, Doha, Qatar.
⁷ Faculty of Health and Life Sciences, Northumbria University, Newcastle, UK.
⁸ Faculty of Medicine "Ibn El Jazzar", University of Sousse, Sousse, Tunisia.
⁹ Faculty of Sciences, University of Sfax, Sfax, Tunisia.
¹⁰ College of Health Science, University of Doha for Science and Technology, Doha, Qatar.

Abstract

Background: Previous studies conducted in North America, Europe, and East Asia (Liu et al., EClinicalMedicine 44:101293, 2022; Matsui et al., JAMA Netw Open 2:e195111, 2019; Awad et al., J Am Coll Emerg Physicians Open 4:e12957, 2023; Yoon et al., Prehosp Emerg Care :1-7, 2022) reported gender disparities in the provision of bystander CPR for patients with out-of-hospital cardiac arrest (OHCA). However, it remains unknown whether similar disparities exist in the Middle Eastern and Gulf regions. The primary objective of this study is to evaluate gender differences in the provision of bystander CPR for patients with OHCA in Qatar.

Methods: Retrospective analysis of data obtained from Hamad Medical Corporation OHCA registry in the State of Qatar (2016-2022). We included adults with non-traumatic and EMS-attended OHCA. We used multilevel logistic regression to examine the association between gender and provision of bystander CPR.

Results: In total, 4283 patients were included. Of those, 3414 (79.7%) were males, 1639 (38.3%) arrested in public locations, and 1463 (34.2%) received bystander CPR. Unadjusted comparisons showed that females were significantly older than males (mean age: 62.2 vs. 52.7). Females had a lower proportion of OHCA occurring in public locations (15.1% vs. 44.2%) and a lower proportion of shockable rhythm (11.9 vs. 27.5%). Regarding the outcome variable (provision of bystander CPR), the unadjusted analysis showed that the proportion of females who received bystander CPR was lower than that of males (29.2% vs. 35.4%, p < 0.001). However, after adjustment, we found no significant difference in provision of bystander CPR by gender (adjusted OR female vs. male 0.99, 95% CI 0.84-1.20, p = 0.97). In the subgroup who arrested in public locations, the analysis revealed females had greater odds of receiving bystander CPR (adjusted OR female vs. male 1.47, 95% CI 1.10-1.82, p = 0.04).

Conclusions: Overall, bystander CPR was less common in female gender; after adjustment for other covariates, including arrest location, we found no significant gender differences in provision of bystander CPR. We also observed that females were found to have a lower incidence of cardiac arrest in public locations. Nevertheless, if females were to experience cardiac arrest in a public location, they would be more likely to receive CPR. Further research is required to explain the observed differences in provision of bystander CPR.

Keywords: Cardiac arrest; Cardiopulmonary resuscitation; Gender differences; Middle East.