Approximately 1,000 out-of-hospital cardiac arrests (OHCA) occur daily in the United States. The societal burden from the sudden loss of life is high. The extent to which neurological and other survival outcomes after OHCA differs between men and women remains poorly characterized.

The objective is to evaluate for sex differences in OHCA survival outcomes.

Within the national Cardiac Arrest Registry to Enhance Survival (CARES) registry, we identified 249,262 adults with an OHCA from 2013-2018. Using multivariable logistic regression, we evaluated for sex differences in survival outcomes, adjusted for demographics, cardiac arrest characteristics and bystander interventions.

Overall, 89,851 (36%) patients were women. Median age was 64 and 62 years for women and men, respectively. An initial shockable rhythm (25.2% vs 14.7%), witnessed arrest (45.6% vs 41.1%), and bystander cardiopulmonary resuscitation (39% vs 37%) were statistically significant differences and more common in men. Among those surviving to hospital admission, men were more likely to receive targeted temperature management (50.1% vs 45.0%) and undergo coronary angiography (36.8% vs 19.9%). In adjusted analysis, men were less likely to survive to hospital admission (OR 0.74, 95% CI 0.73, 0.76), survive to hospital discharge (OR 0.81, 95% CI 0.78, 0.84), and have favorable neurological survival (OR 0.86, 95% CI 0.83, 0.90).

Despite men having more favorable prognostic features for OHCA and higher rates of hospital interventions, men have lower likelihood of survival compared to women in all three outcomes measures of survival to hospital admission, survival to hospital discharge, and functional neurological survival.