This prospective, multicenter, population-based cohort study examined sex differences in epidemiology, prehospital care, and outcomes (ROSC, survival to admission, survival to discharge/30 days, neurological outcome) among 33,650 EMS-treated OHCA patients in China throughout 2020.
Females had better prehospital outcomes (adjusted OR 1.21 for ROSC; 1.33 for survival to hospital admission) but this advantage disappeared by discharge—no significant sex difference was found for survival to discharge/30 days (adjusted OR 0.85, 95% CI 0.66–1.10) or favorable neurological outcome (adjusted OR 0.84, 95% CI 0.62–1.14). Females aged ≥50 years, those with shockable rhythm, or those without prehospital epinephrine had lower odds of survival than males.
Full in-hospital care data were not presented, limiting understanding of why the prehospital female survival advantage was lost; the study was limited to one calendar year (2020) in China, potentially affected by COVID-19 disruptions; and as an observational study, unmeasured confounders (e.g., comorbidities, socioeconomic factors) may remain.
Clinicians and EMS systems should not assume that females with OHCA fare equally well overall—despite a prehospital advantage, females lose that benefit by hospital discharge, pointing to gaps in in-hospital care that warrant targeted disparity-reduction strategies, especially for women aged ≥50 or those with shockable rhythms.
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