Introduction and objective:
Out-of-hospital sudden cardiac arrest (OHCA) remains a significant cause of death, and early defibrillation by bystanders using an automated external defibrilator (AED) increases survival. Despite the lack of gender differences in basic life support (BLS) algorithms, reports suggest disparities in AED use among women. The aim of the study is to assess global gender differences in bystander AED use, and to identify potential determinants of these differences.

Review methods:
The review was conducted according to PRISMA 2020. PubMed, Web of Science, and Scopus were searched (publications 2014–2024). Studies of OHCA with non-traumatic etiology and reporting bystander AED use by bystanders by gender were included; exclusively paediatric populations were excluded. Modifiers, including the location of the event and age, were extracted.

Brief description of the state of knowledge:
120 abstracts were screened from 163 records after removing 43 duplicates. 10 studies from Asia, Australia, North America, and Europe were finally included in the analysis. In most studies, women were less likely than men to receive an AED; the effect was greater in public spaces and remote locations, and in some cases, it was non-significant in private settings. In some analyses, after controlling for the location of arrest, the differences disappeared. Interpretation is limited by heterogeneity in definitions (pad placement vs. defibrillation) and covariates, as well as the variable proportion of patients under 18 years of age.

Summary:
There is a global, context-dependent gender disparity in bystander AED use, to the detriment of women. Standardization of definitions and reporting, with mandatory stratification by location and age, and research in under-represented regions, is necessary. Corrective actions should include targeted BLS training, dispatch scripts that standardize chest exposure, and AED use in women.