Representation of female and male pictorial instructions on automated external defibrillators, pad packages, and defibrillation pads.

Objective: To evaluate the representation of sex pictograms displayed on automated external defibrillators (AEDs), pad packages, and defibrillation pads, assessing inclusivity and potential implications for real-life AED use. Methods: Between May and October 2025, investigators from seven countries worldwide captured original photographs of AEDs, pad packages, and defibrillation pads from manufacturers, distributors, and institutional networks. Only adult, commercially available AEDs and defibrillation pads intended for real-life use were included; training or manual AEDs were excluded. Two independent researchers assessed each pictogram for sex representation, with consensus by a third reviewer when needed. Results: Female pictograms were rare across all reviewed AEDs, pad packages, and defibrillation pad sets. Among 51 AEDs with pictograms, only two (3.9%) included any female pictograms, whereas most displayed only adult male pictograms (62.7%). In pad packages, female pictograms appeared on three packages (7.0%), while 48.8% showed only adult male pictograms. In defibrillation pad sets, female pictograms appeared in two sets (4.5%); most showed only adult male pictograms (56.8%). Neonatal and pediatric pictograms were uncommon overall, with pediatric boy pictograms representing the predominant across AEDs, pad packages, and defibrillation pad sets. Conclusions: Instructional imagery on AEDs, pad packages, and defibrillation pads overwhelmingly represents male, with minimal or absent female depictions. This imbalance may reinforce gender bias, potentially leading to incorrect pad placement on women and reducing inclusivity in resuscitation. Manufacturers and resuscitation councils could promote accurate and balanced visual representations to ensure equitable and realistic AED use across sexes and body types during cardiac arrest management.