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Objectives: To examine gender-related differences in the management and survival of out-of-hospital cardiac arrest (OHCA) in Spain during 2 time series., Material and Methods: Analysis of data recorded in the prospective Spanish OHCA registry (OHSCAR in its Spanish acronym) for 2 time series (2013-2014 and 2017-2018). We included all 11 036 consecutive cases in which an emergency team intervened. The dependent variables were arrival at the hospital after return of spontaneous circulation, overall survival to discharge, and overall survival with good neurological outcomes. Sex was the independent variable. We report descriptive statistics, patient group comparisons, and changes over time., Results: Women were significantly older and less likely to experience an OHCA in a public place, receive automatic external defibrillation, have a shockable heart rhythm, and be attended by an ambulance team within 15 minutes. In addition, fewer women underwent percutaneous coronary interventions or received treatment for hypothermia on admission to the hospital. In 2013-2014 and 2017-2018, respectively, the likelihood of survival was lower for women than men on admission (odds ratio [OR], 0.52 vs OR, 0.61; P .001 and P = .009 in the 2 time series) and at discharge (OR, 0.69 vs 0.72 for men; P = .001 in both time series). Survival with good neurological outcomes was also less likely in women (OR, 0.50 vs 0.63; P .001 in both series)., Conclusion: The odds for survival and survival with good neurological outcomes were lower for women in nearly all patient groups in both time series. These findings suggest the need to adopt new approaches to address gender differences in OHCA.