About 350,000 Americans have heart attacks outside of hospitals each year, and only about one in 10 survive, according to the American Heart Association. Those odds generally improve when someone is nearby who can perform CPR.
However, a Kansas City cardiologist has found that blacks and women benefit less from cardiopulmonary resuscitation performed by a passerby.
Bystander cardiopulmonary resuscitation is possible because many non-medical professionals receive training in cardiopulmonary resuscitation from volunteer organizations and other settings.
Dr. Paul Chan, cardiologist at Saint Luke’s Mid America Heart Institute and a team of researchers examined more than 600,000 cardiac arrests that occurred outside of hospitals. Of these, 40% received CPR from a bystander. On average, people who received this help had a 28% higher chance of survival.
However, survival rates varied widely by race and gender. White men who received bystander CPR had a 41% higher chance of survival, while black women had only a 5% higher chance of survival.
Previous studies Chan has shown that black and Hispanic adults are less likely to receive bystander CPR. Compared to white children, bystander CPR was 41% less common in black children and 22% less common in Hispanic children. according to the American Heart Association.
Chan compared these results to concerns that would arise if, for example, a proven cancer treatment drug were to prove less effective in certain groups of people.
The difference? Medicines can be standardized.
“Unlike chemotherapy, where you give the same patient 50 mg every time, regardless of race or gender, in cardiopulmonary resuscitation, we don’t know if the dose is the same regardless of the patient’s gender or ethnicity,” Chan said. “The reasons for differences in effectiveness can be many.”
Among Native Americans and whites, the chance of survival with bystander resuscitation was 40% and 33% higher, respectively, than those who did not receive bystander resuscitation. However, among black adults, the chance of survival was only 9% higher.
In men who received bystander cardiopulmonary resuscitation, the chance of survival was increased by 35%, while in women it was only increased by 15%.
The study notes that more research is needed to determine the exact reasons for these disparities, particularly along racial lines, but Chan and his colleagues have some theories.
CPR typically uses male dummies. Without training on female dummies, bystanders trained in CPR may feel more uncomfortable performing CPR on a woman, Chan said.
The study also suggests that differences in dispatcher training levels and resources may lead to inferior quality of CPR instructions in black communities.
“Anyone can do it — our kids can do it, our parents can do it. It’s literally a skill that everyone has to learn, and everyone has to feel comfortable using it,” said Laura Lopez, executive director of the Kansas City American Heart Association. But, Lopez said, there are also notable differences in the frequency of CPR training across communities. Communities with residents of color tend to have less CPR training than others, she said.
Chan and Lopez both noted existing efforts to improve and expand training in historically underserved communities, but said more can be done. The AHA is currently focused on expanding outreach and education initiatives.
This includes cardiopulmonary resuscitation (CPR), which requires less training and no certification. Lopez said there are many instructional videos on heart.org/CPR This can teach anyone how to perform these compressions in just 60 seconds.
Missouri has seen a significant increase in bystander interventions over the past decade, says Kayla Riel, state coordinator of the Missouri Cardiac Arrest Registry to Enhance Survival (MO CARES), part of a national registry that collects data on cardiac events outside of hospitals.
But the problems persist. In the past, women received only single-digit percentages of help from passers-by. The figure has now improved to around 13 percent, but that is still low, says Riel.
And only about three percent of black women on the registry received bystander-initiated CPR, even though they account for 10 percent of all cardiac arrests in the state.
Riel said organizations across the metropolitan area – from fire departments to health departments to hospitals – are working to improve training to reduce these inequities. MO PROVIDES also organizes training events.
“We recently received a grant that allowed us to purchase a variety of female mannequins,” Riel said. “And it’s really helped us expand our mannequin library so agencies can borrow these mannequins and use them themselves.”
Angie Springs, a spokeswoman for the American Red Cross of Missouri and Arkansas, said her organization also plans to combine CARES data with information on low bystander response rates. That and other information could help identify communities that need more hands-on CPR and CPR certification offerings, Springs said.
