About 350,000 Americans have heart attacks outside of hospitals each year, and only about one out of 10 survive, according to the American Heart Association. Those odds generally improve if someone is nearby to administer CPR.
But a Kansas City cardiologist has found that Black people and women are less likely to benefit from a bystander giving them CPR.
Bystander CPR is possible because many people who are not medical professionals receive training in CPR through volunteer organizations and in other settings.
Dr. Paul Chan, a cardiologist at Saint Luke’s Mid America Heart Institute, and a team of researchers looked at more than 600,000 cardiac arrests that occurred outside of hospital settings. Of those, 40% of people received CPR from a bystander. On average, people who received this care had a 28% higher chance of survival.
But survival outcomes varied greatly between race and gender. White men who received bystander CPR were 41% more likely to survive, but Black women only had a 5% greater chance of survival.
Previous studies Chan has been involved with showed Black and Hispanic adults are less likely to receive CPR from bystanders. Compared to white children, bystander CPR was 41% less likely for Black children and 22% less likely for Hispanic kids, according to the American Heart Association.
Chan compared these results to concerns that would arise, if, for example, a proven medication for cancer treatment was less effective for certain groups of people.
The difference? Medication can be standardized.
“In contrast to chemotherapy, where you're getting that dose, you’re getting 50mg every time to the same patient regardless of race or sex, with CPR we don't know if that dose is the same, delivered equally by the patient's sex or race ethnicity,” Chan said. “The reasons for differences in the effectiveness can be many fold."
Native American adults and white adults had a respective 40% and 33% increased odds of survival from bystander CPR, compared to those who did not receive bystander CPR. But Black adults only had 9% increased odds.
Men who received bystander CPR had 35% increased odds of survival, while women only had 15% increased odds.
The study notes a need for future research to help determine the exact reasons for these disparities, particularly along racial lines. However, Chan and his fellow researchers do have some theories.
CPR training usually involves male test dummies. Without training on female test dummies, people who are trained to administer CPR as bystanders might be more uncomfortable applying compressions to a woman's chest, Chan said.
The study also suggests that different levels of dispatcher training and resources could lead to lower-quality instructions for CPR in Black communities.
“Anyone can do it — our kids can do it, our, you know, our parents can do it. It's literally a skill that everybody needs to learn and everybody needs to be comfortable in giving,” said Laura Lopez, executive director Kansas City American Heart Association. But, Lopez said, there are also notable variances in rates of CPR training across communities. Communities of color typically have lower rates of CPR training than some others, she said.
Chan and Lopez both noted existing efforts to increase and improve training in historically underserved communities, but said more still can be done. The AHA is now focused on increasing outreach and education initiatives.
That includes hands-only CPR, which requires less training and no certification. Lopez said there are plenty of educational videos on heart.org/CPR which can teach anyone how to perform these compressions in as little as 60 seconds.
Missouri has seen a significant increase in bystander interventions in the last decade, said Kayla Riel, the state coordinator for Missouri Cardiac Arrest Registry to Enhance Survival, or MO CARES, part of a national registry that tracks data based on out-of-hospital cardiac events.
But the issues persist. In the past, women were receiving bystander intervention in the single digits. It’s improved now to about 13%, but that’s still low, Riel said.
And of Black women in the registry, only about 3% of those received bystander-initiated CPR despite making up 10% of all cardiac arrests in the state.
Riel said organizations across the metro ranging from fire departments to health departments to hospitals have become involved in improving training to reduce these disparities. MO CARES hosts training events as well.
“We did receive a grant very recently that has allowed us to purchase diverse female mannequins,” Riel said. “And it's really helped expand our mannequin library so that agencies can also borrow these mannequins and utilize them in their own hands.”
Angie Springs, a spokesperson for the American Red Cross of Missouri and Arkansas, said her organization also plans to incorporate CARES data with information on low bystander response rates. That information and other data could help identify communities needing more hands-on CPR and CPR certification offerings, Springs said.
