Nav: Home

Two novel studies explore why women receive less CPR from bystanders

November 05, 2018

DALLAS, Nov. 5, 2018 -- Concerns about inappropriate contact or causing injury may help explain why bystanders are less likely to perform CPR on women - even "virtual" women - than on men who collapse with cardiac arrest, according to two studies presented at the American Heart Association's Resuscitation Science Symposium 2018, an international conference highlighting the best in cardiovascular resuscitation research.

Cardiac arrest occurs when the heart's electrical system malfunctions, often in the absence of any previous symptoms. In the United States, more than 350,000 cardiac arrests occur outside hospitals each year. While the survival rate is less than 12 percent, CPR can double or triple a victim's odds of surviving.

Previous research has shown women who suffer out-of-hospital cardiac arrest receive CPR less frequently than men, said Sarah M. Perman, M.D., M.S.C.E., assistant professor of Emergency Medicine at the University of Colorado School of Medicine in Denver and lead author on the survey study.

In a new survey (Poster Presentation 198) Colorado researchers asked 54 people online to explain, with no word limit, why women might be less likely to get CPR when they collapse in public. In the replies, the team identified four themes:
  • Potentially inappropriate touching or exposure;

  • Fear of being accused of sexual assault;

  • Fear of causing physical injury;

  • Poor recognition of women in cardiac arrest--specifically a perception that women are less likely to have heart problems, or may be overdramatizing or "faking" an incident; or

  • The misconception that breasts make CPR more challenging.

"The consequences of all of these major themes is that women will potentially receive no CPR or delays in initiation of CPR," Perman said. "While these are actual fears the public holds, it is important to realize that CPR is lifesaving and should be rendered to collapsed individuals regardless of gender, race or ethnicity."

Worries about accusations of sexual assault or inappropriate touching were cited twice as many times by men as by women, while more women mentioned fear of causing injury. Although the study was too small to discern definite trends, these concerns may represent an important challenge in public health messaging, Perman said.

"Bystander CPR has been linked to better survival and neurologic recovery after out-of-hospital cardiac arrest. Quality chest compressions require that rescuers put their hands on the chest and push hard--regardless of (recipient's) gender, the act of CPR is no different," she said.

The pool of responders was about 60 percent male and 85 percent Caucasian. Almost three in 10 reported having received CPR training.

The researchers have expanded this pilot survey and have a manuscript under review that details the outcomes of a large national sample of public perceptions. The research team plans to work with CPR training sites to counteract bystander fears about providing CPR to women, Perman said.

Separate research (Poster Presentation 196) in Philadelphia tested a novel approach to exploring bystander response to cardiac arrest based on the victim's sex - using virtual reality.

Because it happens suddenly, real-world cardiac arrest is hard to study, said Marion Leary, M.S.N., M.P.H., lead study author and director of innovation research at the University of Pennsylvania's Center for Resuscitation Science. But using virtual reality, scientists can learn more about bystander response and how to improve CPR training courses.

This study's 75 participants--adult volunteers from the community--were not told specifically what would happen in the virtual environment and were asked to respond as if they were experiencing a real-life emergency. The setting was a busy city where a pedestrian collapses while someone cries for help.

A CPR manikin was kept out of sight until participants were in the virtual environment. Then the manikin was placed in real life at the location where the victim would collapse in the virtual world, allowing participants to perform CPR (and attach an automated external defibrillator, or AED) in the virtual environment while receiving "hands-on" feedback in the real environment, Leary said.

The team's findings showed that in their descriptive study, participants in their cohort performed CPR or used an AED on virtual-reality female victims less than on virtual male victims. But a study with more participants is needed to statistically identify any significant gender gaps and to confirm the trend found, Leary said.

Regardless of the victim's sex, "if you see someone collapse, call 911, begin CPR, and if there is an AED around, use it," Leary said. "Doing something is better than doing nothing. You have the power to help save someone's life."
-end-
Co-authors for the online CPR survey are Shelby K. Shelton, M.P.H.; Christopher Knoepke, Ph.D., M.S.W.; Kathryn Rappaport, M.D.; Daniel D. Matlock, M.D., M.P.H.; Kathleen Adelgais, M.D., M.P.H.; Edward P. Havranek, M.D.; and Stacie L. Daugherty, M.D., M.S.P.H. The project was funded by the Center for Women's Health Research at the University of Colorado School of Medicine. Dr. Perman also receives support from the National Heart, Lung, and Blood Institute.

Co-authors for the virtual reality research are Alfredo Almodovar Jr., B.S.; David Buckler, B.A.; Jaldhi Patel; Zainab A. Chaudhary; Ariel Karwat, B.S.; Benjamin S. Abella, M.D., M.Phil.; and Audrey L Blewer, Ph.D., M.P.H. The project was funded by the Laerdal Foundation and Medtronic Foundation. Author disclosures are on the abstracts.

Note: Scientific presentation for both posters is 1:15 p.m. CT, Saturday, Nov. 10, 2018 at the Hyatt Regency Chicago.

Additional Resources: Statements and conclusions of study authors that are presented at American Heart Association scientific meetings are solely those of the study authors and do not necessarily reflect association policy or pharmaceutical position. The association makes no representation or warranty as to their accuracy or reliability. The association receives funding primarily from individuals; foundations and corporations (including, device manufacturers and other companies) also make donations and fund specific association programs and events. The association has strict policies to prevent these relationships from influencing the science content. Revenues from pharmaceutical and device corporations are available at https://www.heart.org/en/about-us/aha-financial-information.

About the American Heart Association

The American Heart Association is a leading force for a world of longer, healthier lives. With nearly a century of lifesaving work, the Dallas-based association is dedicated to ensuring equitable health for all. We are a trustworthy source empowering people to improve their heart health, brain health and well-being. We collaborate with numerous organizations and millions of volunteers to fund innovative research, advocate for stronger public health policies, and share lifesaving resources and information. Connect with us on heart.org, Facebook, Twitter or by calling 1-800-AHA-USA1.

American Heart Association

Related Cardiac Arrest Articles:

Intravenous sodium nitrite ineffective for out-of-hospital cardiac arrest
Among patients who had an out-of-hospital cardiac arrest, intravenous sodium nitrite given by paramedics during resuscitation did not significantly improve their chances of being admitted to or discharged from the hospital alive, according to research presented at the American College of Cardiology's Annual Scientific Session Together with World Congress of Cardiology (ACC.20/WCC).
Getting to the heart of epinephrine use in pediatric cardiac arrest patients
The effectiveness of epinephrine treatment during resuscitation of adult patients with cardiac arrest is generally promising, but little is known about its effects in pediatric patients.
Bystanders can help more cardiac arrest victims survive
Only 8% of Americans survive cardiac arrest outside a hospital, but that percentage could increase significantly if bystanders recognize cardiac arrest and perform simple lifesaving tasks, a UVA Health physician says in a New England Journal of Medicine article.
Opioid-related cardiac arrest patients differ from other cardiac arrests
People who suffer cardiac arrest due to an opioid overdose are younger, have fewer chronic medical conditions and may be more likely to be to receive bystander CPR, according to a review of emergency response records in Maine.
Selective coronary angiography following cardiac arrest
In the current issue of Cardiovascular Innovations and Applications volume 4, issue 2, pp.
Sudden cardiac arrest in athletes: Prevention and management
It's marathon season, and every so often a news report will focus on an athlete who has collapsed from sudden cardiac arrest.
Scientific statement on predicting survival for cardiac arrest survivors
If a loved one has a heart attack that stops the heart, ends up in a coma, and the treating physician approaches you about taking the person off life support, would you trust that the physician knows when to make the call or how to judge that the person won't recover?
Cardiac arrest among hospitalized patients may be underestimated
More patients may be having cardiac arrests in the hospital than previously believed.
Women are less likely to be resuscitated and survive a cardiac arrest than men
Women who have a cardiac arrest outside the hospital setting are less likely to receive resuscitation from bystanders and more likely to die than men, according to new research published in the European Heart Journal.
Compression-only CPR increases survival of out-of-hospital cardiac arrest
In a Swedish study of out-of-hospital cardiac arrest, bystander CPR rates nearly doubled and compression-only, or Hands-Only CPR, rates increased six-fold over the 18-year review.
More Cardiac Arrest News and Cardiac Arrest Current Events

Trending Science News

Current Coronavirus (COVID-19) News

Top Science Podcasts

We have hand picked the top science podcasts of 2020.
Now Playing: TED Radio Hour

Listen Again: Reinvention
Change is hard, but it's also an opportunity to discover and reimagine what you thought you knew. From our economy, to music, to even ourselves–this hour TED speakers explore the power of reinvention. Guests include OK Go lead singer Damian Kulash Jr., former college gymnastics coach Valorie Kondos Field, Stockton Mayor Michael Tubbs, and entrepreneur Nick Hanauer.
Now Playing: Science for the People

#562 Superbug to Bedside
By now we're all good and scared about antibiotic resistance, one of the many things coming to get us all. But there's good news, sort of. News antibiotics are coming out! How do they get tested? What does that kind of a trial look like and how does it happen? Host Bethany Brookeshire talks with Matt McCarthy, author of "Superbugs: The Race to Stop an Epidemic", about the ins and outs of testing a new antibiotic in the hospital.
Now Playing: Radiolab

Dispatch 6: Strange Times
Covid has disrupted the most basic routines of our days and nights. But in the middle of a conversation about how to fight the virus, we find a place impervious to the stalled plans and frenetic demands of the outside world. It's a very different kind of front line, where urgent work means moving slow, and time is marked out in tiny pre-planned steps. Then, on a walk through the woods, we consider how the tempo of our lives affects our minds and discover how the beats of biology shape our bodies. This episode was produced with help from Molly Webster and Tracie Hunte. Support Radiolab today at Radiolab.org/donate.