When a person’s heart stops, their odds of survival are greater if a bystander immediately performs CPR.
But having someone step in during this critical moment is not all that matters.
A new study has uncovered dramatic differences in outcomes based on the race and sex of the people who went into cardiac arrest and got CPR. White people were three times more likely than Black people to survive the episode, and men of any background were twice as likely to survive as women, researchers found. In all of these cases, CPR was administered by someone other than a first responder.
The findings published this week in the American Heart Association journal “Circulation” confounded researchers examining outcomes for the life-saving technique and opened up a new array of questions they’re hoping to explore.
It wasn’t just a matter of whether a bystander stepped in to perform CPR on a person in distress, said Dr. Paul Chan, the lead author and a cardiologist at Saint Luke’s Mid America Heart Institute, in Kansas City. It mattered how well people were performing the technique, he told USA TODAY. The question going forward, Chan said, is, “Can it be done just as well in all different groups of people, so we can really ensure health care equity for all individuals who suffer cardiac arrest?”
Prior research has shown bystanders are less likely to perform on Black and Latino people. However, researchers found that even when Black people received CPR from a bystander, their odds of surviving were considerably lower.
The study, which received funding from the National Institutes of Health, drew from data collected from more than 623,000 people who experienced cardiac arrests outside the hospital between 2013 and 2022. Nearly 58,100 people in that group, or 9%, survived.
Race, sex intersect
Nearly 40% of people who went into cardiac arrest received CPR, or cardiopulmonary resuscitation, from a bystander. Bystanders could include family, friends or people nearby. When a bystander tried to resuscitate someone, that person, on average, had a 28% greater chance of surviving than someone who didn’t receive CPR. CPR recipients are more likely to avoid serious brain injuries caused by the lack of oxygen flowing to the brain.
Chan and other researchers found that survival outcomes differed dramatically depending on the recipient’s race and biological sex. For example, white men who experienced cardiac arrest and received CPR from a bystander were 41% more likely to survive, the best odds of any group. Meanwhile, Black women had the lowest survival chances of any group, just 5%. Chan said bystander CPR provided in these cases offered “very negligible benefits.”
Differences in CPR recipients’ income and where they lived did not alter the outcomes for Black people and women, the study found. The causes for these stark survival differences aren’t clear.
Chan, the study author, wondered whether training could be a factor. He noted that mannequins used in CPR certification courses tend to have white and male features. Another possible issue, he said, is that bystanders may perceive women as frail or may not want to touch or expose a woman’s upper body while performing CPR. Additionally, Chan thought it was important to look into access to formal training, which has historically been limited in communities of color.
The findings were not surprising, but they were worrisome and “sobering,” said Dr. Lisa Cooper, director of the Johns Hopkins Center for Health Equity, who was not affiliated with the study.
The quality of training may not fully explain the gap in outcomes, she said in an email. Cooper added she would like to understand the prior medical status of the people in the study who were experiencing cardiac arrest, as well as the training the bystanders received, whether it was online or in person. She also wanted to know whether 911 dispatcher instructions to bystanders varied in different communities. These questions were limited in the study, researchers said.
High-quality CPR needed
Organizations such as the American Heart Association and the American Red Cross that offer CPR training and certification may be a focus for future study. In emailed responses, both groups said they aim to ensure that they’re offering quality training in all communities.
“The study points out that CPR saves lives, but high-quality CPR is also very important,” Dr. Comilla Sasson, vice president of health science for the American Heart Association, said in a statement. “There are some things we can do to help ensure equitable outcomes for all patients needing CPR.”
The Heart Association has advocated for required CPR training at high schools nationwide, she said. This would include hands-on practice, which is key to getting people comfortable with performing resuscitation on everyone, including women.
The findings confirm that a bystander performing CPR is critical to saving a person’s life, said Dr. Paula Einhorn, a program officer in the NIH’s National Heart, Lung, and Blood Institute.
“Unfortunately,” she said, “the survival benefit is not equal for everyone.”
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