Black, Hispanic adults less likely than whites to receive ‘life-saving’ bystander CPR during cardiac arrest, study finds


Black and Hispanic adults who suffer cardiac arrest in public are less likely to receive CPR from anyone standing by before a medical team arrives, a new study finds.

Overall, the relative odds of householders performing CPR were 26% lower for blacks and Hispanics than whites, and bystanders were 37% less likely to perform CPR for cardiac arrests for blacks and Hispanics than whites. The study was published Thursday in the New England Journal of Medicine.

“These results were important to understand and likely emblematic of other larger societal issues affecting health care and treatment,” said Dr. Paul Chan, the study’s lead author and a cardiologist at Saint Luke’s Mid America Heart Institute in Missouri, in a news release.

“In cardiac arrests, you depend on the audience to respond. Without them, the likelihood of survival before the arrival of first responders and paramedics is significantly lower,” he said. “Therefore, this study really reveals the structural and individual challenges we face as a society, which are not so obvious with other medical conditions. with biases”.

The researchers – from Saint Luke’s Mid America Heart Institute, the University of Missouri-Kansas City and other US institutions – analyzed data from the National Cardiac Arrest Registry to improve survival for 110,054 people in the United States who had an out-of-hospital cardiac arrest. Between 2013 and 2019. The researchers analyzed data on the race and ethnicity of people who had a cardiac arrest but did not have racial data.

The researchers found that 45.6 percent of blacks and Hispanics received bystander CPR when cardiac arrests occurred in public places, compared to 60 percent of whites.

Specifically, blacks and Hispanics were less likely than whites to be in all public location categories, including workplaces, 53.2% and 61.8%; recreational facilities, 55.8% vs 74.4%; and public transport centers, 48.3% vs 69.6%, according to the data.

“Racial and ethnic differences in bystander CPR in public settings raise additional concerns about implicit and explicit responses to out-of-hospital cardiac arrests,” the researchers wrote.

The data also showed that 38.5 percent of blacks and Hispanics received bystander CPR when a cardiac arrest occurred at home, compared with 47.4 percent of whites.

“Several factors may explain the lower incidence of bystander CPR among blacks and Hispanics compared to whites during home arrests,” the researchers wrote. “CPR training is less common in black and Hispanic communities, and dispatcher-assisted bystander CPR may be less available.”

The researchers noted that the lower likelihood of bystanders performing CPR on blacks and Hispanics continued even in the most black and Hispanic neighborhoods.

“Blacks and Hispanics were less likely than whites to receive life-saving bystander CPR at home and in public places, regardless of race or ethnicity or income in the neighborhood where the cardiac arrest occurred,” the researchers wrote.

The study’s findings suggest that these disparities in whether someone receives CPR from a bystander may contribute to the fact that Blacks may be less likely to survive an out-of-hospital cardiac arrest.

The study’s findings were “worrying” but not surprising to Dr. Georges Benjamin, executive director of the Public Health Association.

“To me, it’s disappointing that this hasn’t been fixed all these years, because we’ve known this for a long time,” said Benjamin, who organized CPR training programs as chief of emergency medicine at Walter Reed Army Medical. the center

Benjamin, who was not involved in the new study, agreed with the authors that part of the reason for the racial disparity in bystander CPR may be a lack of training in Black and Brown communities. Failure to receive bystander CPR during a cardiac arrest can have “significant clinical consequences” for the person whose heart has stopped pumping.

“Bystander CPR ensures blood circulation, oxygenation to the brain and other vital organs,” Benjamin said. “So the sooner you can get the blood circulating, even at a low level, the more likely it is that the person will get enough oxygen to keep the brain functioning at a level” until the person receives hospital care.

The study’s findings also came as no surprise to Dr. Jayne Morgan, a cardiologist and executive director of health and community education at Piedmont Healthcare/Hospital System in Atlanta, who was not involved in the new paper.

“No, I’m not particularly surprised by the findings, as socioeconomic infrastructure affects all areas of the lives of those affected in a negative and compounding effect,” Morgan wrote in an email to CNN on Thursday.

“Certainly, time to intervention is critical, and bystander access and use of CPR and defibrillators is part of that,” he said, adding that differences in the extent of CPR training in communities also play a role in someone’s chance of receiving CPR. .

The study’s findings on disparities could be used to help improve the likelihood of immediate CPR for anyone in cardiac arrest, Dr. Walter Clair, of Vanderbilt University Medical Center, wrote in an editorial accompanying the study Thursday.

“In interpreting the results, the authors properly addressed the role that implicit bias may have played in the observed racial and ethnic differences. The overall incidence of bystander CPR in out-of-hospital cardiac arrest in this study is disappointing, and these data suggest that reluctance to provide CPR among bystanders may have a greater impact. than in black and Hispanic communities. White communities,” Clair wrote.

“We need to use what we learn about disparities to help improve the likelihood of bystander CPR for everyone. This study reminds us that our efforts to reduce cardiovascular morbidity may be complicated in part by a legacy of structural racism and unfavorable social determinants of sudden cardiac death that have left many of our communities segregated.” .