Women less likely to receive CPR

March 01, 2024

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Women with public cardiac arrest less likely than men to receive CPR

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Key takeaways:

• Women were less likely than men to receive bystander CPR after a public out-of-hospital cardiac arrest.

• Findings did not change in analyses by neighborhood composition.

Women who experience cardiac arrest in public locationshave a decreased likelihood of receiving bystander CPR and automated external defibrillator application than men, regardless of neighborhood race composition, researchers reported.

In a retrospective study using the Cardiac Arrest Registry to Enhance Survival (CARES) database, researchers also found that the observed sex differences were not seen when examining survival to hospital discharge, suggesting a need for targeted education strategies and public health community programming to reduce bystander response disparities.

Women were less likely than men to receive bystander CPR after a public out-of-hospital cardiac arrest. Image: Adobe Stock

“Females are less likely than males to receive bystander CPR despite neighborhood composition,” Audrey L. Blewer, PhD, MPH, assistant professor of family medicine and community health and population health sciences at Duke University School of Medicine, told Healio. “We need to promote the public message that anyone can save a life. When someone encounters a cardiac arrest, they need to call 911, push hard and fast on the center of the person’s chest, and use a defibrillator (shock box) if available. Receipt of CPR should not differ based on the sex of the person having a cardiac arrest.”

Audrey L. Blewer

Blewer and colleagues analyzed CARES data to assess 309,662 adult out-of-hospital cardiac arrests not witnessed by emergency medical services (EMS) personnel from 2013 to 2019, with data stratified by neighborhood composition using U.S. Census Bureau information. The CARES registry includes all nontraumatic out-of-hospital cardiac arrests in which resuscitation was attempted by a 911 responder, including CPR, defibrillation or both. The mean age of patients was 62 years; 36% were women and 21% were Black.

The primary outcome was odds of receipt of bystander CPR stratified by sex and location, considering neighborhood-level race or ethnicity. Secondary outcomes were AED application and survival to hospital discharge.

The findings were published in the Journal of the American Heart Association.

Within the cohort, 39% received bystander CPR, 39% received AED application and 10% survived to hospital discharge. Twenty percent of arrests occurred in predominantly Black neighborhoods and 19% occurred in predominantly Hispanic neighborhoods.

Among adults who experienced public out-of-hospital cardiac arrest, 43% of women and 47% of men received bystander CPR (P < .001). Researchers found that women who had an out-of-hospital cardiac arrest were 14% less likely to receive bystander CPR than men (OR = 0.86; 95% CI, 0.82-0.89).

Analyses that incorporated neighborhood composition did not change the findings. ORs for women vs. men receiving bystander CPR after a public cardiac arrest were 0.8 for predominantly white neighborhoods (95% CI, 0.75-0.85), 0.87 for predominantly Black neighborhoods (95% CI, 0.76-0.98) and 0.83 for predominantly Hispanic neighborhoods (95% CI, 0.73-0.96). Sex-based differences were similar when assessing AED application after a public cardiac arrest.

In contrast, compared with men, women were more likely to survive to hospital discharge in both predominantly white and predominantly Black neighborhoods.

“There is a critical need to understand the potential sources of bias that may impact the receipt of CPR by females in the public setting,” Blewer told Healio.

The researchers noted that additional language may need to be incorporated into the bystander CPR trainingcurriculum to remove potential biases or fears of performing bystander CPR in public on women, adding that a recent study suggested respondents feared inappropriately touching the woman or harming her.

“Tailoring CPR training curriculum to address some of these issues may help reduce known inequities,” the researchers wrote. “Furthermore, the American Heart Association is looking specifically at these sex-based issues and has included additional materials in courses to address these barriers.”

For more information:

Audrey L. Blewer, PhD, MPH, can be reached at audrey.blewer@duke.edu; X (twitter): @audreyblewer.

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