Sep 1, 2019
Show Notes for Episode Twelve of seX & whY: Sex and Gender Differences in CPR Part 1 & 2
Host: Jeannette Wolfe
Guest: Dr Justin Morgenstern
Two big databases surrounding cardiac arrest
Here are two great articles that cover this material in depth
What we know
(46% vs 52% in one study)
(one study 29% men vs women 16% with initial shockable rhythm)
Gender disparities among adult recipients of bystander cardiopulmonary resuscitations in the Public from Audrey Blewer in Cir Cardiovasc Qual Outcomes 2018
Primary study question- is there an association between an individual’s biological sex and the likelihood they will receive bystander CPR
Resuscitation Outcomes Consortium (ROC) 2011-2015
This was a retrospective analysis of data collected in a prospectively for several clinical trials in out of hospital cardiac arrests from 7 of these sites.
Occurs in a residential institution or hospital
Less than 18
CPR initiated by someone who was not a layperson (police EMS doc)
The variable they used in logistic regression modeling included whether event was witnessed, location, layperson CPR, time of event, and basic demographics including age, race, gender
Nontraumatic out of hospital cardiac arrests
Mean age 64
17% public location (3297)
82% private (15788)
Overall 37% received CPR (38% of men and 35% of women)
If collapse occurred in public place
If collapse occurred in private place
Overall: Males had 29% increased odds of survival
Bottom line: If you have a OHCA in public you are about 6% more likely to receive CPR if you are a man than a woman
There are also studies suggesting subtle gender differences in EMS treatment of chest pain/cardiac arrest:
Ok so why is that happening?
So first let’s talk about some general barriers to stepping up and doing CPR in public-
A 2008 study by Swor in Annals of EM interviewed almost 700 bystanders to an OHCA. Although about ½ of the bystanders had previous CPR training only about 20% actually started doing CPR.
Cited barriers to doing CPR included:
- feeling of panic (reported by about 38% )
- concern of doing it incorrectly (9%)
- concern they could cause harm (1%)
- reluctance to do mouth to mouth (1%)
In another study which surveyed community members from areas in which there were low rates of bystander CPR to understand why the rates were so low, answers included:
- fear of getting sued
- emotional overtones of the situation
- lack of knowledge
- situational concerns
A different study suggested that disagreeable physical characteristics- read dentures and vomit- might hamper CPR initiation.
Overall you are more likely to step up and do CPR if
So the next question is, are these the reasons why there is a gender difference in who gets bystander CPR or are there additional factors to consider.
Public Perceptions on Why Women Receive Less Bystander Cardiopulmonary Resuscitation than Men in Out of Hospital Cardiac Arrest
Perman Circulation 2019
Primary Question- what are the public perceptions as to why women are less likely to get bystander CPR?
Methods- Electric survey via Amazon’s crowdsourcing platform- Mechanical Turk. Participants were English, >18 and familiar with CPR principles
Mechanical Turk- have “master users” people achieve this rate by apparently having a history of completing other surveys out appropriately in the past (essentially successfully answering planted “attention” surveys which suggests that they are actually reading the surveys)
Participants were asked 11 multiple choice questions and one free text- “ Do you have any ideas on why women may be less likely to receive CPR than men when they collapse in public?” Free text responses were coded and major themes were identified by using an inductive qualitative method.
542 completed surveys
average age 38
equal number of males and females about 1% of participants were transgender
81% White 7% Black 6% Asian 3% Hispanic
45% college diploma
½ were trained at some time in CPR (top reasons for training were cited a work or volunteer related requirement)
24 had actually done CPR on a collapsed person-
Three major themes evolving:
1) Sexualization of woman’s bodies (40% of men mentioned versus 29% of women)
- fear of making incidental contact with a woman’s breast
“I think that people are afraid to touch the breast region, so hesitate to administer CPR”
- fear of being wrongfully accused of sexual abuse
“Bystanders, especially male bystanders, may be afraid to touch women especially in the chest area... anxious that their help my be unnecessary and therefore touching may be misconstrued”
“Men are afraid of seeming like perverts”
2) Perception that women are weaker and frailer and thus at greater risk for injury if CPR was not really needed
“People might be afraid of hurting them since women tend to be smaller and more fragile looking than men”
3) Misperception of what actual distress looks like in females
”They are not known to have as many heart attacks in public, they are known to be healthier”
“ Maybe people assume they are being dramatic and overreacting so CPR isn’t needed”
Interestingly in the open- ended responses it was frequently implied by use of pronouns that the bystander initiating CPR would be a man. Along these lines, this European paper hints that gender related issues may also influence who steps up to start CPR.
My (liberal) summary of paper:
“Look I’m not super thrilled about the idea of touching a woman’s breast and quite frankly I’m a little scared about being accused of sexual assault. And also, if I’m honest, I’m a little suspicious that the woman might be collapsing from something less serious, because most cardiac arrests seem to happen in guys. Finally, if I do start CPR on a woman and they really didn’t need it, I’m afraid I might accidentally physically hurt her.
Five take home points
North Carolina’s Heart Rescue Intervention
Article about CPR and Good Samaritan laws