By Amy Norton
Health Day Reporter
THURSDAY, Oct. 27, 2022 (HealthDay News) — When someone collapses in front of witnesses, the chances of receiving potentially life-saving CPR may depend in part on skin color, a new study finds.
Researchers found that Black and Hispanic Americans who suffer cardiac arrest are up to 37% less likely than white people to be resuscitated in public places and at home by laypeople.
The reasons for the disparity aren’t certain, but there are possible explanations, said lead researcher Dr. Paul Chan of Saint Luke’s Mid America Heart Institute in Kansas City, Mo.
CPR training, he said, is less available in black and Hispanic communities, and there are other barriers, such as cost, that may help explain the disparities in home cardiac arrest responses.
However, when the study began, the researchers expected that the differences would narrow when cardiac arrests occurred in public. The more people around, the greater the chances that a bystander will be trained in CPR.
Instead, the differences were larger: During cardiac arrests at home, blacks and Hispanics were 26% less likely than whites to receive CPR. In the public sector, this gap grew to 37%.
“That was striking. It wasn’t what we expected,” Chan said. “And it raises a lot of questions about why.”
Unfortunately, bias — conscious or unconscious — could play a role, Chan and other experts said. Viewers might be less likely to make “assumptions” about a white person collapsing than about a black or Hispanic person, Chan said.
But the differences weren’t limited to cardiac arrests occurring in white neighborhoods, he noted.
In neighborhoods of all income groups, and even those with a majority of black or Hispanic origins, white cardiac arrest victims were more likely to receive bystander CPR.
Cardiac arrest occurs when the heart suddenly stops beating normally due to a problem in its electrical system. Usually, the person collapses unconscious and stops breathing normally. Without emergency medical treatment, it can quickly become fatal.
Having a bystander immediately begin CPR chest compressions can keep blood and oxygen flowing through the victim’s body until paramedics arrive. But in reality, only about 45% of Americans who experience cardiac arrest outside of a hospital receive bystander CPR, according to the American Heart Association.
The new findings, published on October 27 in the New England Journal of Medicine, agree with this statistic.
Chan’s team used a large US registry to find more than 110,000 cases of cardiac arrest where witnesses were present. Despite this, most victims did not receive CPR, with rates being particularly low for blacks and Hispanics.
When they went into cardiac arrest at home, about 39% received CPR, versus 47% of whites. And when the arrest took place in public, nearly 46% of Black and Hispanic victims received CPR, versus 60% of their White counterparts.
Such differences were found regardless of whether the surrounding neighborhood was primarily white, racially diverse, or majority Black or Hispanic, and whether it was high or low income.
“It’s sad, it’s heartbreaking,” said Dr. Katie Berlacher, a member of the American College of Cardiology’s Health Justice Task Force and a cardiologist at the University of Pittsburgh.
But she also said she wasn’t surprised. Although more people are available to respond to cardiac arrest in public, those people may be biased, consciously or not, Berlacher said. These biases, she noted, can affect how quickly they approach the person who has collapsed, call 911, or try to find someone knowledgeable about CPR.
dr Anezi Uzendu has worked with the Heart Association to develop a ‘toolkit’ to reduce inequalities in care and survival in cardiac arrest. He also survived cardiac arrest, thanks in part to the action of bystanders who administered CPR after collapsing at age 25 while playing basketball at his gym.
“It can happen to anyone,” said Uzendu, who is also a cardiologist at Saint Luke’s but was not involved with the study.
Uzendu has beaten the odds as the cardiac arrest survival rate is low at about 12%, according to the Heart Association. And studies show that survival is even lower for blacks and Hispanics than for whites.
CPR can double or triple the chances of survival, and it has been hypothesized that greater access to CPR training could close the racial divide in cardiac arrest survival.
But the new findings show that CPR training isn’t the only solution, Uzendu said.
“Some of this disparity may be due to a lack of education,” he said. “Part of this may be due to structural racism. Some of this may be due to implicit or explicit bias.”
However, all three physicians agreed that greater access to CPR training could make a big difference—especially since an estimated 70% of cardiac arrests happen at home, where bias probably wouldn’t be the issue.
One way to achieve this, according to Chan, is by offering free or low-cost training in appropriate places, such as churches or community centers in underserved neighborhoods.
Training should also include people of color, Berlacher said — from the trainers to the actors in the course videos.
In terms of survival from cardiac arrest, Chan’s team found what previous studies have shown: Blacks and Hispanics were more likely to die. Of those who suffered cardiac arrest in public, just under 23% survived, compared to almost 32% of whites.
“CPR can make a huge difference in survival,” Chan said.
The American Heart Association has more on learning CPR.
SOURCES: Paul S. Chan, MD, Professor, Physician, Cardiologist, University of Missouri-Kansas City School of Medicine, Saint Luke’s Mid America Heart Institute, Kansas City, Missouri; Kathryn Berlacher, MD, MS, Assistant Professor of Medicine, Medical Director, Magee Women’s Heart Program, University of Pittsburgh Medical Center, and Member, Health Equity Task Force, American College of Cardiology, Washington, DC; Anezi Uzendu, MD, interventional cardiologist, Saint Luke’s Mid America Heart Institute; New England Journal of Medicine, October 27, 2022