Likelihood of Receiving Lifesaving Bystander CPR May Be Associated with Your Race

Black or Hispanic patients with out-of-hospital cardiac arrest (OHCA) were less likely to receive lifesaving bystander cardiopulmonary resuscitation (CPR), according to Garcia and colleagues’ study performed using the Cardiac Arrest Registry to Enhance Survival (CARES) database. The study reported that survival of Black or Hispanic patients after OHCA is worse than that of White patients. These results expand on the established trends in health inequities in cardiac arrest survivorship and begin to illuminate on the potential reasons of such race-based differences in health outcomes.

In this United States-based study, investigators retrospectively identified 110,054 cases of witnessed out-of-hospital cardiac arrest occurring from 2013 through 2019. Of these, 32.2% events occurred in Black or Hispanic individuals (N = 35,469). The likelihood of undergoing bystander CPR at home in Black or Hispanic persons was lower than for White persons (38.5% versus 47.4%; adjusted odds ratio [OR], 0.74; 95% confidence interval [CI], 0.72-0.76). The likelihood of receiving bystander CPR in public locations was 37% lower for Black or Hispanic patients versus White individuals (OR, 0.63; 95% CI, 0.60-0.66).

In fact, Black or Hispanic patients were less likely to receive potentially lifesaving bystander CPR for all setting studies – both for OHCA occurring at home or in public locations regardless of whether this occurred in predominantly White neighborhoods, predominantly Black or Hispanic neighborhoods, or in more integrated neighborhoods. These findings held true across all neighborhood income strata studied.

Dr. Angel Garcia, cardiology fellow at Saint Luke’s Mid America, and lead author said “regarding home witnessed arrests, several factors which can explain some of the racial/ethnic differences in bystander cardiopulmonary resuscitation (CPR) include the costs of CPR training, a lower frequency of CPR training among minority communities, and potential language barriers during dispatcher-assisted bystander CPR. Moreover, in relation to cardiac arrests that were witnessed in public, given all of the variables accounted for within our study, the pervasive trend that Black or Hispanic persons were less likely than White persons to receive bystander CPR raises concern for implicit and explicit bias.”

These findings are alarming and multifaceted interventions are needed to overcome the underlying root causes. Optimistically, Dr. Garcia noted that “although our findings are unfortunate, they do highlight specific targets for improving future cardiac arrest outcomes. For example, making CPR training more affordable or of no cost for poorer communities, conducting CPR training sessions more frequently within minority communities, and providing more multi-cultural CPR education and equipment are all ways that can aid in improving the performance of bystander CPR by and for Black or Hispanic individuals.”

Time is of the essence when it comes to implementing critical interventions to bridge gaps in care and outcomes for cardiac arrest survivorship. Bystander CPR and defibrillator access are proven strategies to improve outcomes. This study shifts our focus to dive into the root of these disparities and potentially indicate structural racism and implicit biases as key targets for addressing race-based disparities in care. Improving cardiovascular morbidity and mortality requires a keen understanding of the underpinnings of health inequality and dedicated investments in multifactorial strategies to bridge these gaps.

Reference:

Garcia RA, Spertus JA, Girotra S, Nallamothu BK, Kennedy KF, McNally BF, Breathett K, Del Rios M, Sasson C, Chan PS. Racial and Ethnic Differences in Bystander CPR for Witnessed Cardiac Arrest. N Engl J Med. 2022 Oct 27;387(17):1569-1578. doi: 10.1056/NEJMoa2200798. PMID: 36300973; PMCID: PMC9760357.

NEW in @NEJM.

“Black and Hispanic persons were ⬇️ likely to receive bystander CPR at home (38.5%) than White persons (47.4%) and ⬇️ likely to receive bystander CPR in public locations than White persons (45.6% vs. 60.0%).“

This is a devastating finding.https://t.co/y4KBAVHqAl pic.twitter.com/0DMpVZUZxZ

— Utibe R. Essien, MD MPH (@UREssien) October 28, 2022

In a registry of 110K witnessed out-of-hospital cardiac arrests, Black or Hispanic persons were less likely than White persons to receive bystander CPR (38% vs 47%, aOR 0.74) – similar across neighborhood income strata and location (home, public). https://t.co/WByqY1dwWG @NEJM pic.twitter.com/925WpDJdtb

— Pradeep Natarajan (@pnatarajanmd) October 27, 2022