Imagine: you are in the street and the person next to you collapses. What to do? If you intervene, it is more likely that you perform CPR in a man than in a woman with the same symptoms. The result: men are more likely to receive CPR from passersby, and therefore more likely to survive Sudden cardiac arrest This discovery, published last year, attracted much media attention at the time, but remains poorly understood. Two studies presented this week at the American Heart Association's annual conference examine the problem and possible ways to address this disparity in care.
"Women have a lower rate of CPR per viewer," says Sarah Perman of the University of Colorado's School of Medicine. But no one really knows why this is so, although the possible reasons are easy to guess. Perman and his coauthors turned to Amazon's crowdsourcing service, Mechanical Turk, for answers. They offered participants a dollar to answer the open question: "Do you have any idea why women are less likely to benefit from CPR than men when they collapse in public?
The 54 responses they obtained shed light on public perceptions of why this might happen – although Mr. Standing notes that these are just the initial results of a small survey ( although national). Another more comprehensive survey is being peer reviewed, she said. Its results are broadly consistent with the results of the preliminary survey and were also performed using Amazon's Mechanical Turk software.
As a clinician, she was not surprised to see responses expressing concerns about accidentally hurting women and her inability to understand exactly how bad a woman's symptoms are. These are two known problems that affect care.
However, "I was surprised by the high proportion of people who reacted to unwanted touching," she says. Respondents expressed concern that touching a woman's chest could be interpreted as aggression or unwanted sexual touching.
"Men do not want to appear caught off guard or uncomfortable by placing their hands on the breast of a woman they do not know," one reads in an answer. Another said, "Men are probably afraid to be charged with any form of sexual assault of any kind."
Given that misrepresentation of sexual assault is not more common than misrepresentation of other types of crimes, this result could tell more about the public's misperceptions than about the actual concerns of the accused. ;a third. But that does not mean it's not disturbing. "It's not a scenario where a woman is in distress," says Perman. "It's a scenario where a woman is on the ground, without pulse, potentially dead." In this scenario, where a few broken ribs are a known consequence of CPR and not perceived as an assault, she was surprised to see this fear on the list at all.
In a sense, it is not surprising that doctors and other researchers do not really understand what happens when passers-by choose to administer CPR or not. "By definition, sudden cardiac arrest is sudden," says Marion Leary of the University of Pennsylvania. "We do not know when it will happen or where." This means that it is virtually impossible to study the responses of people on the ground.
The doctoral student and nurse researcher is the lead author of an article examining a new method to solve this methodological problem. She and her co-authors examined the response to a heart attack using virtual reality. Seventy-five participants wore a virtual reality headset and interacted with a CPR manikin in a virtual scenario. The manikin was randomly presented in either male or female, white or non-white form.
By considering only sex, their results showed that people (especially men) were more likely to practice CPR and use an automated external defibrillator on men. As in the first article, however, a larger study is needed to fully understand the trend and determine which parts (if any) are statistically significant and can be used to explain why women are less likely to benefit from the RCP. Additional studies are also planned to understand how the race is represented, explains Leary.
"I like the use of virtual reality because we can manipulate different factors that we know are a problem," Leary said. But the use of virtual reality can go beyond studying and help make CPR training more inclusive – and therefore more effective. "Right now it's a unique training program," says Leary. Because aspects such as gender and race are not addressed in CPR training, and CPR programs use a standardized manikin, it is possible to anxiety about different body types and prevent passers-by to react quickly.
"We want people to call 911, we want people to do CPR, we want people to ask for and use a mobile AED," she says. Identify the barriers that prevent them from going through these vital steps and how to remove them (for example, potentially using a virtual reality app to simulate different types of people suffering from cardiac arrest in a CPR course, what his team is currently exploring) is important. "Once you've discovered that, the worst thing you can do is not fix it," says Perman.
Correction: A previous version of this article was wrongly referring to Leary as a nurse practitioner. She is a nurse researcher.