American Heart Association
American Heart Association
November 16, 2018
3 min read

Women less likely to receive bystander CPR

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Marion Leary
Marion Leary

CHICAGO — People are less likely to perform CPR for women than men who are experiencing cardiac arrest, according to two studies presented at the American Heart Association Resuscitation Science Symposium.

Regardless of the victim’s sex, “if you see someone collapse, call 911, begin CPR, and if there is an AED around, use it,” Marion Leary, MSN, MPH, lead researcher of one study and director of innovation research at the University of Pennsylvania’s Center for Resuscitation Science, said in a press release. “Doing something is better than doing nothing. You have the power to help save someone’s life.”

Virtual reality to study bystander CPR

Leary and colleagues used virtual reality to explore sex-based differences in bystander response to cardiac arrest. Specifically, they used a virtual reality system integrated with a CPR-recording manikin and randomly assigned the avatar victim to male or female sex.

Study participants were able to give vocal commands to simulated bystanders and perform CPR on the simulated victim in the virtual environment while simultaneously performing CPR on the manikin, which recorded quality of CPR. The nature of the event was unknown to the participants, but they were told to act as they would in any emergency situation.

Of the 75 participants, 59% performed CPR and 11% used an automated external defibrillator. More male victims than female victims received CPR (65% vs. 54%) and an AED was used more often in male victims than female victims (21% vs. 15%). Furthermore, when the victim was a woman vs. a man, CPR was performed less often by both male (56% vs. 71%) and female participants (50% vs. 58%).

Among the 75 participants, the mean age was 31 years, 35% were women, 49% were white and 66% had never been trained in CPR or were trained more than 2 years before.

Leary noted that this was only an observational study and was not powered to look at the difference in response based on gender.

Potential reasons for sex-based differences

To explore the drivers behind the sex-based differences in bystander CPR, Sarah M. Perman, MD, MSCE, assistant professor of emergency medicine at the University of Colorado School of Medicine in Denver, and colleagues conducted an online survey of 54 U.S. adults with knowledge of CPR.

Sarah Perman
Sarah M. Perman

Four themes emerged among the free-text responses as to why women may be less likely to receive bystander CPR. These included:

  • fear of inappropriate touching (16 responses);
  • fear of being accused of sexual assault or sexual harassment (17 responses);
  • concern about hurting or injuring a woman (12 responses);
  • poor recognition of cardiac arrest in women (five responses); and
  • the belief that breasts make CPR more difficult (three responses).

Perman noted in the release that men were twice as likely as women to cite concerns about accusations of sexual assault or inappropriate touching as the reasons for why women may be less likely to receive bystander CPR.

“The consequences of all of these major themes is that women will potentially receive no CPR or delays in initiation of CPR,” Perman said. “While these are actual fears the public holds, it is important to realize that CPR is lifesaving and should be rendered to collapsed individuals regardless of gender, race or ethnicity.”

The survey conducted by Perman and her colleagues was sent using Mechanical Turk (MTurk), Amazon’s crowdsourcing platform, to U.S. adults who were reimbursed $1 for their participation. Of the 54 participants who responded within 55 minutes of deploying the pilot survey, 13% were located in the West, 13% in the Southwest, 16.7% in the Midwest, 27.8% in the Southeast and 29.6% in the Northeast. Nearly 30% were trained in CPR and 5.6% had performed CPR on a person. The mean age was 36.9 years and 38.9% were women.

“Bystander CPR has been linked to better survival and neurologic recovery after out-of-hospital cardiac arrest. Quality chest compressions require that rescuers put their hands on the chest and push hard — regardless of (recipient’s) gender, the act of CPR is no different,” she said.

The pilot survey has been expanded and the researchers have a manuscript under review that describes the public perceptions of CPR in a large national sample, according to the release. – by Melissa Foster


Leary M, et al. Poster 196.

Perman SM, et al. APS.01.09 – Bystander CPR 1.

Both presented at: American Heart Association Resuscitation Science Symposium; Nov. 10-11, 2018; Chicago.

Disclosure: Leary reports she receives research grants from the Medtronic Foundation, the Laerdal Foundation; she receives other research support from Laerdal Medical; and she has ownership interest in Licensing IP. Perman reports she receives research grants from the NIH/NHLBI.