Future training in bystander CPR needs targeted approach in 'high-risk' neighborhoods

(Press-News.org) Residents living in high-income white and high-income integrated neighborhoods were more likely to receive bystander CPR (cardiopulmonary resuscitation) during an out-of-hospital cardiac arrest than arrest victims in low-income black neighborhoods, according to a publication in the Oct. 25 issue of the New England Journal of Medicine (NEJM). Arrest victims in low-income white, low-income integrated and high-income black neighborhoods were also less likely to receive bystander CPR.

In an effort to look at future CPR training processes and public health planning, researchers from Emory University, the University of Colorado and several other institutions wanted to better understand the effects of different neighborhoods on the probability of receiving bystander CPR in out-of-hospital cardiac arrests. More than 300,000 out-of-hospital cardiac arrests occur in the U.S. each year, with outcomes varying depending on geographic location of the patient, according to the researchers.

Using surveillance data that was prospectively submitted from 29 U.S. sites to the Cardiac Arrest Registry to Enhance Survival (CARES), the researchers looked at data from Oct. 1, 2005 through Dec. 31, 2009, accessing the relationship between income and racial/ethnic composition of a neighborhood and bystander CPR administered. Out of 14,225 usable cardiac arrests registered in CARES, bystander CPR was provided to 4,068 patients.

"We have learned that the neighborhood where we live connects us to the chances of receiving bystander CPR, or not, during a cardiac arrest," says Bryan McNally, MD, MPH, associate professor in the Department of Emergency Medicine at Emory University School of Medicine and Rollins School of Public Health and co-author of this study.

"Arrest victims who received bystander CPR were more likely to be male and white. Black and Latino patients were less likely to receive CPR. The association was most apparent in low-income black neighborhoods where the odds of receiving bystander CPR was 50 percent lower than that of a high-income non-black neighborhood."

Neighborhoods were defined as high- versus low-income based on a median household income threshold of $40,000 and as white or black if more than 80 percent of the census tract was predominately of one race. Neighborhoods without a predominant racial/ethnic composition were defined as integrated.

The researchers say because of their findings, there needs to be a commitment to globally increase CPR training efforts for all people. Historically, CPR training required multiple hours of training, was considered intimidating and was offered in conventional settings, such as workplaces and schools. Today, CPR training is faster, simpler, less intimidating and easier to remember.

"Rather than widely blanketing the entire U.S. with CPR training, a targeted, tailored approach in these "high-risk" neighborhoods may be a more efficient method, given limited resources," says McNally.

### The CARES program was developed by Emory's Department of Emergency Medicine faculty, and has been funded by the CDC for the past eight years.