African American children from poor neighborhoods who suffer a cardiac arrest are among the least likely to receive CPR from a bystander, according to a new study that finds both neighborhood characteristics and race may play a role in who gets the life-saving intervention.
Racial disparities were less pronounced in wealthier neighborhoods, researchers report in the Journal of the American Heart Association.
The study, which examined outcomes for more than 7,000 U.S. children, most of them African American or white, found that kids in the poorest predominantly black neighborhoods were about half as likely to receive cardiopulmonary resuscitation (CPR) from a bystander as those in the most privileged areas.
“This tells us there is an opportunity to improve bystander CPR by really targeting these neighborhoods for training,” said the study’s lead author, Dr. Maryam Y. Naim, a pediatric intensivist and an assistant professor at the Children’s Hospital of Philadelphia and the University of Pennsylvania’s Perelman School of Medicine.
For adults or children, when the heart stops beating - known as cardiac arrest - CPR makes a difference to who survives and how much lasting damage is done, the authors note. When medical personnel are not yet on the scene, trained bystanders can start CPR and past studies show that it improves survival rates. Bystanders can also be trained to use an automated external defibrillator (AED) to shock the heart to start it beating again.
“In 39 states, all high school graduates are mandated to be trained in bystander CPR and AED use, but I feel it’s also important to educate parents since the majority of these cardiac arrests are occurring in infants less than a year in age,” Naim said.
With some 60% of childhood cardiac arrests occurring in infants, Naim suggests that a good time for this kind of intervention might be when newborns are being discharged from the hospital.
To look at factors that may prevent children from getting lifesaving CPR from a bystander, Naim and her colleagues turned to the Cardiac Arrest Registry to Enhance Survival, or CARES. They examined 7,086 out-of-hospital cardiac arrests between 2013 and 2017 in children aged 18 years and under that were not caused by a traumatic injury.
Children were most likely to suffer cardiac arrest because of respiratory problems, Naim said.
Along with the race and ethnicity of the children, details about their neighborhoods were examined. Naim and her colleagues computed a score for each locality based on four criteria: racial composition, unemployment rate, education level and median income. A neighborhood whose residents were more than 80% African American, more than 10% unemployed, less than 80% with a high school diploma and had a median household income less than $50,000 got a score of four.
Compared with neighborhoods scoring zero - the most advantaged localities - bystander CPR was 20% less likely in neighborhoods with a score of one, 25% less likely with a score of two, 38% less likely with a score of three and 54% less likely with a score of four.
CPR was more common for children over age 2 years compared to younger kids, and for cardiac arrests that occurred outside the home.
The study population was 31% white; 31% black; about 11% Hispanic; 3% “other,” including Native American, Pacific Islander and Asian; and about 24% “unknown.” Overall, just under half of the cardiac arrest cases received bystander CPR.
“This is a great study using the CARES database, our best and largest registry of out of the hospital cardiac arrests,” said Dr. Clifton Callaway, vice chair of emergency medicine at UPMC in Pittsburgh, Pennsylvania, and a member of the American Heart Association’s Emergency Cardiovascular Care Committee.
“It showed that children from neighborhoods where the majority of people are nonwhite do not get bystander CPR at the same rates as those from neighborhoods that are predominantly white,” Callaway said. “And that is something we need to work on as a country.”
Callaway seconds Naim’s call for parental CPR training before newborns are sent home from the hospital.
“We know it works for other public health problems,” he said. “We have made car seat training a mandatory part of taking a baby home. And injuries to children in motor vehicle crashes have declined and declined over the years.”
SOURCE: bit.ly/2JzFi6R Journal of the American Heart Association, released July 10, 2019.
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