We’d all like to assume if we went into cardiac arrest in the street, someone would come to our aid.

But it turns out gender can affect your chances of being resuscitated — and women are at a disadvantage.

Key points:

• Research shows some people fear they will be accused of sexual harassment if they give a woman CPR
• Yet all Australian states and territories have Good Samaritan laws which protect bystanders acting in good faith
• Some CPR trainers are tackling this issue by using female-presenting mannequins in classes

Recent research presented at the European Emergency Medicine Congress found bystanders were less likely to give cardiopulmonary resuscitation (CPR) to women than men, particularly if they went into cardiac arrest in public.

A pair of Canadian researchers, Sylvie Cossette at the Montreal Heart Institute and Alexis Cournoyer at the Montreal Sacred Heart Hospital, analysed more than 39,300 patients who had out-of-hospital cardiac arrests between 2005 and 2015.

They found only 54 per cent were given CPR by a bystander.

The researchers then focused on the roughly 9,000 people from the total group who went into cardiac arrest in a public place (as opposed to a private residence) and found bystanders gave CPR to more men (68 per cent) than women (61 per cent).

But when the researchers looked at cardiac arrests in private settings, older women were more likely to receive CPR than older men.

Cardiologist and director of the Victor Chang Cardiac Research Institute Jason Kovacic said research showing that women who go into cardiac arrest outside the home are less likely to be given CPR has been growing over the past decade.

A 2018 study in the US of more than 19,000 patients who had out-of-hospital cardiac arrests found 45 per cent of men received bystander CPR compared to 39 per cent of women — a result echoed by a 2019 study from the Netherlands (73.9 per cent versus 69.2 per cent).

Professor Kovacic said the barriers stopping people from giving CPR to women need to be urgently addressed.

“People who have had a cardiac arrest are in grave trouble and are likely going to die if nothing is done,” he said.

“Some 20,000 to 30,000 people [in Australia] have out-of-hospital cardiac arrests each year so this is a massive problem.”

Clinical and interventional cardiologist Fiona Foo said this gender disparity in CPR rates was one of several reasons why women with heart disease have poorer outcomes compared to men.

She said it was noteworthy that even paramedics were more likely to give CPR to a man than a woman (40 per cent versus 36 per cent), according to 2019 data from NSW.

“The public and doctors still don’t feel that women have heart disease or are going to have a cardiac arrest,” she said.

“There’s still this thought that women don’t die of heart disease when it is actually the second-leading cause of death in women in Australia after dementia.”

Why aren’t women given CPR?

Research suggests there’s three main reasons behind this reluctance:

• fear of inappropriate touching
• fear of causing injury because women are “physically weak or fragile”
• poor awareness of a woman being in cardiac arrest.

A 2019 study of 550 people found 40 per cent of males feared being accused of sexual harassment if they exposed or touched a woman’s chest.

“I think that people are afraid to touch the breast region, so hesitate to administer CPR,” one man, aged 39, told researchers.

“Men are afraid of seeming like perverts,” another man, aged 27, said.

Some even feared legal ramifications.

“Touching of the chest area in women is forbidden in many societies. Nowadays, you could be accused of sexual assault, whether it is being given by a man or a woman to a woman,” a 40-year-old man said.

Study participants also wrongly believed women rarely went into cardiac arrest due to male-centric representations in the media, and the fact that male mannequins are used for CPR training.

“Images in the media are always of men arresting so maybe people think ‘oh, she’s just fainted’ rather than ‘she has a heart issue,'” Dr Foo suggested.

Professor Kovacic said he could understand why some people might hesitate to expose a woman’s breasts in public.

He said he once had to give CPR to a male patient in the exit row of a crowded airplane and had no hesitation in exposing the man’s chest, but may have felt differently if it was a woman.

“Would I have been that comfortable if this was a female, particularly a younger female?

“Laypeople, who don’t have the background I do, very understandably may think ‘am I doing the right thing? Is this really a cardiac arrest or is it something else I don’t know about where CPR would be inappropriate?'”

He said the best thing people can do is assume it is a cardiac arrest — and remember the law is on their side.

All Australian states and territories have some form of Good Samaritan legislation which means bystanders can act without fear of civil prosecution if they help someone in good faith.

“If you do a fair and reasonable thing and you’re just trying to help, the law isn’t there to catch you up,” Professor Kovacic said.

The Womanikin

If you’ve done CPR training, there’s a good chance you were trained on a mannequin without breasts.

You may have used a dummy dubbed “Resusci Anne” which was developed by a Norwegian toy maker around 60 years ago.

Although the “Anne” model has a female face and hair (it’s based on an unidentified woman who died in the River Seine in the 1880s), many are flat-chested.

So would bystander CPR rates for women improve if people were trained on dummies that had breasts?

Almost four years ago, a New-York-based ad agency called Joan Creative created an attachment for CPR dummies call the “Womanikin”.

It’s a vest with silicon breasts so students become used to the idea they will have to touch someone’s breasts when doing chest compressions.

It’s gone on to be used in training in Canada, the US and Switzerland, but also caught the attention of one CPR trainer Down Under.

Brisbane-based CPR trainer Gayle Guthrie was shocked to hear about lower CPR rates for women, so decided to make her own version of the Womanikin by putting bras filled with rice on her training mannequins.

“I wanted them to move to the side, make some smaller, some larger and demonstrate that when a woman is on her back, the breasts do move in the majority of women,” she said.

When she introduced “female” mannequins to classes she let students choose whether they would learn on male-presenting or female-presenting dummies.

“But we found that people were leaving the female mannequins and only working on the males.”

After that, she decided to directly distribute the “female” mannequins to students and tell them why they were important.

“We tell them we need you to have this conversation with your family, your brothers, your uncles. Tell them it’s OK to do CPR on a woman.

“What we want to see is people treating the heart as gender neutral.”

Australian Red Cross, a major provider of CPR trainer, use a variety of mannequins in classes but have no female-style dummies.

The Australian Resuscitation Council does not endorse or recommend any particular brand of training manikins and states the realism of the mannequin does not necessarily result in better outcomes for training.

Janet Bray, who leads the basic life support guidelines at the Australian Resuscitation Council, said training mannequins tend to be male-presenting as more men have cardiac arrests than women.

Australian Resuscitation Outcomes Consortium data from 2019 showed 66 per cent of out-of-hospital cardiac arrests were male patients.

‘My life is worth more than my boobs’

Perth woman Melissa Del Popolo, 54, owes her life to bystander CPR.

Six years ago she had a cardiac arrest while on a treadmill during a stress test her GP recommended after seeing an increase in her blood pressure.

Fortunately, being in a medical setting, doctors immediately administered CPR and defibrillated the then-48-year-old.

“But it could have literally happened anywhere. I had angina attacks previously in the gym and at a restaurant in Bali.”

She said any concerns about exposing a woman’s chest during CPR are “ridiculous”.

“My life is worth more than flashing my boobs to the world,” she said.

“If you’re worried that by performing CPR on somebody you’re going to touch their breasts — which we all know are just subcutaneous fat — just put that out of your mind, just think about that person, their life and their family.”

Professor Kovacic said gender makes no difference to how someone administers CPR.

“The guidelines and steps are exactly the same.”

Only bulky clothing needs to be removed to administer CPR so a woman’s bra can stay on during compressions, CPR trainer Ms Guthrie said.

However, it must be taken off when using a defibrillator. The metal in an underwire bra can potentially interfere with the shock from an automated external defibrillator.

Last modified: March 10, 2024