Image courtesy U.S. Naval Forces Central Command/ U.S. Fifth Fleet

Researchers from Duke University looked at who gets life-saving cardiopulmonary resuscitation during emergencies and found that living in rural areas could put a heart attack sufferer at greater risk of death.

By Stephanie Soucheray

Frantic pumps of the chest and that urgent kiss of life: Thanks to television and the movies, everyone thinks they know what CPR looks like. But in many communities across the United States, less than 3 percent of the population can properly administer the life-saving intervention.

CPR class.
CPR class. Image courtesy U.S. Naval Forces Central Command/U.S. Fifth Fleet

A new study from a team of cardiologists at the Duke Clinical Research Institute shows that in any given county in America, only 5 percent to 16 percent of citizens can perform cardiopulmonary resuscitation (CPR). In rural counties, or counties with predominantly black and Latino populations, that percentage dips even further, to around 1 percent.

And that low number of CPR-trained bystanders in rural and minority-dense counties correlates to geographic differences in cardiac arrest survival, according to the study.

But lack of trained CPR providers is a problem in cities too, said Lance Thigpen, a CPR instructor in Raleigh.

Thigpen works for CPR Consultants, a company that teaches lay people and health care workers CPR. He said most of the people taking CPR classes are doing so not out of a desire to learn how to save a life, but because someone is making them.

“Most of the people who come to us are doing it for compliance,” said Thigpen. “They need to for a job or school.”

CPR Consultants offers a “friends and family” class one or two times per month for $33. The two-hour class teaches lay people CPR, but Thigpen said it’s not popular.

“People have a sense that, ‘Oh, this won’t happen to me,’ or, ‘I won’t need to know this,’” said Duke researcher Monique Anderson, who published her findings in the Nov. 18 edition of JAMA Internal Medicine.

The study is the first to look at CPR training rates among non-medical professionals in the country. Anderson trolled through piles of data to break down CPR rates on the county level.

“This was a huge undertaking because we had to form relationships with CPR organizations and look at 14 million people who have been trained in CPR across the country,” she said.

Geographic Distribution of Counties by Tertiles of Cardiopulmonary Resuscitation (CPR) Training in the US Community CPR Training Cohort
Geographic Distribution of Counties by Tertiles of Cardiopulmonary Resuscitation (CPR) Training in the US Community CPR Training Cohort (Eastern US). Image courtesy JAMA Internal Medicine

Anderson said it was reading recent literature about bystander CPR that sparked her interest in breaking down CPR availability by county. In any given year, 350,000 Americans will have a heart attack outside of a hospital, and bystander CPR is often one of the first and best interventions needed to save someone’s life. People who receive CPR double their chance of survival outside of the hospital.

Anderson said people may be reluctant to learn CPR because they may be shy, embarrassed or indifferent. She said she looks to Denmark as a model for America. In Denmark, CPR training is required in order to get a driver’s license, and public schools are required to teach pupils to perform CPR.

In the U.S., Anderson and her fellow researchers looked at the 13.1 million people trained to perform CPR in 2012 by the American Heart Association, the American Red Cross and the Health & Safety Institute, the three major organizations that provide CPR training in the country.

The median percentage of CPR-trained citizens was 2.39 percent. While low overall, the numbers were worse in the South and West than in the Northeast.

Anderson said she was surprised by the lack of training in rural counties, where people are already disadvantaged by being farther away from hospitals and having longer travel times for EMTs. CPR, she said, is the second act in a chain of intervention, and should be performed immediately after bystanders have called 911 for an ambulance.

“The chain of survival is so important for rural patients,” she said. “They need emergency medical services within seven to eight minutes after a cardiac event. We need to be having a national conversation about these disparities.”

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