New research highlights a persistent gender gap in rates of cardiopulmonary resuscitation (CPR) and survival after cardiac arrest, with women significantly less likely than men to receive lifesaving intervention.
A large-scale analysis from Duke University found that women were 14% less likely to receive bystander CPR or defibrillation compared with men, even after adjusting for neighbourhood and demographic factors (Blewer et al., 2024). This finding aligns with earlier work showing that in the United Kingdom, only 68% of women experiencing cardiac arrest received bystander CPR, compared with 73% of men (Blom et al., 2019).
Social and cultural discomfort about touching a woman’s chest is often cited as a key reason for hesitation among bystanders. Studies suggest that this reluctance is reinforced by a long-standing gender bias in CPR training. A 2024 analysis found that 95% of commercially available CPR manikins are flat-chested, with only one model including realistic breast features (Szabo et al., 2024). This lack of anatomical accuracy limits the realism of training scenarios and may foster unconscious bias during real emergencies.
The survival implications are substantial. A systematic review of international data confirmed that women have consistently lower out-of-hospital survival rates than men, although outcomes vary by region and setting (Lakbar et al., 2022). Experts argue that the omission of female anatomy from CPR training may play an indirect but important role in this disparity.
Evidence also points to a straightforward intervention. A study published in JEMS reported that when silicone breast adjuncts were attached to manikins, participants were almost twice as likely to report comfort performing CPR on women (Kim et al., 2023). Researchers conclude that breast-inclusive training tools could help normalise correct hand placement, improve bystander confidence, and ultimately save more women’s lives.
The growing body of evidence calls for urgent reform in CPR education, ensuring that all bodies are represented in training resources and public awareness campaigns. As Szabo et al. (2024) note, “CPR training is not only a clinical issue, but a gender and rights-based healthcare issue.”
References
- Blewer, A. L., Starks, M. A., Malta-Hansen, C., et al. (2024). Sex differences in receipt of bystander cardiopulmonary resuscitation considering neighbourhood racial and ethnic composition. Journal of the American Heart Association, 13, e031113.
- Blom, M. T., Oving, I., Berdowski, J., van Valkengoed, I. G. M., Bardai, A., & Tan, H. L. (2019). Women have lower chances than men to be resuscitated and survive out-of-hospital cardiac arrest. European Heart Journal, 40(47), 3824–3834. https://doi.org/10.1093/eurheartj/ehz297
- Lakbar, I., Ippolito, M., Nassiri, A., Delamarre, L., Tadger, P., Leone, M., & Einav, S. (2022). Sex and out-of-hospital cardiac arrest survival: a systematic review. Annals of Intensive Care, 12, 114. https://doi.org/10.1186/s13613-022-01091-9
- Szabo, R. A., Forrest, K., Morley, P., Barwick, S., Bajaj, K., Britt, K., Yong, S. A., Park-Ross, J., Story, D., & Stokes-Parish, J. (2024). CPR training as a gender and rights-based healthcare issue. Health Promotion International. https://doi.org/10.1093/heapro/daae156
- Kim, R. T., Liu, S. C., Schipper, A. E., Sloane, C. S. M., Shimelis, L., Faber, D. A., Zou, R., Wang, E., et al. (2023, October 26). Implementation of a breast adjunct for CPR training manikins increased reported comfort in performing CPR on women. Journal of Emergency Medical Services (JEMS).