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Response by Perman et al to Letter Regarding Article, "Public Perceptions on Why Women Receive Less Bystander Cardiopulmonary Resuscitation Than Men in Out-of-Hospital Cardiac Arrest".

August 27, 2019 e511 Sarah M. Perman, MD, MSCE Shelby K. Shelton, MPH Christopher Knoepke, PhD, MSW Kathryn Rappaport, MD Daniel D. Matlock, MD, MPH Kathleen Adelgais, MD, MPH Edward P. Havranek, MD Stacie L. Daugherty, MD, MSPH In Response: We appreciate the inquiry regarding our recent article1 published in the Go Red For Women edition of Circulation. Several studies in the United States and internationally have demonstrated that women who experience out-of-hospital cardiac arrest receive lower rates of bystander cardiopulmonary resuscitation (CPR) in comparison with men.2–5 Our study sought to explore public perceptions of these findings by using a large crowd-sourcing survey platform in the United States. Among more than 500 US adults, respondents identified 3 major themes for why women might be less likely to receive bystander CPR than men: (1) Women’s bodies are sexualized; (2) Women are perceived as physically weak or fragile and prone to injury; and (3) Misperceptions about women in acute medical distress.5 We agree with Peran et al that our findings reflect perceptions of a US cohort and we cannot determine whether they are applicable to other countries. Further study to explore the relevance of these themes internationally or conversely to identify different themes is warranted. In their Letter to the Editor, Peran et al report their observation of no difference in the rates of bystander CPR in more than 2000 men and women who experience out-of-hospital cardiac arrest in the Czech Republic. They suggest that the differences seen in Prague in comparison with several other studies demonstrating lower rates of bystander CPR in women may be attributable to the use of dispatcher-assisted CPR (D-CPR) in the Czech Republic. D-CPR is a telephone intervention whereby emergency medical dispatchers coach bystanders in performing CPR by instructing them in real time to perform CPR and coaching them until trained rescuers arrive. By providing this real-time instruction, Peran et al hypothesize that D-CPR may reduce bystander inhibitions to perform this life saving procedure. This is an interesting observation that warrants further testing, as many nations are actively deploying D-CPR and, to our knowledge, the specific impact that D-CPR has on reducing disparities in the provision of CPR has not been confirmed. Although assurance from a dispatcher to perform chest compressions on a woman in cardiac arrest may help some bystanders, there is still potential that bystanders’ misperceptions about women in medical crisis and fears regarding injury or inappropriate touching might pervade despite telephone coaching by dispatchers. Almost half of our study participants knew how to perform CPR, yet a lack of knowledge was not reported as a significant perceived limitation to performing CPR on women. Future studies should empirically test whether D-CPR and other interventions improve rates of bystander CPR and, importantly, improve bystander CPR equitably among all patient groups. Although the data presented by Peran et al out of the Prague EMS system are encouraging, further analysis is necessary to understand barriers and facilitators to © 2019 American Heart Association, Inc. RESPONSE TO LETTER TO THE EDITOR