Sudden Cardiac Arrest, Societal Inequity, and Implicit Bias

Tragically, Damar Hamlin of the Buffalo Bills experienced sudden cardiac arrest in the first quarter of the heavily televised Monday Night Football game versus the Cincinnati Bengals. Recent updates from his current medical team note that his breathing tube has been removed, he is able to communicate, and that his neurological function remains intact. This is a remarkable success and is undoubtedly linked to the diligent care provided by his supporting medical staff. Sudden cardiac arrest in athletes on the competitive field is rare, however, when it occurs, is very emotionally traumatic for all parties involved with the incident. 

The sequence of events that occurred on Monday night are the exact progression of care that should occur following a cardiac arrest. Rapid assessment of a collapsed athlete, diagnosis of sudden cardiac arrest, and initiation of immediate cardiopulmonary resuscitation (CPR) and use of an automated external defibrillator. Following this template,  the recovery results can be remarkable, as seen in the case of Mr. Hamilin. 

 Unfortunately, this established and validated sequence of resuscitative events do not always occur in lay persons when sudden cardiac arrest occurs in public locations. In a seminal 2022 NEJM article, Dr. Raul Garcia and colleagues suggest that Black and Hispanic adults who go into cardiac arrest in public are less likely to receive bystander CPR before a medical team arrives, which is a critical variable in survival outcomes. 

The researchers analyzed data from the national Cardiac Arrest Registry to Enhance Survival on 110,054 people in the United States who had cardiac arrests outside of a hospital setting between 2013 and 2019.  45.6% of Blacks and Hispanics received bystander CPR when cardiac arrests happened in public locations compared with 60% of Whites. The authors suggest that these differences in CPR may contribute to how Black and Hispanic people may be less likely to survive an out-of-hospital cardiac arrest. 

When a cardiac arrest occurs outside the home, bystanders likely do not personally know the person who had the cardiac arrest. Furthermore, implicit bias may deter bystander response for a Black or Hispanic person having a cardiac arrest as compared with a White person. Notably, police and health care providers have been shown to harbor bias in their views and treatment of Black and Hispanic persons, and these biases may also be held by laypersons who witness a cardiac arrest. 

This study emphasizes that our efforts to decrease cardiovascular morbidity may be interwoven with a legacy of structural racism that has left many of our communities segregated, with inequitable social determinants of sudden cardiac death, and at the mercy of societal biases. We have to begin to thoughtfully confront our structural and individual biases in order to move towards our intended goal of equity.

Click here to read the full study: Racial and Ethnic Differences in Bystander CPR for Witnessed Cardiac Arrest