As an emergency medicine pediatrician at Children’s Minnesota, Dr. Manu Madhok cares for some of the smallest and most vulnerable patients.
“Losing any child is the hardest, but that age group of 0 to 1 is really hard,” Dr. Madhok said.
Sometimes, urgent critical-care work needs to be done before an infant even arrives at the hospital. When a heart stops beating, blood isn’t going to the brain. The child’s best chance of survival depends on immediate application of CPR (cardiopulmonary resuscitation).
The care an infant receives in those first few minutes of crisis—faster than paramedics can arrive—often determines who survives as well as a survivor’s long-term health outcome, Dr. Madhok said. In other words, quality CPR can save a baby’s life and reduce the chances of life-altering brain damage.
CPR involves performing chest compressions on someone whose heart has stopped beating. It can also include mouth-to-mouth resuscitation, if the person has stopped breathing.
Contrary to public perception, CPR doesn’t save all lives. But without it, an individual’s chance of survival plummets. When someone’s heart stops beating, survival depends largely on immediate CPR.
“At that point in time, that’s the lifesaving measure we need to provide,” Dr. Madhok said.
There’s disturbing evidence, gathered over the past few years, that CPR is less likely to be administered to people of color and low-income people, and that those communities are less likely to have access to CPR training. More training, including some local efforts, could start to change that.
Dr. Madhok suspected that Black and Hispanic children are less likely to receive CPR from people nearby, called bystander CPR. Past research has shown that Black and Hispanic adults are much less likely to receive bystander CPR than white people, both at home and in public.
So Dr. Madhok and others decided to analyze the rates of bystander CPR in a younger age group. His 2022 study, published in the journal Circulation, found similar disparities:
- White: 75 percent of children in cardiac arrest received bystander CPR; of those, hearts started beating again 27.5 percent of the time.
- Black: 67 percent of kids received bystander CPR; of those, hearts started beating again 20 percent of the time. This means Black children are 35 percent less likely to have successful bystander CPR than white children.
- Hispanic/Latino: 68 percent of children received bystander CPR; of those, hearts started beating again 24 percent of the time. This means Hispanic children are 20 percent less likely to have successful bystander CPR than white children.
- Other races/ethnicities: 69 percent of kids received bystander CPR; of those, hearts started beating again 21 percent of the time. This means children of other races are 30 percent less likely to have successful bystander CPR than white children.
These disparities have probably existed since the 1980s, a transition period for the practice of CPR. That’s when medical authorities concluded that regular civilians, not just experts with advanced medical training, could administer CPR.
By the 1990s, researchers had determined that Black people were much less likely to receive CPR than white people, said study co-author Aditya Shekhar, a University of Minnesota graduate who is now a student at Icahn School of Medicine at Mount Sinai in New York City. Since then, “more studies have tragically confirmed that finding,” Shekhar said.
Who receives CPR training—and who doesn’t?
One reason for the racial gap is that there are fewer people trained in CPR in neighborhoods where Black and Hispanic people live and work. But a 2022 study found that Black and Hispanic people were less likely than white people to receive bystander CPR no matter where they were—at home or in public—raising the concern that bias also plays a role.
“To what extent that is, data hasn’t shown,” Shekhar said. Researchers point out that if there is a bias, it is not only among white people, since they found similar differences in Black and Hispanic communities.
“People could be more likely to help someone who looks like them, but the optimist in me likes to think they would help anybody who goes down,” Shekhar said.
Institutional racism may play a larger role, he suggested. Historically, there has been a lack of access to general health literacy for Black and lower-income people. And because the adult data showed a disparity among people who get CPR at home as well as in public, researchers suspect that less access to CPR training could play a big role.
In Minnesota, most CPR classes require fees (ranging from $37 for American Red Cross online classes to $99 for an in-person class in downtown Minneapolis) and are taught in English. People of color who attend free CPR classes at Children’s Minnesota often remark that it was the only class they could find without a fee, said Melissa Damas, a respiratory therapist at Children’s Minnesota who teaches the classes to patients and the community.
Researchers also theorize that 911 dispatcher assistance, in which someone who calls 911 receives on-the-spot guidance during an emergency, might be less available in minority neighborhoods, which could lead to disparities in at-home CPR. People of color and immigrants may be less likely to dial 911 out of fear of deportation or general distrust of government, researchers said in the study. (Dispatcher-assisted CPR is available throughout Minnesota thanks to a 2021 state statute. And in Ramsey County, an app alerts bystanders with CPR training that help is needed nearby.)
Although most Americans say they’ve received CPR training at some point, according to a survey published in 2022, only about one-fifth said they were up to date on their training. About 22 million Americans are trained in CPR yearly, according to the American Heart Association. That number includes about 675,000 community members who participate in various types of training that don’t offer official certification. But the organization does not track the race of participants.
Efforts to train more diverse communities may be underway in Minnesota. In addition to the free classes at Children’s, there are some grassroots efforts.
Hennepin Healthcare started offering classes to groups when neighborhood organizations contacted the hospital to ask for training, said Kerry Degen, deputy chief of Hennepin Healthcare Emergency Medical Services.
“Groups that walk through their neighborhoods and encounter more individuals who have overdosed reached out to us,” Degen said. “And a lot of ambulance services around the state do work in their communities. We have also offered CPR for babysitting clinics, or partnered with different groups on booths at events.”
And, as of 2014, a Minnesota law requires that all students in Minnesota get CPR training at some point between seventh grade and high school graduation.
‘You don’t have to go to college’
The good news? Learning CPR is not hard.
“You don’t have to go to college,” Dr. Madhok said. In fact, you no longer have to take an eight-hour class. The CPR class at Children’s takes 90 minutes. The American Heart Association even has a 60-second video that teaches hands-only CPR.
Experts now believe that hands-only CPR is just as effective when delivered by a non-medical expert as traditional CPR that includes breathing resuscitation.
Classes not only teach CPR skills; they also alleviate the fear many people have that they will hurt someone by performing CPR, Dr. Madhok said.
“People may feel they’re harming a child by pushing too hard. But if you’re trained, you know you wouldn’t harm someone,” he said. “The message to people is to learn CPR.”
Recently, Dr. Madhok took care of a toddler who had been at a birthday party near a lake. A bystander saw the girl floating in the water as the mother was setting out a picnic blanket. The bystander started CPR, and the girl began coughing and breathing before the paramedics got there.
“She was brought to the emergency department, evaluated, and closely monitored, and was able to be discharged to home later that day,” Dr. Madhok said. “Early bystander CPR contributed to a good outcome for this child.”
WHAT TO DO IF SOMEONE NEAR YOU NEEDS CPR
- Call 911 and stay on the line.
- Start chest compressions.
- Continue compressions until the person starts breathing or someone with more experience or an automatic external defibrillator arrives.
- Switch your call to video; ask the 911 dispatcher for help. If the dispatcher is not trained in CPR, they will transfer you to someone who is.
- Compressions should be done quickly, at about the same beat as that in songs such as: “Stayin’ Alive” by the Bee Gees, “Stronger” by Britney Spears, or “Gettin Jiggy Wit It” by Will Smith. (Listen to a 50-song CPR playlist here.)
- If you’re doing CPR correctly, you will get tired, so enlist others to tag team until paramedics arrive.
- Watch a one-minute video from the American Heart Association to learn the basic steps.
WHERE TO GET CPR TRAINING
Children’s Minnesota offers free classes and interpreters on a first-come, first-served basis. Call 651-220-5279 for a schedule and to reserve a spot.
Ask community groups you belong to or local paramedics if they are hosting free classes.
Paid online and in-person classes are available through the American Red Cross.