Women are less likely to receive CPR than men. Training on manikins with breasts could help

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If someone’s heart suddenly stops beating, they may only have minutes to live. Doing CPR (cardiopulmonary resusciation) can increase their chances of survival. CPR makes sure blood keeps pumping, providing oxygen to the brain and vital organs until specialist treatment arrives.

But research shows bystanders are less likely to intervene to perform CPR when that person is a woman. A recent Australian study analysed 4,491 cardiac arrests between 2017–19 and found bystanders were more likely to give CPR to men (74%) than women (65%).

Could this partly be because CPR training dummies (known as manikins) don’t have breasts? Our new research looked at manikins available worldwide to train people in performing CPR and found 95% are flat-chested.

Anatomically, breasts don’t change CPR technique. But they may influence whether people attempt it – and hesitation in these crucial moments could mean the difference between life and death.

Pixel-Shot/Shutterstock

Heart health disparities

Cardiovascular diseases – including heart disease, stroke and cardiac arrest – are the leading cause of death for women across the world.

But if a woman has a cardiac arrest outside hospital (meaning her heart stops pumping properly), she is 10% less likely to receive CPR than a man. Women are also less likely to survive CPR and more likely to have brain damage following cardiac arrests.

People cross a busy street in lined with trees in Melbourne.
Bystanders are less likely to intervene if a woman needs CPR, compared to a man. doublelee/Shutterstock

These are just some of many unequal health outcomes women experience, along with transgender and non-binary people. Compared to men, their symptoms are more likely to be dismissed or misdiagnosed, or it may take longer for them to receive a diagnosis.

Bystander reluctance

There is also increasing evidence women are less likely to receive CPR compared to men.

This may be partly due to bystander concerns they’ll be accused of sexual harassment, worry they might cause damage (in some cases based on a perception women are more “frail”) and discomfort about touching a woman’s breast.

Bystanders may also have trouble recognising a woman is experiencing a cardiac arrest.

Even in simulations of scenarios, researchers have found those who intervened were less likely to remove a woman’s clothing to prepare for resuscitation, compared to men. And women were less likely to receive CPR or defibrillation (an electric charge to restart the heart) – even when the training was an online game that didn’t involve touching anyone.

There is evidence that how people act in resuscitation training scenarios mirrors what they do in real emergencies. This means it’s vital to train people to recognise a cardiac arrest and be prepared to intervene, across genders and body types.

Skewed to male bodies

Most CPR training resources feature male bodies, or don’t specify a sex. If the bodies don’t have breasts, it implies a male default.

For example, a 2022 study looking at CPR training across North, Central and South America, found most manikins available were white (88%), male (94%) and lean (99%).

A woman's hands press down on a male manikin torso wearing a blue jacket.
It’s extremely rare for a manikin to have breasts or a larger body. M Isolation photo/Shutterstock

These studies reflect what we see in our own work, training other health practitioners to do CPR. We have noticed all the manikins available to for training are flat-chested. One of us (Rebecca) found it difficult to find any training manikins with breasts.

A single manikin with breasts

Our new research investigated what CPR manikins are available and how diverse they are. We identified 20 CPR manikins on the global market in 2023. Manikins are usually a torso with a head and no arms.

Of the 20 available, five (25%) were sold as “female” – but only one of these had breasts. That means 95% of available CPR training manikins were flat-chested.

We also looked at other features of diversity, including skin tone and larger bodies. We found 65% had more than one skin tone available, but just one was a larger size body. More research is needed on how these aspects affect bystanders in giving CPR.

Breasts don’t change CPR technique

CPR technique doesn’t change when someone has breasts. The barriers are cultural. And while you might feel uncomfortable, starting CPR as soon as possible could save a life.

Signs someone might need CPR include not breathing properly or at all, or not responding to you.

To perform effective CPR, you should:

  • put the heel of your hand on the middle of their chest
  • put your other hand on the top of the first hand, and interlock fingers (keep your arms straight)
  • press down hard, to a depth of about 5cm before releasing
  • push the chest at a rate of 100-120 beats per minute (you can sing a song) in your head to help keep time!)

https://www.youtube.com/embed/Plse2FOkV4Q?wmode=transparent&start=94 An example of how to do CPR – with a flat-chested manikin.

What about a defibrillator?

You don’t need to remove someone’s bra to perform CPR. But you may need to if a defibrillator is required.

A defibrillator is a device that applies an electric charge to restore the heartbeat. A bra with an underwire could cause a slight burn to the skin when the debrillator’s pads apply the electric charge. But if you can’t remove the bra, don’t let it delay care.

What should change?

Our research highlights the need for a range of CPR training manikins with breasts, as well as different body sizes.

Training resources need to better prepare people to intervene and perform CPR on people with breasts. We also need greater education about women’s risk of getting and dying from heart-related diseases.

Jessica Stokes-Parish, Assistant Professor in Medicine, Bond University and Rebecca A. Szabo, Honorary Senior Lecturer in Critical Care and Obstetrics, Gynaecology and Newborn Health, The University of Melbourne

This article is republished from The Conversation under a Creative Commons license. Read the original article.

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    In yesterday’s edition of 10almonds, one of the items in the “health news from around the world” section was:

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    That’s fascinating, but what does it do for us?

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    CT images of the brain.
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    If this article has raised issues for you, or if you’re concerned about someone you know, call Lifeline on 13 11 14.

    Nial Wheate, Professor of Pharmaceutical Chemistry, Macquarie University

    This article is republished from The Conversation under a Creative Commons license. Read the original article.

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    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    Migraine: When Headaches Are The Tip Of The Neurological Iceberg

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    • Just under 23% said “a headache, but caused by a neurological disorder”
    • Just over 21% said “a neurological disorder that can cause headaches”
    • Just under 10% said “a headache, but with an attention-grabbing name”

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    A migraine is a headache, but above a certain level of severity: True or False?

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      • Worsened by or causing avoidance of routine physical activity
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      • Sensitivity to both light and sound

    Source: Cephalalgia | ICHD-II Classification: Parts 1–3: Primary, Secondary and Other

    As one of our subscribers wrote:

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    Migraine is a neurological disorder: True or False?

    True! While the underlying causes aren’t known, what is known is that there are genetic and neurological factors at play.

    ❝Migraine is a recurrent, disabling neurological disorder. The World Health Organization ranks migraine as the most prevalent, disabling, long-term neurological condition when taking into account years lost due to disability.

    Considerable progress has been made in elucidating the pathophysiological mechanisms of migraine, associated genetic factors that may influence susceptibility to the disease❞

    Source: JHP | Mechanisms of migraine as a chronic evolutive condition

    Migraine is just a headache with a more attention-grabbing name: True or False?

    Clearly, False.

    As we’ve already covered why above, we’ll just close today with a nod to an old joke amongst people with chronic illnesses in general:

    “Are you just saying that because you want attention?”

    “Yes… Medical attention!”

    Want to learn more?

    You can find a lot of resources at…

    NIH | National Institute of Neurological Disorders & Stroke | Migraine

    and…

    The Migraine Trust ← helpfully, this one has a “Calm mode” to tone down the colorscheme of the website!

    Particularly useful from the above site are its pages:

    Take care!

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