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Canadian Journal of Cardiology

Removing the “Man” in “Manikin”: The Importance of Sociodemographic Diversity in Resuscitation Training

Published:November 20, 2022DOI:https://doi.org/10.1016/j.cjca.2022.10.016
      Out-of-hospital cardiac arrest (OHCA) is a leading cause of morbidity and mortality worldwide.
      • Kiguchi T.
      • Okubo M.
      • Nishiyama C.
      • et al.
      Out-of-hospital cardiac arrest across the world: first report from the International Liaison Committee on Resuscitation (ILCOR).
      These unexpected events are tragic, placing a psychological burden on survivors, families, friends, health care providers, and entire communities.
      • Grubic N.
      • Puskas J.
      • Phelan D.
      • et al.
      Shock to the heart: psychosocial implications and applications of sudden cardiac death in the young.
      In Canada alone, nearly 35,000 OHCAs occur annually and < 10% of such patients survive to hospital discharge.
      • Buick J.E.
      • Drennan I.R.
      • Scales D.C.
      • et al.
      Improving temporal trends in survival and neurological outcomes after out-of-hospital cardiac arrest.
      ,
      Heart and Stroke Foundation of Canada. 2020 CPR & ECC Guidelines.
      Bystander cardiopulmonary resuscitation (CPR) and automated external defibrillator (AED) use improve survival after OHCA.
      • Holmberg M.J.
      • Vognsen M.
      • Andersen M.S.
      • Donnino M.W.
      • Andersen L.W.
      Bystander automated external defibrillator use and clinical outcomes after out-of-hospital cardiac arrest: a systematic review and meta-analysis.
      • Song J.
      • Guo W.
      • Lu X.
      • Kang X.
      • Song Y.
      • Gong D.
      The effect of bystander cardiopulmonary resuscitation on the survival of out-of-hospital cardiac arrests: a systematic review and meta-analysis.
      • Grubic N.
      • Peng Y.P.
      • Walker M.
      • Brooks S.C.
      Bystander-initiated cardiopulmonary resuscitation and automated external defibrillator use after out-of-hospital cardiac arrest: uncovering disparities in care and survival across the urban–rural spectrum.
      Recent North American estimates have shown that only 41% of OHCA patients receive bystander-initiated CPR and < 6% have an AED applied by a bystander before the arrival of professional responders.
      • Tsao C.W.
      • Aday A.W.
      • Almarzooq Z.I.
      • et al.
      Heart disease and stroke statistics—2022 update: a report from the American Heart Association.
      Significant variation in these care processes exist across different groups and geographies, highlighting vast disparities in bystander CPR and AED use.
      • Grubic N.
      • Peng Y.P.
      • Walker M.
      • Brooks S.C.
      Bystander-initiated cardiopulmonary resuscitation and automated external defibrillator use after out-of-hospital cardiac arrest: uncovering disparities in care and survival across the urban–rural spectrum.
      ,
      • Blewer A.L.
      • Schmicker R.H.
      • Morrison L.J.
      • et al.
      Variation in bystander cardiopulmonary resuscitation delivery and subsequent survival from out-of-hospital cardiac arrest based on neighborhood-level ethnic characteristics.
      ,
      • Jadhav S.
      • Gaddam S.
      Gender and location disparities in prehospital bystander AED usage.
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      References

        • Kiguchi T.
        • Okubo M.
        • Nishiyama C.
        • et al.
        Out-of-hospital cardiac arrest across the world: first report from the International Liaison Committee on Resuscitation (ILCOR).
        Resuscitation. 2020; 152: 39-49
        • Grubic N.
        • Puskas J.
        • Phelan D.
        • et al.
        Shock to the heart: psychosocial implications and applications of sudden cardiac death in the young.
        Curr Cardiol Rep. 2020; 22: 168
        • Buick J.E.
        • Drennan I.R.
        • Scales D.C.
        • et al.
        Improving temporal trends in survival and neurological outcomes after out-of-hospital cardiac arrest.
        Circ Cardiovasc Qual Outcomes. 2018; 11e003561
      1. Heart and Stroke Foundation of Canada. 2020 CPR & ECC Guidelines.
        (Available at:) (Accessed October 1, 2022)
        • Holmberg M.J.
        • Vognsen M.
        • Andersen M.S.
        • Donnino M.W.
        • Andersen L.W.
        Bystander automated external defibrillator use and clinical outcomes after out-of-hospital cardiac arrest: a systematic review and meta-analysis.
        Resuscitation. 2017; 120: 77-87
        • Song J.
        • Guo W.
        • Lu X.
        • Kang X.
        • Song Y.
        • Gong D.
        The effect of bystander cardiopulmonary resuscitation on the survival of out-of-hospital cardiac arrests: a systematic review and meta-analysis.
        Scand J Trauma Resusc Emerg Med. 2018; 26: 86
        • Grubic N.
        • Peng Y.P.
        • Walker M.
        • Brooks S.C.
        Bystander-initiated cardiopulmonary resuscitation and automated external defibrillator use after out-of-hospital cardiac arrest: uncovering disparities in care and survival across the urban–rural spectrum.
        Resuscitation. 2022; 175: 150-158
        • Tsao C.W.
        • Aday A.W.
        • Almarzooq Z.I.
        • et al.
        Heart disease and stroke statistics—2022 update: a report from the American Heart Association.
        Circulation. 2022; 145: e153-e639
        • Blewer A.L.
        • Schmicker R.H.
        • Morrison L.J.
        • et al.
        Variation in bystander cardiopulmonary resuscitation delivery and subsequent survival from out-of-hospital cardiac arrest based on neighborhood-level ethnic characteristics.
        Circulation. 2020; 141: 34-41
        • Jadhav S.
        • Gaddam S.
        Gender and location disparities in prehospital bystander AED usage.
        Resuscitation. 2021; 158: 139-142
        • Yu Y.
        • Meng Q.
        • Munot S.
        • Nguyen T.N.
        • Redfern J.
        • Chow C.K.
        Assessment of community interventions for bystander cardiopulmonary resuscitation in out-of-hospital cardiac arrest.
        JAMA Netw Open. 2020; 3e209256
        • Anderson M.L.
        • Cox M.
        • Al-Khatib S.M.
        • et al.
        Rates of cardiopulmonary resuscitation training in the United States.
        JAMA Intern Med. 2014; 174: 194
        • Blewer A.L.
        • Ibrahim S.A.
        • Leary M.
        • et al.
        Cardiopulmonary resuscitation training disparities in the United States.
        J Am Heart Assoc. 2017; 6e006124
        • Sasson C.
        • Magid D.J.
        • Chan P.
        • et al.
        Association of neighborhood characteristics with bystander-initiated CPR.
        N Engl J Med. 2012; 367: 1607-1615
        • Shah K.S.
        • Shah A.S.
        • Bhopal R.
        Systematic review and meta-analysis of out-of-hospital cardiac arrest and race or ethnicity: black US populations fare worse.
        Eur J Prev Cardiol. 2014; 21: 619-638
        • Mody P.
        • Pandey A.
        • Slutsky A.S.
        • et al.
        Gender-based differences in outcomes among resuscitated patients with out-of-hospital cardiac arrest.
        Circulation. 2021; 143: 641-649
        • Souers A.
        • Zuver C.
        • Rodriguez A.
        • et al.
        Bystander CPR occurrences in out of hospital cardiac arrest between sexes.
        Resuscitation. 2021; 166: 1-6
        • Liu N.
        • Ning Y.
        • Ong M.E.H.
        • et al.
        Gender disparities among adult recipients of layperson bystander cardiopulmonary resuscitation by location of cardiac arrest in Pan-Asian communities: a registry-based study.
        eClinicalMedicine. 2022; 44101293
        • Spagnol Silverman L.
        • Fabi R.
        Deadly bias: a call for gender diversity in cardiac life support simulation training.
        BMJ Simul Technol Enhanc Learn. 2021; 7: 183-184
        • Gupta S.
        • Al-Rawi R.
        • Iomini P.
        • et al.
        Determining the Importance of Various Genders, Races and Body Shapes for CPR Education Using Mannikins: Images in Media (DIVERSE II).
        Can J Cardiol. 2022; (XX:XXX-X)
        • Meissner C.A.
        • Brigham J.C.
        Thirty years of investigating the own-race bias in memory for faces: a meta-analytic review.
        Psychol Public Policy, Law. 2001; 7: 3-35
      2. Duggan M, Ellison NB, Lampe C, Lenhart A, Madden M. Social media update 2014. Pew Research Center, January 9, 2015. Available at: http://www.pewinternet.org/2015/01/09/social-media-update-2014/. Accessed October 1, 2022.

        • O’Neill Z.R.
        • Raparelli V.
        • Norris C.M.
        • Pilote L.
        Demystifying how to incorporate sex and gender into cardiovascular research: a practical guide [e-pub ahead of print].
        Can J Cardiol. 2022 May 23; https://doi.org/10.1016/j.cjca.2022.05.017
      3. Heart and Stroke Foundation of Canada. World Restart a Heart Day October 16. Available at: https://cpr.heartandstroke.ca/s/article/World-Restart-a-Heart. Accessed October 1, 2022.

        • Stellefson M.
        • Paige S.R.
        • Chaney B.H.
        • Chaney J.D.
        Evolving role of social media in health promotion: updated responsibilities for health education specialists.
        Int J Environ Res Public Health. 2020; 17: 1153
        • Krammel M.
        • Schnaubelt S.
        • Weidenauer D.
        • et al.
        Gender and age-specific aspects of awareness and knowledge in basic life support.
        PLoS One. 2018; 13e0198918
        • Eneanya N.D.
        • Olaniran K.
        • Xu D.
        • et al.
        Health literacy mediates racial disparities in cardiopulmonary resuscitation knowledge among chronic kidney disease patients.
        J Health Care Poor Underserved. 2018; 29: 1069-1082
        • Perman S.M.
        • Shelton S.K.
        • Knoepke C.
        • et al.
        Public perceptions on why women receive less bystander cardiopulmonary resuscitation than men in out-of-hospital cardiac arrest.
        Circulation. 2019; 139: 1060-1068
        • Lee H.
        • Oh J.
        • Lee J.
        • et al.
        Retrospective study using computed tomography to compare sufficient chest compression depth for cardiopulmonary resuscitation in obese patients.
        J Am Heart Assoc. 2019; 8e013948
        • Jeejeebhoy F.M.
        • Zelop C.M.
        • Lipman S.
        • et al.
        Cardiac arrest in pregnancy.
        Circulation. 2015; 132: 1747-1773
        • Blount C.
        • Lynes C.
        • Richie J.
        • et al.
        Lack of racial diversity in cardiopulmonary resuscitation training videos: a cross-sectional analysis.
        Am J Emerg Med. 2022; 56: 365-367
        • Liblik K.
        • Byun J.
        • Lloyd-Kuzik A.
        • et al.
        The DIVERSE study: Determining the Importance of Various Genders, Races, and Body Shapes for CPR Education Using Manikins [e-pub ahead of print].
        Curr Probl Cardiol. 2022 Feb 22; https://doi.org/10.1016/j.cpcardiol.2022.101159
        • Foronda C.
        • Prather S.L.
        • Baptiste D.
        • et al.
        Underrepresentation of racial diversity in simulation: an international study.
        Nurs Educ Perspect. 2020; 41: 152-156
        • Sabin J.A.
        Tackling implicit bias in health care.
        N Engl J Med. 2022; 387: 105-107
        • Del Rios Rivera M.
        Eliminating disparities in out-of-hospital cardiac arrest survival.
        Circ Cardiovasc Qual Outcomes. 2018; 11e004989
        • Greenwald A.G.
        • Dasgupta N.
        • Dovidio J.F.
        • et al.
        Implicit-bias remedies: treating discriminatory bias as a public-health problem.
        Psychol Sci Public Interest. 2022; 23: 7-40
        • Gonzalez C.M.
        • Lypson M.L.
        • Sukhera J.
        Twelve tips for teaching implicit bias recognition and management.
        Med Teach. 2021; 43: 1368-1373

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