Letters Cardiopulmonary resuscitation

Provision of cardiopulmonary resuscitation differs across ethnic and racial groups

BMJ 2012; 345 doi: http://dx.doi.org/10.1136/bmj.e7615 (Published 13 November 2012) Cite this as: BMJ 2012;345:e7615
  1. Keval S V Shah, medical student1,
  2. Anoop S V Shah, cardiology research fellow2,
  3. Raj Bhopal, Bruce and John Usher professor of public health and honorary consultant in public health medicine3
  1. 1University of Southampton, Southampton, UK
  2. 2Centre for Cardiovascular Science, University of Edinburgh, Edinburgh EH16 4SU, UK
  3. 3Centre for Population Health Sciences, Medical School, Edinburgh
  1. anoopsshah{at}gmail.com

Nolan and colleagues’ review on cardiopulmonary resuscitation (CPR) did not cover the important problem of ethnic and racial differences in provision of cardiopulmonary resuscitation and therefore survival after cardiac arrest.1

Provision of CPR is not standard across all ethnic and racial groups. A recent systematic review and meta-analysis conducted by us concluded that black patients are less likely to receive bystander CPR, have a witnessed arrest, or have an initial favourable rhythm of ventricular fibrillation or ventricular tachycardia.2 Black patients are therefore less likely to have a favourable outcome after out of hospital cardiac arrest, with lower rates of survival to hospital admission and discharge compared with white people.2 We also identified a paucity of data on ethnic and racial differences in the characteristics of out of hospital cardiac arrest, including CPR, outside the US, as well as data for other ethnic and racial groups.2

To our knowledge, only one study has explored differences in the characteristics and outcomes of out of hospital cardiac arrest in other racial groups, and this study showed comparable care between South Asians and white people.3 The study showed that, although out of hospital cardiac arrest tended to occur at a younger age in South Asians than in white people, there was no significant difference in provision of bystander CPR, initial rhythm, response times, and, importantly, survival to hospital admission or discharge.3

Nolan and colleagues highlight that there are still several questions that will govern the direction of future research. Exploring racial and ethnic inequalities in provision of prehospital care has been somewhat neglected. Further research is now needed to close the gaps in the knowledge and understanding of the underlying reasons that contribute to racial differences in the characteristics of out of hospital cardiac arrest.


Cite this as: BMJ 2012;345:e7615


  • Competing interests: None declared.