During Sex, In Public - Why Are We So Afraid Of CPR?

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New research shows that compromising circumstances in the bedroom – like having sex – and being a female in public play a significant role in the decision to whom we administer CPR.

Only about 46% of people experiencing out-of-hospital cardiac arrest (OHCA) receive bystander intervention before professional help arrives. Recent research notes that compromising circumstances (during sex) and being a female in public play a role in whether or not it happens. But why?

Cardiac arrest outside a hospital setting has a 90% mortality rate but the chance of survival goes up two- to threefold if early CPR is performed. So, determining why bystander delays or nothing at all happens is essential.

Could discomfort with breasts be at the core of why 45% of males but only 39% of females received bystander CPR (B-CPR) in public? Perhaps, because there was no significant gender difference inside homes. That men are1.23 times more likely to receive it could be making something out nothing, or could it be that people feel less comfortable initiating B-CPR on a female stranger than a male one? If so, the same could hold true for variations in age and body size or even social status. 

It could instead be differences between how heart disease in women and men presents itself (see Heart Disease in Women: Fact Vs. Fiction) - events in men are more recognizable as what we consider "heart attacks."

And when it comes to cardiac arrest during sex, men are a stereotype also. Because it's true, finds a recent report in the Journal of the American College of Cardiology Using data from the community-based Oregon Sudden Unexpected Death Study, researchers found that sudden cardiac arrest (SCA) associated with sex occurred 94% of the time in men. Even though they were not strangers, these partner-witnessed events had roughly the same bystander CPR intervention as people on the street (about 1/3 performed CPR). And, thus, a very low survival rate.

But relax, cardiac arrest during sex is a lot rarer than we think. And 75 percent of the time it was during extramarital affairs in unfamiliar locations after too much to eat or drink. But even then an hour of additional sexual activity per week is adding mortality of <1 per 10,000 person-years.

How do we go about spreading the message that rapid intervention is any person’s best and only chance at survival under these conditions?

Strategies for improved placement and use of portable automated external defibrillators (AEDs) are touted as one way to tackle the problem. Their swift use double survival but cost and availability plus the high variability of place and time of cardiac arrest occurrence are reasons why AEDs can't be the only solution.  (See Can Starbucks And Pizza Shops Prevent Deaths?).

Given the fact that survival is less than 10% without immediate action, the issue is an important public health concern. More than 350,000 cardiac arrests occur outside hospitals each year. Survival is fundamentally linked to early, rapid intervention of CPR. For those who receive immediate (or within the first few minutes) CPR, their chances of survival improve substantially.

With 70% OHCA taking place in the home, possessing the ability to save a life will tend to be orchestrated on a loved one. Famed rocker Tom Petty recently succumbed to such a cardiac arrest (to learn more, see here).

In Want a Nation of Super Heroes? Early CPR Makes Every Second Count!, I detail the importance of CPR being mandatory in schools. But, it isn’t uniform or universal.

In 2011, the American Heart Association (AHA) published “Importance and Implementation of Training in Cardiopulmonary Resuscitation and Automated External Defibrillation in Schools” in the journal Circulation. The AHA has urged all teachers and students should be trained in CPR and first aid as a requirement to graduate from secondary school. Legislative interest in 2009-2010 led to its inclusion in the curriculum of 36 states, though it is often written more like a suggestion without any consistent implementation. Cost is a big concern, but ways to minimize costs were readily addressed in the Circulation report.

The arbitrary nature of many school requirements always baffles me. Replace vending machine soda, but sell macaroni and cheese and pizza in the cafeteria. Make an entire school nut-free, but don’t teach basic emergency services, first aid and CPR.

Anguish ensues when a bystander is not properly armed with the tools to intervene on a loved one under such circumstances. With strangers, intervention is even less likely.

Bottom Line

Circumstances surrounding cardiac arrests factor into whether an individual is able to and willing to intervene. 

Determining why is crucial to guiding better policy.

Thankfully, more research on the topic is underway. Reducing barriers albeit implementing measures to enhance the public’s comfort level with performing CPR or expanding AED placement and access are worthwhile endeavors. And, undoubtedly, save lives.