What TV Gets Wrong About Cardiac Arrest and Resuscitation

What TV Gets Wrong About Cardiac Arrest and Resuscitation

New evidence suggests that CPR scenes on television often mislead viewers about who needs CPR, where cardiac arrests occur and how CPR should be performed.

Study: Out-of-Hospital Cardiac Arrest and Compression-Only CPR on Scripted TV. Photo credit: Pixel-Shot/Shutterstock.com

In a recently published research letter inDistribution: population health and outcomes, researchers analyzed depictions of out-of-hospital cardiac arrest (OHCA) and compression-only cardiopulmonary resuscitation (COCPR) on scripted television.

Television can shape public understanding of cardiac arrest

More than 350,000 OHCAs occur annually, and bystander CPR can increase the chances of survival. The American Heart Association (AHA) has implemented public awareness programs to reduce barriers to bystander action, with a focus on COCPR. However, COCPR prevalence is low, particularly among women and black and Latino individuals.

The reasons for the low prevalence are multifactorial. One reason for this could be the lack of representation of COCPR on scripted television. A scoping review found that health content on television could influence viewer behavior. While studies have examined CPR depictions in medical dramas, there is no on-screen examination of OHCA and COCPR across scripted television more broadly.

Screening scripted television for resuscitation and cardiac arrest

In the present descriptive study, researchers examined the portrayal of OHCA and COCPR in scripted television. The team searched the Internet Movie Database (IMDb) for depictions of OHCA and COCPR in television episodes. Non-American unscripted programs and those released before 2008, when the AHA endorsed COCPR, were excluded. The search strategy identified 169 episodes.

Researchers assessed whether the character received COCPR for each OHCA and inferred sociodemographic variables of the person experiencing OHCA and COCPR providers from contextual clues, action dialogue, and the actor's IMDb pages. Adherence to proper COCPR was defined as verifying safety or responsiveness at the scene, calling or requesting someone to call 911, and initiating chest compressions. Episodes were coded as OHCA if the event was perceived as cardiac arrest, regardless of medical accuracy.

In total, OHCA was presented in 93 episodes, 91 percent of which depicted CPR. Of these, 54 episodes involved out-of-hospital CPR being performed by a layperson who was likely not trained in basic life support. These 54 episodes that potentially constituted COCPR were included in descriptive analyses. Proper COCPR was demonstrated in only 16 episodes, and ventilations were performed along with compressions in 26 episodes.

In addition, the pulse was checked in 23 episodes. The misrepresentations were not satirical. The main witnesses to an OHCA were friends (22 percent), partners (20 percent), or colleagues or strangers (18 percent). One fifth of the OHCAs in the sample occurred at home. Most people who received COCPR were white (about 65 percent), men (68 percent), and ages 21-40 (44 percent). Likewise, most people who performed COCPR were white (70 percent), men (64 percent), and ages 21 to 40 (64 percent).

Aligning televised CPR scenes with public health goals

In summary, the study found inaccuracies that could mislead viewers about OHCAs. More than 50 percent of COCPR recipients were under 40 years old, while the actual average age of COCPR recipients is 61.8 years. Furthermore, 80 percent of OHCAs occur at home in real life, compared to 20 percent in the sample. Television depictions also frequently featured men and whites as both providers and recipients of COCPR, which may reflect greater inequalities in on-screen roles rather than intentional bias, but could still influence viewers' perceptions and provide an area for future research on implicit bias.

Limitations of the study include lack of COCPR representations not captured by the search strategy, use of actor demographics from IMDb, and programmer bias. Furthermore, the study did not take into account the socio-demographic distribution of the audience. Overall, 58 percent of those who experienced an OHCA received COCPR, which is higher than the real probability, about 40 percent, and can motivate people to act when they witness an OHCA.

However, the frequent depiction of outdated practices such as pulse checks is at odds with the AHA's current efforts to reduce barriers to bystander action. Because the analysis is observational and descriptive, the results do not reveal causal effects on viewer behavior. The authors note that collaboration between public health authorities and content creators could help align on-screen representations with modern resuscitation guidelines and eliminate disparities in obtaining COCPR.

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