The Womanikin, Working To Close The CPR Gender Gap

When students in wilderness EMT Alice Henshaw's training courses grab practice dummies for CPR drills, they have their choice of a traditional, flat-chested training manikin or one that looks a little different: a manikin zipped into a neoprene vest with silicone breasts.

That's the Womanikin, a universal attachment for CPR dummies created by New York-based ad agency Joan Creative in partnership with The United State of Women.

The idea behind this breasted vest — and the related awareness campaign — is to address gender disparities in training and performance of CPR, which is vital for anyone experiencing cardiac arrest.

Research shows that bystanders are less likely to perform CPR on women than men, and experts say superficial anatomical differences may lead people to assume chest compressions must be performed differently on men and women, which is not true.

The Womanikin campaign is part of a larger discussion among public health advocates working to solve this problem.

"It's not just men who have sudden cardiac arrests, and it's not just men we have to save," says Dr. Holly Andersen, a cardiologist, professor of clinical medicine, and director of education and outreach for the Ronald O. Perelman Heart Institute.

A 2017 study looked at data from more than 19,000 people experiencing cardiac events and found that only 39% of the women received CPR from strangers in public as compared to 45% of the men, and that men's odds of surviving were 23% higher than those of women. Even in a virtual reality setting, study subjects were less likely to use CPR on female avatars. The same held true for use of an AED, also called a defibrillator, the device that can help shock hearts back into a regular rhythm.

Andersen, who has worked with Joan Creative to promote the Womanikin since its launch, says the majority of out-of-hospital cardiac arrests occur in public settings, followed by private residences and nursing homes. Because every minute without CPR decreases a person's chances of survival by 10%, Andersen says, it is not enough just to wait for emergency responders to arrive — bystanders must be willing to act.  (Watch the video below that demonstrating how to do hands-only CPR.)

Why women aren't getting CPR

There are many reasons why people might hesitate to perform CPR or use an AED on women, explains Marion Leary, the director of innovation at the Penn Nursing, who was the lead author on the virtual reality study.

For instance, people don't want to be perceived as assaulting a woman, and might be fearful of hurting the victim or ending up in a lawsuit. According to Andersen, legal action is unlikely because variations of Good Samaritan laws offer some protection in all 50 states. Leary says no potential embarrassment or injury is worth refraining from CPR.

"You can't hurt someone worse than dead," Leary says. "If you do nothing and they're in cardiac arrest, a person will die."

Bystanders may also be less likely to perform CPR on women because they are less aware that women experience cardiac arrests. Leary says women are underrepresented in CPR training materials. Informational videos mostly feature male actors, she says, and the conventional manikin is flat-chested.

"We've been training people relatively the same way since CPR was first quote-unquote 'discovered,'" Leary says. "We need to start thinking about how we can use the technology and innovation of today to really train people differently so that they feel comfortable performing CPR when the time arises."

The American Heart Association has formed an all-female working group of resuscitation experts to think about how to decrease disparities in gender, race and ethnicity in CPR training and application, Leary says.

According to Comilla Sasson, the association's vice president for science and innovation for emergency cardiovascular care, the group will channel their findings into the new 2020 AHA guidelines for CPR and emergency cardiovascular care, which will be released next October. These guidelines will have national reach, Sasson says, because the AHA trains the country's health care providers.


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