New findings indicate television CPR scenes frequently 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 Television. Image credit: Pixel-Shot/Shutterstock.com
In a recent research letter published in Circulation: Population Health and Outcomes, researchers analyzed depictions of out-of-hospital cardiac arrest (OHCA) and compression-only cardiopulmonary resuscitation (COCPR) on scripted television.
Television may shape public understanding of cardiac arrest
Annually, more than 350,000 OHCAs occur, and bystander CPR administration can increase the odds of survival. The American Heart Association (AHA) has introduced public awareness programs to decrease barriers to bystander action, with emphasis on COCPR. However, COCPR prevalence is low, especially in females and Black and Latino individuals.
The reasons for the low prevalence are multifactorial. The lack of depiction of COCPR in scripted television could be one reason. A scoping review found that health content on television could influence the behaviors of viewers. While studies have investigated CPR depictions in medical dramas, there is no examination of on-screen OHCA and COCPR across scripted television more broadly.
Screening scripted television for CPR and cardiac arrest
In the present descriptive study, researchers examined the depiction of OHCA and COCPR on scripted television. The team searched the Internet Movie Database (IMDb) for OHCA and COCPR depictions in television episodes. Non-American, unscripted shows, and those released before 2008, when the AHA endorsed COCPR, were excluded. The search strategy identified 169 episodes.
The researchers assessed whether the character received COCPR for each OHCA and derived sociodemographic variables of the individual experiencing OHCA and COCPR provider(s) from contextual cues, plot dialogue, and actor IMDb pages. Adherence to correct COCPR was defined as checking for scene safety or responsiveness, calling or asking someone to call 911, and beginning chest compressions. Episodes were coded as OHCA if the event was perceived as cardiac arrest, irrespective of medical accuracy.
Overall, OHCA was depicted in 93 episodes, 91 percent of which depicted CPR. Of these, 54 episodes depicted out-of-hospital CPR administration by a layperson likely not trained in basic life support. These 54 episodes, which potentially depicted COCPR, were included in descriptive analyses. Correct COCPR was shown in only 16 episodes, and breaths were given along with compressions in 26 episodes.
Further, the pulse was checked in 23 episodes. The incorrect depictions were not satirical. The primary witnesses to an OHCA were friends, 22 percent, partners, 20 percent, or coworkers or strangers, 18 percent. One-fifth of OHCAs in the sample occurred at home. Most individuals receiving COCPR were White, approximately 65 percent, male, 68 percent, and aged 21–40 years, 44 percent. Similarly, most people performing COCPR were White, 70 percent, male, 64 percent, and aged 21–40 years, 64 percent.
Aligning television CPR scenes with public health goals
In sum, the study found inaccuracies that may mislead viewers about OHCAs. More than 50 percent of COCPR recipients were aged below 40 years, whereas the real-world average age of COCPR receipt is 61.8 years. Moreover, 80 percent of OHCAs occur at home in real life compared to 20 percent in the sample. Television depictions also commonly featured males and White individuals as both COCPR providers and recipients, which may reflect broader disparities in on-screen roles rather than intentional bias, but could nonetheless influence viewer perceptions and represent an area for future research on implicit bias.
The study’s limitations include missing COCPR depictions not captured by the search strategy, use of actor demographics from IMDb, and coder bias. Additionally, the study did not account for the sociodemographic distribution of the audience. Overall, 58 percent of those experiencing an OHCA received COCPR, which is higher than the real-world likelihood, around 40 percent, and may motivate people to act if they witness an OHCA.
However, the frequent portrayal of outdated practices, such as pulse checks, runs counter to current AHA efforts to reduce barriers to bystander action. Because the analysis is observational and descriptive, the findings do not establish causal effects on viewer behavior. The authors note that collaboration between public health agencies and content creators could help align on-screen portrayals with contemporary resuscitation guidance and address disparities in COCPR receipt.
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Outdated CPR on TV could delay lifesaving interventions