The purpose of this study was to analyze racial differences in the outcome of sudden cardiac arrest in an area served by the Seattle Fire Department’s emergency medical services division. The differences were analyzed in terms of service-related and demographic factors known to influence resuscitation and survival. These factors were: presence of ventricular fibrillation, witnessed collapse, prompt (bystander) initiation of CPR, emergency team response times (including early application of defibrillation), younger age, location of collapse (home vs. away from home).

From May 30, 1984 to July 31, 1986, the fire department personnel responded to 1,332 victims (1,087 Whites, 137 Blacks, and 108 of other ethnic group). The “overall survival rates for Blacks and Whites were 10.2% (14/137) and 16.7% (182/1087) (P<.07) respectively; the proportions discharged without major neurologic disability were 8% (11/137) and 15.2% (165/1087) (P<.04).” Resuscitative efforts were “ceased for 129 White and 12 Black victims because of rigor mortis or assessment by other health care professionals not to resuscitate.” And, although black victims were younger than the white ones (P<.001), “which, other factors being equal, would tend to favor the survival of the Black victims,” whites were 2.15 (95% CI: 1.11-4.17) times more likely to survive than blacks. The likelihood of surviving without major neurological disability was also greater for whites as compared with blacks (OR 2.75, 95% CI: 1.29-5.87). The poorer outcome observed may be “partially explained by the fact that, on arrival of the emergency team, a slightly lower proportion of the Black victims (40.2% vs. 49.1%) were found in ventricular fibrillation; “however, racial differences persisted when considering only those victims found in ventricular fibrillation.” “The initial resuscitation rate was significantly less for Black victims found in ventricular fibrillation (31.9% vs. 60.4%, P<.0008).” After controlling for several potential confounding variables, whites were 3.2 times more likely to be resuscitated and admitted to the hospital (95% CI=1.58-6.44).

The study found no racially-based differences in emergency team response times, in the proportion of cases receiving advanced life support, or in outcomes when paramedics witnessed the arrests. Hence, there were no indications that service factors were responsible for the racial differences in outcome. Rather, the authors suggest that “the underlying socioeconomic and health status of the minority population are factors likely to affect outcome from cardiac arrest.”