TV Shows Often Fumble When Portraying CPR

Scripted television shows fail to accurately portray the realities of out-of-hospital cardiac arrest (OHCA) and often depict out-of-date practices for compression-only cardiopulmonary resuscitation (CPR), according to a new study published this week.

On the small screen, investigators report, less than one-third of episodes got the fundamentals of hands-only CPR right.

“Even though all of the episodes we analyzed were released after [the American Heart Association] endorsed hands-only CPR, we still see people checking for a pulse, giving breaths, and things like that,” lead researcher Ore Fawole, BS (University of Pittsburgh School of Medicine, PA), told TCTMD. “Overall, the depictions of CPR aren’t the greatest.”

Among 54 television episodes that showed compression-only CPR given out-of-hospital by a layperson, just 16% showed it done correctly. In nearly half of the episodes (n = 26), the CPR provider gave breaths along with compressions, and 23 showed them checking for a pulse.

The researchers say their study, which was published in Circulation: Population Health and Outcomes, is important because people model their behaviors based on what they see on television, movies, and social media.

“People are watching thousands and thousands of hours of television every single year, but you only see your primary-care physician once a year for 1 hour,” said Fawole. “A lot of the health content that you’re consuming, a lot of the stuff that you learn about medicine in general, is going to come from the stuff that you see on TV. It’s important that’s representative of what’s going to happen in real life. It’s important that it’s accurate, and it’s important that it’s digestible.”

Senior investigator Beth Hoffman, PhD, MPH (University of Pittsburgh School of Public Health), said there is even anecdotal evidence showing that people mirror what they see on television. In 2023, a 12-year boy performed chest compressions that he learned on the Netflix drama Stranger Things on an unconscious man who nearly drowned.

“We do know that [television’s portrayal of CPR] does influence people,” Hoffman said. “The idea now is, how can we make it so that it has even more of a positive influence?”

White Men Mostly Get and Give CPR

The American Heart Association (AHA) adopted hands-only CPR in 2008 based on studies showing that uninterrupted, high-quality chest compressions without rescue breaths can be lifesaving for people who collapse from sudden cardiac arrest.

“[With] hands-only CPR in the first few minutes, which is what the AHA recommends for lay people, the science shows it’s as effective as the CPR that healthcare providers do,” said Hoffman about the simplified approach. “It’s really about reducing those barriers to action. People get confused: how many breaths do I give? How many compressions? People don’t want to give breaths. People will check for a pulse and aren’t really that great at it.”

The analysis focused on depictions of OHCA and compression-only CPR airing since 2008 on scripted television shows. In all, 93 episodes depicted OHCA and 85 depicted hands-only CPR. Of these, 63.5% showed CPR given by a layperson who wouldn’t be expected to have training in basic life support. The 54 episodes that portrayed bystander CPR included such shows as Yellowstone, Breaking Bad, The Walking Dead, Ray Donovan, and The Blacklist, among others.

In addition to the inaccuracies, the analysis found that the primary witnesses to the OHCA were friends (22.2%), partners (20.4%), or strangers/coworkers (18.5%). In all, 20.4% of OHCAs occurred at home. In terms of people receiving hands-only CPR, 64.8% were white, 22.2% were Black, 7.4% were Asian, and 1.9% were white Hispanic. Most were men (68.5%) and 44.4% were 21 to 40 years old. Among those giving CPR, 70.3% were white, 16.6% were Black, 7.4% were Asian, and 3.7% were white Hispanic. Again, most CPR providers were men (64.8%), and the majority were 40 years or younger.       

One limitation of the study is that investigators are not certain if the disparities on television reflect casting choices or if they mirror the real world where such disparities have also been observed.

Identifying With TV Characters

The researchers point out that the percentage of people on television who received hands-only CPR after OHCA was higher than real-world rates. They also note that the majority of OHCAs occur at home, compared with just 20% in their analysis. The disparities seen in the study—mostly white males giving and receiving CPR—are an issue because this can reinforce implicit biases among viewers.

“Being able to see any character that you identify with, or any character that you see on TV, jump in and perform CPR is important because [you may] think, ‘Hey, this character can do it, I can do it too,’” said Fawole.

Katherine Allan, PhD (Unity Health/University of Toronto, Canada), who specializes in arrhythmia and resuscitation research, said that she would have liked to learn more about the types of inaccuracies portrayed on the scripted dramas. For example, the compressions might have been too fast, too slow, or insufficiently deep enough to be effective for OHCA.

“Still, they make a really good point,” she told TCTMD. “It’s not great that there’s these inaccuracies. A lot of people may pick up and try to mimic something they saw on television, because they think that’s how it should be done.”

Like the researchers, Allan noted that most OHCAs do not happen in public but instead at home. In addition, it’s been well documented in the scientific literature that there are some racial/ethnic communities with lower rates of bystander CPR, so depicting these different demographics on screen could have a downstream effect where these groups wouldn’t be hesitant to jump in and perform CPR.

One of Allan’s areas of research is investigating different ways to increase the number of people learning CPR as well as to raise the rate of bystander CPR, which has stagnated in North America.  

“One of the things we always wonder about is whether watching stuff on social media or television translates into behavior change,” she said. “Do people mimic what they saw? There are anecdotal reports, but we don’t have a good way of quantifying that, or measuring the impact. Still, I believe it’s really important to disseminate information this way, because so many people get their information from social media and television programs.”