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In Japan, Strangers are More Likely than Family to Give CPR for Cardiac Arrest

Dark heart art

When it comes to Japanese people giving CPR to someone suffering a cardiac arrest, it appears as though water is actually thicker than blood. A recent review of 547,218 cases of cardiac arrests in Japan between 2005 and 2009 was presented at the American Heart Association. The results were surprising, to say the least. But why would this possibly be the case? How could a family member be so less helpful in this time of emergency?

What is Cardiac Arrest?

Before we get into the results, we have to understand what a cardiac arrest is. Many people mistake cardiac arrest with heart attacks, but these are not the same things. A heart attack is when a part of the heart doesn’t receive enough oxygen-rich blood because an artery is blocked, so that deprived part of the heart begins to die. The longer the time without treatment, the more damage there will be. The heart usually does not stop beating in a heart attack, and symptoms may occur hours, days, or weeks before a heart attack. This is very different from a cardiac arrest.

Just by the name, you can probably tell that the heart stops. In fact, cardiac arrest occurs immediately and without warning, and it’s caused by an electrical malfunction in the heart. The malfunction makes the heart beat irregularly, which disrupts the pumping action that the heart needs to keep us alive. What ends up happening is the heart cannot pump blood to the brain, lungs, and other organs, and the experience is characterized by someone losing consciousness and showing no pulse. People who suffer from cardiac arrest have only minutes to live, unless they are treated, in which case they can be saved.

Heart attacks increase the risk for sudden cardiac arrest, and sometimes (but not usually) cardiac arrest occurs after a heart attack or during recovery. However, despite the fact that people with heart attacks don’t usually get cardiac arrests, of the people who do suffer cardiac arrests, heart attacks – like other heart conditions – are often the cause.

In short, a heart attack means you’ve begun the rapid process of dying; but cardiac arrest means you’re about to die.

What can be done about this? CPR immediately following a cardiac arrest can effectively double or even triple a victim’s chance of survival.

This is a particularly serious problem in Japan, where – according to Japan’s health ministry – heart disease accounted for almost 200,000 deaths last year – 16% in the country. In a country where the amount of old people is rapidly rising, it’s already the second-leading cause of death after cancer.

The Hearts of Japan

“If you go into cardiac arrest in front of your family, you may not survive,” said Hideo Inaba, lead author of the recent study, from the Kanazawa University Graduate School of Medicine in Kanazawa, here in Japan. Inaba and his research colleagues identified almost 140,000 cardiac arrests witnessed by bystanders without a physician’s involvement. Bystanders included family members, friends, colleagues, passersby, and others. Here are some of the findings, as reported by MedicalXpress:

  • The time interval between collapse and emergency call and between call and arrival to patients was shortest when witnessed by passers-by.
  • Family members were least likely (36.5 percent) to administer CPR, but most likely to receive telephone instructions from dispatchers (45.8 percent).
  • The telephone instruction to family members most frequently failed (39.4 percent) and family members most often used chest compressions only (67.9 percent).

“Different strategies, including basic life support instruction targeting smaller households, especially those with elderly residents, would improve survival,” Inaba said, “as would recruiting well-trained citizens willing to perform CPR on victims whose arrest was witnessed by family members.”

Indeed, it seems as though education on the matter may be the most important factor in saving people’s lives. That is because many of the family members who witnessed cardiac arrests were afraid of injuring their loved ones. If this is the case, then ignorance is not bliss – ignorance is lethal.

According to Inaba, cultural and demographic factors also make a difference. A 2008 study found that Japanese women were less likely to attempt CPR than men. There are also of course locational factors involved, such as where the cardiac arrest occurs and what life support responses are available around there. An appropriate elaboration can be seen from a summary by the Japan Daily Press:

Friends and colleagues are twice as likely to spring into action and perform CPR, while strangers passing by were 1.5 times more likely than family, with, unfortunately for husbands across Japan, wives being the least likely to give chest compressions or rescue breathing. The researchers presented that this was a result of a combination of cultural, emotional, and demographic issues. Inaba says that Japanese people often want to be optimistic about other family members which can lead to hesitation.

Also common to Japan is the fact that elderly people are only living with their spouses, and Inaba says that wives have rarely been given enough training for CPR. The research also poses that women are less likely to respond quickly because societal upbringing teaches them to be humble and look to others such as bosses, husbands, or even in-laws when it comes to important decisions.

These are interesting explanations, though I don’t understand why women being culturally conditioned to delegate difficult decisions to others would yield such a discrepancy in strangers vs. family; but perhaps it’s the interaction of many of the above factors. This explanation is certainly not too far-fetched, though the more factors that cause these results, the harder it is to find a solution to this problem. Regardless, I can’t help but wonder if there are other significant factors missing these explanations entirely.

For example, perhaps the highly stressed family member would be far less calm and collected than a stranger who is less emotionally compromised. It would make sense that someone who is mentally composed would be better able to act appropriately, and traumatically seeing a loved one collapse to the ground would certainly make it difficult to stay calm.


In Japan, we know that cardiac arrests are safer in the vicinity of strangers, colleagues or friends than family members, and in front of men rather than women (especially female spouses). We don’t know, however, why this is true. 

Considering how this was such a large-scale study, I don’t think we need to say “we need more Japanese researchers to replicate these findings.” What we do need is, rather, a different population with which to compare these results. It would be beneficial to see the results of a hundred thousand cases from America and other countries to see whether these results are typical, or a Japanese-specific phenomenon.

If it is in fact a phenomenon that we only see in Japan (or perhaps it’s in certain societies with similar values), then this would be another example showing that the culture of Japan unwittingly promotes behaviour that is not conducive to the survival of its own people. Otherwise, there may be another explanation that scientists haven’t yet considered.

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