PSA: CPR (20/30)

     Two summers ago I did a short PSA on drowning because many people don't know how to recognize the signs, which are often subtle (not the thrashing and yelling that Hollywood teaches us to expect). Today I present another PSA on a topic that has the potential to save even more lives: CPR. 

     First, I have some quick background info. CPR is used to treat cardiac arrest (also called sudden cardiac arrest or SCA). While a heart attack can lead to SCA, the two are not the same. In a heart attack, a blockage in the heart's blood vessels deprives areas of the heart of oxygen, which causes the affected cells to die, resulting in pain. The heart will usually continue to beat though. In a SCA it's the electricity of the heart that is affected. The normal electrical systems of the heart that control heart rate and rhythm stop working, and thus the heart stops beating completely, often without warning. There are many possible causes of SCA, everything from coronary artery disease to inherited heart defects (e.g. hypertrophic cardiomyopathy, valve diseases, Brugada syndrome) to stress to drowning to simply being hit in the chest by a baseball at the exact moment that the heart's electrical system is vulnerable (i.e. commotio cordis). If a heart attack is left untreated, it can also lead to a SCA once enough cells die or enough scar tissue forms. Because it is the electrical system of the heart that is failing, victims of SCAs require immediate defibrillation to "jump start" (so to speak) the heart and get it to beat properly again. If the heart is not beating, oxygen is not being delivered to the rest of the body, including the brain, and permanent brain damage can occur within 4 minutes, and death typically follows by 8 or 10 minutes. This is especially concerning because, as their name implies, SCAs often happen without any warning (the first sign is typically when a victim loses consciousness) and 88% occur while a victim is at home, away from the immediate help of emergency services.

     About right now you might be asking how all this affects you. If you're not a healthcare professional, you might never be trained in how to use a defibrillator, which is what a person suffering from an SCA most needs. However, anyone can be trained to perform cardiopulmonary resuscitation (CPR). While CPR typically does not cure an SCA, it buys valuable time. By keeping the heart pumping, CPR ensures that oxygen is still delivered to the rest of the body and thus staves off the death of other cells until defibrillation can be performed and the heart can resume pumping on its own. According to the American Heart Association (AHA), CPR can double or triple a victim's chance of survival, but in the US it is performed in only 32% of cases. So what can you do?

     The simplest answer is to take a CPR class. The AHA and Red Cross regularly offer classes in Basic Life Support (BLS), which includes training in the performance of CPR and the use of a defibrillator, and often includes training in the Heimlich maneuver as well. Classes do not cost much, last a couple hours, and are offered in different versions for laypersons and healthcare professionals. If you don't have the time or money for that, at least learn the basic steps. They've been simplified over the years to encourage more people to learn them and they're rather easy now. As depicted in the graphic to the right, the first step is check a person for responsiveness. You can yell at them or rub their sternum with your knuckles, and then check for breathing. If they don't respond at all and/or they're not breathing, move to the next step. If you're by yourself, call 9-1-1. If someone else is with you have them make the call and send them to find an automatic external defibrillator (AED) as well. Next, begin CPR. The AHA currently recommends that laypeople do what they call "compressions only" CPR, which means that you don't have to stop to give the victim breaths. You simply need to "push hard, push fast" in the center of the victim's chest. Ideally you're pushing at a rate of 100 bpm, and you're allowing for full recoil of the chest, but the fact of the matter is that poorly performed CPR is still going to be better than no CPR at all. Even if you are incredibly nervous (and that's normal), it's far better to start compressions than to sit around wringing your hands waiting for EMS to arrive. If you're scared of hurting the victim the fact is that they are already dead (at least in a cardiopulmonary sense), and your attempts to provide CPR can only help. The bottom line: just try.  Still nervous? Here's a 90-second video explaining how to perform CPR, complete with cheesiness and the Bee Gees. 

    Lastly, I'll conclude this PSA with some encouraging news about CPR from Sweden. Almost one third of Sweden's population of 9.6 million is trained in CPR. That fact in and of itself is pretty amazing and worth celebrating, but the Swedes continue to go above and beyond to find ways to help their citizens survive a cardiac arrest. In The New England Journal of Medicine published June 11, 2015 Swedish researchers published two articles back-to-back that explored the effects of early CPR (before EMS services arrived) and on how to dispatch laypersons to the scene of an out-of-hospital cardiac arrest. The first study showed that when CPR was initiated before EMS services arrived, a victim's chances of surviving increased from 4.0% to 10.5%, a significant increase. The second study looked at the use of a new app for people trained in CPR. When a call is made that someone has just suffered a cardiac arrest, the app will notify any users within 500 m of the incident and dispatch them to perform CPR until EMS arrives. This study found that the app resulted in bystander-initiated CPR in 62% of the incidents, as opposed to 46% in the control group (still better than the US average of 32%) when the app was not used. Already some cities and counties across the US are trying to create their own similar apps. Who knows? In a few years or a decade, maybe bystander-initiated CPR will occur in 75% or 80% of cardiac arrest cases, and maybe we can bring the survival rate higher than the dismal 4% or 10.5%.