Basic training can save lives lost to out-of-hospital sudden cardiac arrest By Vemuri S. Murthy, MD

Bystander CPR Saves Lives

It’s not uncommon to come across daily news reports of people dying suddenly without any previous health complaints. Nor is it unusual to hear about sudden cardiac arrest victims who survive as a result of receiving timely CPR (cardio-pulmonary resuscitation) from a Good Samaritan bystander or family member, before professional help arrives on the scene. Prompt CPR can greatly increase the number of survivors. Simple instruction equips bystanders to recognize sudden cardiac arrest symptoms and administer chest compressions in the appropriate manner.

National CPR and AED Awareness Week takes place every June 1-7. The week is a reminder that all of us—individuals and communities—can step up by providing emergency help. However, we need not wait for this designated period in June to consider learning basic CPR.

Here in Illinois, the Good Samaritan Act provides legal protection to bystanders against civil damages if the person acted in good faith, complied with generally recognized standards, and provided services without compensation. Good Samaritans need only be trained in CPR rather than undergo certification. The Act protects people who are trained in accordance with American Heart Association or American Red Cross standards. Training can range from a four-hour course to a 20-minute video at home, the office, or in a classroom.

Sudden Cardiac Arrest (SCA) is a leading cause of mortality worldwide. In the United States, more than 359,000 out-of-hospital cardiac arrests occur each year, according to the American Heart Association (AHA). With a survival rate of less than 10%, about 90% of victims die outside the hospital. As the most recent evidence-based resuscitation guidelines make clear, immediate bystander intervention can double or triple their chances of survival.

During SCA, a person will collapse, with loss of consciousness, breathing and pulse. In some cases, this may be preceded by symptoms such as chest pain, shortness of breath, palpitations, dizziness or vomiting.

SCA can happen to anybody at any time. A robust athlete sustaining cardiac arrest due to blunt trauma to the chest (commotio cordis) caused by a speeding ball, is one example of a trivial accident that can result in death. Not everybody who collapses may be in cardiac arrest. However, people who collapse suddenly and become unresponsive are probably in cardiac arrest and need to be initially attended to like those in cardiac arrest.

SCA is caused by a disruption in the conduction mechanism that produces regular heart rhythm. It leads to ventricular fibrillation (erratic beating with no blood being pumped to the various parts of the body). It can happen during a massive heart attack (when the blood supply to the heart is severely compromised due to blockage in the vessels of the heart). Other conditions causing SCA include drowning, drug-overdose, electric shock, lightning, etc. In infants and children, cardiac arrest is usually secondary to severe respiratory problems.

SCA is a life-threatening medical emergency. When the circulation stops, the brain starts to die within a few minutes due to the lack of oxygen. This may result in irreversible brain damage. The victim’s chances of survival with recovery of brain function will depend on the interventions by people at the scene who can provide immediate CPR. In an out-of-hospital SCA, call 911, and in the few minutes before professional emergency help arrives, begin CPR.

The availability of Automated External Defibrillators (AEDs) in public areas is also an important factor in survival. If you are trained to use an AED, use it as soon as possible. An AED is a portable device that detects the erratic rhythm (ventricular fibrillation) in a cardiac arrest victim, and delivers an electric shock to reverse the irregular rhythm. Most people feel comfortable using this device after brief training. AEDs have a track record of saving lives when accessible at public places.

CPR awareness programs are offered to the general public throughout the United States. These community-oriented programs are conducted at public places, such as high schools and workplaces, among other locations.

Vemuri S. Murthy, MD, a Chicago anesthesiologist, is an American Heart Association (AHA) volunteer and teaching faculty, and a member of the AHA International Committee. He is the current chairman of the Chicago Medical Society Council and the founder of Project SMILE (Saving More Illinois Lives through Education), a community CPR awareness project of the Chicago Medical Society. Dr. Murthy acknowledges the AHA for the evidence-based information in this article.