South Florida Hospital News
Monday November 20, 2017
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October 2011 - Volume 8 - Issue 4

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Join the “Push to Save a Life!”

October is Sudden Cardiac Arrest Awareness month. Interestingly enough, it is also Breast Cancer Awareness month. If you were to ask most non-medically affiliated people what is sudden cardiac arrest, they would likely say a heart attack (which is not really correct). However, if you were to ask virtually anyone what is breast cancer, there would be little doubt in people’s minds what you are talking about. Therefore, it would appear that the awareness advocates for breast cancer have really done an admirable job—one which we who work with the victims and rare survivors of sudden cardiac arrest (SCA) should learn from and aspire to. Ironically, if one were to ask a group of women in their 20’s and 30’s, what they most afraid of dying from, the most common answer, by a large majority, would be breast cancer. In point of fact, a woman in America is nine times more likely to die of cardiovascular disease than of breast cancer.
 
SCA is one of the most lethal (and frightening) manifestations of heart disease. Somewhere between one quarter and one third of a million people suffer from this event each year. (The reason for the discrepancy in the statistics relates to the fact that it is often difficult if not impossible to determine the exact cause of death of people who died unobserved). This is tantamount to two 9/11 events each week. The mobilization to protect our country and our society following that landmark event one decade ago has been prodigious and appropriate. However, the efforts to address a problem which is 100 times more lethal have really paled by comparison.
 
What are the facts? SCA is a condition in which, for one of multiple reasons (only one of which may be what we classically refer to as a “heart attack”, or myocardial infarction) the heart suddenly stops functioning. When the heart is not pumping blood to itself, the brain and other vital organs, death will rapidly ensue – the probability of death increases approximately 10% for every minute that the heart is not pumping. After 10 minutes of no blood flow, even if the heart is somehow “brought back to life”, the chances of any meaningful brain function are minimal. Thus, time is of the essence. Because SCA can and does occur virtually anywhere – at home, on the road, in bed, in the office, on the soccer field, etc., the initial response, especially the first four minutes is critical in the survival of the victim. This difficult reality helps us to understand why, fifty years after the first description of successful cardiopulmonary resuscitation (CPR), and twenty-five years since the beginning of an era in which the mortality from heart disease has progressively declined each year, the survival rate for SCA in America (and much of the rest of the world) hovers around an abysmal 7%. It also helps us to begin to understand why there is almost a 50-fold variation in this survival rate depending upon which community one studies.
 
The traditional approach to the problem has been to develop a highly-trained rapid response team – the emergency medical services (EMS, more commonly known as 911). These highly trained individuals are on immediate call to respond to any of a number of medical emergencies and are only a phone call away. In general, their performance nationwide is excellent. So why are the results in SCA so dreadful? Let’s review the scenario. Someone drops from SCA. Is there anyone there? Do they recognize that the person is not conscious? Do they recognize that he is not breathing normally? If there is no one there, the story is likely over. If the person who witnesses the collapse actually recognizes that something has happened, decides to get involved, challenges the person to respond and finds that he is not conscious, looks and sees that he is not breathing normally (gasping or not breathing at all), then does he panic or does he act? If he panics, or simply does not know what to do, the story is likely over. If he calls 911, then 2-3 of the four most critical minutes are already gone. Another minute or two for dispatch, 5-10 minutes depending on ambient traffic and weather conditions, and, by the time our medical heroes arrive? You guessed it, the story is likely over.
 
In essence, the only reasonable chance that a victim of SCA has for a meaningful survival is if you and I, whoever we are, regardless of our background or medical training, respond immediately. Response requires preparation – if we don’t know what to do before it happens, we will have no time to find out after it happens. Appropriate response is, fortunately quite simple. What is hard is to understand and believe that this person’s life rests in your hands.
 
First, observe what has happened. If the patient is not conscious (awake and responsive) and is not breathing normally (gasping or not breathing at all), call 911. Next, immediately place the patient on a hard flat surface (ground, floor etc) and start PUSHCPR™ (hands locked over the breast bone in the middle of the chest, one hundred compressions per minute, push 2 inches deep and completely release). If there is an automatic external defibrillator (AED) available, apply the pads, turn it on and do what it tells you to do. (One person needs to continue PUSHCPR™ while the other gets the AED and applies it and turns it on). Call for help if possible so that you don’t get so tired that you can no longer deliver effective PUSHCPR™. With blood flow going to the brain and other vital organs (albeit diminished blood flow, but at least something), the victim now has a chance at survival until the help arrives. (For more information on the rapid and easy training in PUSHCPR™, contact the Florida Heart Research Institute at (305) 674-3020 or log onto www.pushcpr.org).
 
One might wonder: I don’t know what I am doing; I might hurt the guy. The first thing to understand is that if you do nothing, the person is dead. Dead is dead. You can only help. What if I get sued? Good Samaritan acts in every state protect anyone who acts reasonably to attempt to save another person’s life. What about infection? I don’t know what sort of disease he may be carrying. No one said anything about putting your mouth to the victim’s mouth – current scientific evidence has demonstrated that compression-only CPR without mouth to mouth resuscitation is equally effective for victims of SCA.
 
After help arrives, they will have their hands full, maintaining resuscitation, administering shocks and medications, transporting, etc. And the receiving hospital will have their hands full supporting the patient, inducing hypothermia to improve the victim’s chances of survival. And should the patient be one of the painfully rare survivors, organizations such as the SCAA (Sudden Cardiac Arrest Association) will have their hands full providing support and access to the growing community of survivors. But it all starts with you and me. Whoever witnesses a cardiac arrest—that person has the opportunity – and the responsibility – to literally join the “Push to Save a Life!”
 

Dr. Paul Kurlansky, board certified cardiothoracic surgeon, Director of Research at the Florida Heart Research Institute, can be reached at (305) 674-3154 or pak@floridaheart.org.

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