HEART Insight:
doi: 10.1097/01.HEARTI.0000403781.71609.31
Features: To The Rescue

Keep 'em Alive

MacReady, Norra

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Hands-Only CPR™ Makes It Easier than Ever to Help in a Cardiac Emergency

Jon Lurie would have died on October 27, 2010, had it not been for the quick thinking of the people around him. “The doctors told me that if I'd chosen to stay home that night, I probably wouldn't have made it, so I like to say I delivered my own body to the very best place I could,” he tells HEART INSIGHT.

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Lurie, 43, a writing instructor at Macalester College in St. Paul, Minn., and his 11-year-old son Malcolm arrived at the Leonard Center, the college's athletic facility, at 7:30 to play some nighttime baseball. While checking in, he began feeling dizzy. “I attempted to get to the floor and lost consciousness about halfway down,” Lurie says. “I remember not being able to catch my breath, and hearing people talk to me but being unable to respond.”

Lurie was in sudden cardiac arrest (SCA), which happens when the heart suddenly stops beating, after veering from its normal, orderly pace to an abnormal quivering called ventricular fibrillation (VF). SCA paralyzes the heart, rendering it incapable of pumping blood to the organs, most notably the brain.

Fortunately, a volleyball game was in progress in a court nearby and many of the athletic faculty were in attendance, including Leonard Center director Soren Nelson, athletic director Kim Chandler, and Randee Garberg, an athletic trainer. By an almost eerie coincidence, all had received cardiopulmonary resuscitation (CPR) training just the day before.

While other staff members comforted Malcolm, they focused on Lurie. At first, he was still breathing and responsive, but then “he stopped breathing, went completely blue and we could tell he had no pulse,” Nelson recalls. Chandler ran to call the paramedics and fetch an automated external defibrillator (AED), while Nelson and Garberg stayed with Lurie. Nelson began CPR. “I got through two full cycles of CPR, and during the third cycle he started breathing slowly, and we could feel a pulse. After about another minute and a half, it seemed like he was breathing normally.”

“It was a great feeling when Jon started breathing and actually looked at us and started answering our questions,” Nelson continues. “You can't really describe it—you realize that he probably would have died if you hadn't done what you did.”

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Nelson is right: Had things gone differently, Lurie might have been one of the 1,000 people who die of SCA every day in the United States. Time is of the essence, warns Alson Inaba, M.D., Associate Professor of Pediatrics at the John A. Burns School of Medicine, University of Hawai'i at Manoa in Honolulu. “Every minute that your heart remains in that lethal rhythm and you do not receive CPR or defibrillation, your chances of survival decrease by 7 to 10 percent every minute. So if it takes the paramedics 10 minutes to arrive and no one performs CPR, your chances of survival can be close to zero—even with all of the paramedics' equipment and lifesaving drugs.”

“If an adult who has been breathing normally suddenly collapses in front of you, they should have enough oxygen in their system to sustain them until the paramedics arrive, as long as you keep the blood pumping by compressing the chest,” Inaba explains. “Compressing the chest squeezes blood out of the heart through the aorta and into the coronary arteries, which feed the heart muscle.”

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Despite the clear benefits of CPR, it is seriously under-used. According to research by Bentley Bobrow, M.D., Associate Professor of Emergency Medicine at Maricopa Medical Center and Arizona Emergency Medical Research Center in Phoenix and his colleagues, only about 30 percent of bystanders attempt CPR when they see someone in cardiac arrest. “Roughly 70 percent of the victims, on average, get nothing,” Bobrow says. “Many lay people are uncertain what to do.”

Even those who know something about CPR may not remember the exact ratio of breaths to compressions or may be afraid of doing more harm than good. Other people may feel uncomfortable making mouth-to-mouth contact with a stranger.

Hands-Only™ (also called compression-only) CPR “may remove many of the barriers to conventional CPR,” Bobrow says. As the name implies, Hands-Only CPR focuses on chest compressions and eliminates the need for mouth-to-mouth breathing. In 2005, concerned about the dismal survival rate of people who experienced out-of-hospital cardiac arrest, the Arizona Department of Health Services launched a statewide effort to encourage more bystanders to perform Hands-Only CPR. Between 2005 and 2009, the proportion of bystanders who attempted CPR increased from 28 percent to nearly 40 percent, and the proportion of rescues that involved Hands-Only CPR jumped from about 20 percent to 76 percent. Most importantly, survival increased from just under 4 percent to nearly 10 percent. Survival was 60 percent more likely with Hands-Only than conventional CPR with breaths and pushes.

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One of the advantages of Hands-Only CPR is its simplicity. “If we want bystanders to start doing CPR, we need to make the message as simple as possible,” says Marion Leary, R.N., Assistant Director of Clinical Research at the Center for Resuscitation Science at the Hospital of the University of Pennsylvania in Philadelphia. “There are a lot more steps involved with conventional CPR. It's simpler just to say, ‘If you find someone down on the ground without a pulse, just start pushing on his chest as hard and as fast as you can.’”

Hands-Only CPR consists of these steps:

▪ Position the person face-up on a hard, flat surface.

▪ Place one hand in the center of the victim's chest and interlock the other on top.

▪ Start compressing the chest hard and fast. Push to the beat of the Bee Gees song “Stayin' Alive,” and keep that in your mind as you are pushing.

▪ Continue until the person begins to breathe or move, or until someone with more advanced training arrives and takes over. You'll want to “look for purposeful movement, such as sitting up and talking to you,” Bobrow says. “Moaning and shaking are not purposeful.”

Conventional CPR with breaths is preferable to Hands-Only if possible, says Inaba, “because you do get some ventilation that way. But if an adult collapses in front of you, it might be better just to compress the chest because you saw the person and know they were breathing until the moment they went down. Remember: Each time you interrupt compressions to do ventilation is time you are not pumping blood through the heart.” Conventional CPR is also preferred for infants and children or adults that may have collapsed due to a respiratory emergency such as choking or drowning.

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Jon Lurie is living proof that CPR works. “It's simple to learn, and it can make the difference between keeping another person alive and allowing their kids to grow up with them, so it's incredibly valuable to the people who are helped by it. I'm in my early 40s—I have a lot of life ahead of me—but I would be gone right now if these people hadn't responded, and responded correctly.”

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The “chain of survival” is a sequence of events that significantly increases the odds of surviving an SCA. The steps are:

1. Recognize an SCA and call 9-1-1. Is the person unresponsive? Not breathing or not breathing normally? He or she is in cardiac arrest. If you can, send someone else to call 9-1-1 and get an AED if available.

2. Start conventional or Hands-Only CPR, with the emphasis on hard and fast chest compressions. Don't wait for the paramedics.

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3. Use an AED as soon as you can, if one is available. Again, don't wait for the paramedics. AEDs are easy to operate, just turn it on and it will tell you everything you need to do.

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4. Effective advanced care. Advanced providers will begin more sophisticated care, such as placing the victim on a ventilator or administering intravenous epinephrine (adrenaline) to keep the heart pumping on the way to the hospital.

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5. Coordinated care afterwards. Many hospitals now have advanced units such as cardiac catheterization, therapeutic hypothermia to prevent neurologic injury, and high-quality intensive care.

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Promptly and properly applied, CPR can maintain critical blood flow to the heart and brain, and an AED can eliminate the chaotic rhythm that caused the cardiac arrest. The combination of CPR and use of an AED provide critical support until paramedics arrive. Most communities offer a variety of free or inexpensive CPR training classes, and you can purchase “CPR Anytime” kits for adults, children, and infants directly from the AHA if you prefer to learn at home.

The AHA trains more than 12 million people in CPR annually. It's easy to find a CPR class:

▪ Visit heart.org/cpr, click on Find a CPR Class to enter your zip code and find a class near you.

▪ For a video demonstration of Hands-Only CPR, apps for your smartphone and more, visit www.handsonlycpr.org

▪ To order a CPR Anytime kit, visit www.shopcpranytime.org. Each kit costs $34.95.

If you want to learn CPR when and where it is most convenient, the AHA's CPR Anytime kits may be your best bet. The kits include a DVD with step-by-step instructions, reminder cards, and an inflatable manikin on which to practice. When you are finished, share this kit with friends or family members to pass on these life-saving skills.

© 2011 American Heart Association, Inc.