I recently had to recertify my credentials in Advanced Cardiac Life Support (ACLS). This is a more advanced form of cardiopulmonary resuscitation (CPR) that not only uses chest compressions and artificial breathing but adds medications and other medical techniques to aid in attempts to provide life-saving treatment to a patient with no pulse and is not breathing.
The main purpose of CPR is to try to keep blood circulating to carry oxygen to the brain and other organs until the heart can start again and breathing can be restored. Time is critical because the brain will start to suffer permanent damage if blood flow stops for as little as 7-10 minutes.
Unfortunately, most people who suffer cardiac arrest do not survive and return to meaningful life. Unlike what you see on TV where most patients survive, statistics suggest that less than 10 percent of cardiac arrests that occur out of the hospital will survive to be discharged from the hospital. Even when people suffer cardiac arrest in the hospital, it is reported that only about 20 percent will recover and be discharged.
The best chance for survival is when the cardiac arrest is witnessed, CPR is started immediately, and there is access to advanced life saving treatment in a short time. One of the most dramatic episodes I was ever involved in happened on the Berlin football field during a Friday night game. The referee blew his whistle and then turned and tipped over like a tree falling with no pulse or breathing. We started CPR on the 50 yard line and fortunately the ambulance was there and the hospital was right across the street. He was revived and actually came back to referee in Berlin another time.
The history of trying to revive unconscious patients is interesting. In the past, all sorts of things have been tried. Long ago doctors thought that nicotine was a heart stimulant. They would try to revive drowning victims or people who collapsed by placing a tube in the rectum, then smoking a cigarette and blowing the smoke into the tube. This is where the “blowing smoke up someone’s a__” saying comes from. This technique did not work.
More recently researchers discovered that the best results occurred when blood could be circulated by compressing the chest and providing some artificial breaths. The chest compressions are the most important factor and should be started immediately. It is reported that less than 50 percent of cardiac arrests have CPR started by witnesses at the scene. Increasing this percentage could improve survival rates. The other important factor is to call 911 to get help. Ambulances were initially developed to be able to get people to the hospital quickly. But even that can take too long, so now ambulance personnel have the training and equipment to provide treatment right on the scene.
A relatively new tool is the automatic external defibrillator (AED), a device now available in many buildings and some emergency response vehicles. This device allows people with some training to be able to deliver life-saving electrical shock to the heart, when indicated, to try to return the heart to a normal beat. The longer it takes to get someone to a place to get a shock, the worst the outcomes. This device can deliver a shock at the scene.
CPR is not appropriate for every patient. However it can be life-saving and appropriate for people who have a relatively normal quality of life. Survivors generally are supported by artificial breathing and life support as they recover. If you witness someone who has a cardiac arrest, and is a candidate for CPR, the best response is to call 911 and start chest compressions until help arrives. Training courses are available and video instructions can be accessed online.
By P. Michael Shattuck, MD, Community Health Network Family Physician
