Calling 911, Starting Chest Compressions Can Save Lives
I recently had to recertify my credentials in Advanced Cardiac Life Support (ACLS). ACLS is a protocol for 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 lifesaving treatment to a patient with no pulse or breathing. Basic Life Support (BLS) is the initial CPR measures usually provided by bystanders before ACLS providers and equipment are available.
The main purpose of CPR is 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 the blood flow stops for as little as 7 to 10 minutes. Unfortunately, most people who suffer cardiac arrest do not survive, but some are successfully resuscitated. If someone suffers cardiac arrest and nothing is done, they will die. The sooner CPR can be started the better the chances of successful resuscitation. 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. Training in BLS will help people know what to do if they witness a cardiac arrest. If you don’t have BLS training, you can still start chest compressions and call for help until someone with more training arrives. It is recommended that the person doing chest compressions push down on the chest about 2 inches, at 100-120 times per minute and the pressure is released between compressions so the chest can return to its resting position.
The idea of trying to resuscitate patients with no pulse or breathing has come a long way. 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 very 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. One of the most effective measures is the ability to provide an electric shock to the heart. This is effective in certain instances when the heart is fibrillating. An electric shock can return the heart to a normal beat and restore circulation. Ambulances now carry defibrillators.
A relatively new tool called an automatic external defibrillator (AED) is now available in many buildings and some emergency response vehicles. This device allows people with some training to deliver the lifesaving electrical shock to the heart, when indicated, to try to return the heart to a normal beat. The longer it takes to get someone a shock, the worse the outcomes. This device can deliver a shock right at the scene before the ambulance arrives.
CPR is not appropriate for every patient. However, it can be life-saving and appropriate for people who desire heroic measures to be attempted in a life threatening situation. 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.
Michael Shattuck, MD, is an emergency department physician at ThedaCare Medical Center-Berlin.
