Tuesday, November 12, 2013

CPR Now Saves Lives

My life was saved by CPR as well.  I also went twenty full minutes with no heartbeat.  In these pages, I have since reported on an individual surviving two and one half hours using CPR.  What this all means is that it sufficient to establish an rhythmic pulse on the heart in order to simply pulse the blood pressure.  This alone shifts the blood about enough to get oxygen rich fluid moving around every cell.  That turns out to be good enough to preserve tissue for hours.

All this means that it is plausible to even do emergency surgery to clear badly obstructed arteries to restart the heart.

Today most heart attack victims are still generally robust individuals quite able to handle invasive surgery and survive so the mere maintenance of CPR right away is pretty certain to succeed.

Right now the current high death rates are derived from the failure to provide timely CPR and waning medical ignorance itself.  The latter is been disabused and I suspect that my particular case may well have helped because it was so early and so clear.  Now we have a mass of supporting cases.

Let us make it clear for all lay people.  When confronted by a collapsed victim: 
1                    Call 911 and get help on the way.
2                    Roll the victim over to chest up.  Then apply with both hands a pressure push over the heart. Develop a pulsing action and try to arc over the chest on your knees to use you own torso to develop the thrust.  Otherwise you will tire too quickly.  Be careful not to push too hard either as a broken rib is not helpful and this is a serious risk with the elderly.  You have now had time to settle yourself and focus your mind.
3                    Medical help will arrive in minutes.  If you insist, take a ten second break to blow air into the lungs although that appears to be meaningless until the heart is restarted.
4                    Make sure the medical team understands that you have provided full duration CPR so it gets into the record.  It is too easy for someone to argue for actual failure based on ignorance and your task is to ensure that does not happen.
5                    Do not count on other people’s heroics

Just that is good enough to save lives.

In the critical minutes, saving a life meant CPR      

by GAIL JOHNSON on OCT 23, 2013 

VANCOUVER ACTOR SONJA Bennett has prepared for a lot of roles over the years, but she admits that she wasn’t ready for one she took on in a harrowing real-life drama.

On March 18, Bennett had just gotten off a plane in Los Angeles with a long-time friend and collaborator, local film producer Kevin Eastwood. (Author’s note: Eastwood is my brother-in-law.) The two were headed to meetings for a movie script she has written called Preggoland. After taking a shuttle from the airport to the nearby car-rental hub, they had just started walking from one kiosk to another when things took a drastic turn.

“Kevin clutched his heart and took two sharp inhalations and then just fell forward onto the cement,” Bennett says during an interview in a Commercial Drive coffee shop. “I didn’t spend very long asking, ‘Are you okay?’ Once he didn’t respond, I called 911 right away.”

Bennett, then seven months pregnant, didn’t know that the 36-year-old Eastwood had just experienced sudden cardiac arrest (SCA). Not to be confused with a heart attack, where blood flow to the heart is blocked, SCA is the unexpected stoppage of heart function and loss of breathing and consciousness. It usually results from an electrical disturbance in the heart that disrupts its pumping action and prevents blood from flowing to the brain, lungs, and other organs. When the heart stops, the lack of oxygenated blood can cause death or permanent brain damage within four to six minutes. Less than 10 percent of victims live through such an event, according to the Canadian Association of Emergency Physicians (CAEP).

The next few minutes were nerve-racking for Bennett and critical for Eastwood’s survival.

She couldn’t tell the 911 dispatcher where she was. He wanted an address and all she could say was that they were about 10 minutes away from the airport. He kept telling her to relax and to listen for breaths.]\

“I said, ‘He is not breathing,’ ” Bennett recalls. The dispatcher instructed Bennett to do cardiopulmonary resuscitation (CPR). Panic-stricken and unsure of exactly how to proceed, she cradled her cellphone on her shoulder and began pressing down on Eastwood’s chest while the operator talked her through it.]

“It was compressions, compressions, compressions,” she says. “It felt like it went on forever.”]

Eventually, two passersby came to help, and an ambulance arrived. The four paramedics took one look at Eastwood and leaped into action.

“At the speed of light, they ripped off his clothes and were using defibrillators,” Bennett says. Eight shocks later, one of the paramedics said, “We’ve got a pulse,” and the ambulance headed to the Ronald Reagan UCLA Medical Center. There, Eastwood was treated with therapeutic hypothermia, in which the body’s temperature is lowered and the patient is put in a drug-induced coma before gradually being warmed up. There are no guarantees, but the procedure gives the body and the brain the best chance of recovering following SCA. After several days, Eastwood awoke. He spent 10 days in hospital, had a defibrillator implanted in his chest, and has since made a full recovery.

Waiting for him to come out of the coma, however, was agonizing for his family and friends. Bennett had the added burden of wondering whether she could have done more in those first few minutes after his collapse.

“I am so thankful that Kevin is all right, because if he had woken up and not been himself, I would spend my entire life going, ‘If only I’d started [CPR] a minute sooner,’ ” she says. “I didn’t start doing CPR for about two minutes, whereas now I would have started CPR first, then called 911, or done them simultaneously.

“I arranged for a CPR course as soon as I got back to Vancouver,” she adds. (Many of Eastwood’s friends joined her.)

Cindy Lund Chow, chief learning officer of St. John Ambulance’s B.C. and Yukon branch, describes CPR as a life skill.

“CPR is a life-saving tool,” Chow says in a phone interview along with Chris Chan, a first-aid instructor and the organization’s director of business intelligence. “It’s not just something you want to think about if you have elderly parents or because it’s required for the workplace. Cardiac arrest is something that can happen to anyone. Doing training is going to enable you to save a life, and that life is most likely going to be of someone you love.”

That’s because about 80 percent of SCAs occur in the home, Chan notes. “If you’re with that person, you are the one who has the ability to keep them alive,” he says.

Just as crucial as performing CPR, Chan emphasizes, is knowing how to use automated external defibrillators (AEDs), which are becoming increasingly common in public spaces such as ice rinks, shopping malls, and airports. (Many CPR courses include instruction on the use of AEDs.)

“The AED is just as important as CPR,” Chan says. “They go together like peanut butter and jam. CPR is very important, but CPR is not going to restart the heart. Research shows that for every minute of delay in defibrillation, survival decreases by seven to 10 percent even if CPR is happening.

“Sudden cardiac arrest doesn’t discriminate,” he adds. “Anybody of any age can have a SCA. You can be super healthy and still have sudden cardiac arrest. It happened to one of our instructors, who was driving at the time. A friend of mine was 28, and he actually died. He had CPR, but what was missing was AED. Because of that, he didn’t survive.”

Many people who witness cardiac arrest, though, don’t perform CPR. CPR is initiated in only about 25 percent of SCA cases in Canada, according to CAEP. Possible reasons include bystanders fearing that attempting CPR will make things worse or that they could hurt the victim. However, anyone who tries to help someone who is unconscious is protected from liability by Good Samaritan laws. Some people don’t want to perform the recommended mouth-to-mouth resuscitation that normally accompanies compressions out of fear of transmissible diseases. (Some schools teach compressions only.) Still others simply don’t know what cardiac arrest looks like.

Signs of SCA include sudden collapse, lack of pulse, no breathing, and loss of consciousness. Sometimes symptoms precede the grave condition, including fatigue, fainting, blackouts, dizziness, chest pain, shortness of breath, weakness, heart palpitations, or vomiting. But it often occurs without any warning.

And CPR and defibrillation must be delivered quickly. “If somebody is not breathing or moving or having any signs of life, you can assume it’s cardiac arrest, and you can do something to help that person,” Chan says.

Everyone should be trained in CPR, according to the CAEP. “All Canadians should respond and provide chest compressions (with or without mouth-to-mouth ventilation) whether they are trained or not, when an adult, child or infant suddenly collapses,” it stated in a 2012 position statement on bystander CPR. The organization also recommended that compulsory CPR training be implemented in high schools: “CPR education should be a prerequisite for a graduating student to earn a high school diploma.”

Bennett says she plans on refreshing her CPR skills regularly, as is recommended. “Half of it is knowing CPR and half of it is having the confidence to do it,” she says. “But even if you’re not sure you’re doing it right, just do it. Anything is better than nothing.

“I did what I could, not in any heroic fashion; I was terrified,” she adds. “The best thing was hearing Kevin’s voice after he woke up….The moral of the story is get your CPR training.”

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