Quick and specific action is the key to saving lives

Cardiac arrests happen. A lot. Every minute, an American dies of a cardiac arrest.

We all know that it would be best to act on the abundant prevention advice available and avoid, to begin with, the heart disease that is the most common cause of cardiac arrest.

But changing the habits of a nation takes a long time, so health professionals such as Duke cardiologist James Jollis, MD, are working to spread a few new, common-sense guidelines for the public -- as well as innovative but simple techniques for emergency personnel -- that could save thousands of lives a year.

The key, Jollis says, is everyone knowing their role.

Bystanders

New research has prompted new CPR guidelines from the American Heart Association which recommend chest compression-only CPR instead of the old practice of compressions and rescue breathing.

If you see someone collapse and become unresponsive, sometimes gasping for air, take four simple steps right away:

• Call 911
• Locate an automated external defibrillator (AED) if possible
• Begin chest compressions
• Apply the AED when available

Kneeling over the victim with arms straight, press hard and fast in the center of the chest at a rate of about 100 compressions per minute.

“Keep compressing the chest until they wake up, an AED is applied, or someone takes over,” Jollis says. If a victim receives bystander CPR, they are twice as likely to survive, yet only one in five persons suffering cardiac arrest in North Carolina receive bystander CPR.

If you are in a public place that has an automated external defibrillator (AED), ask someone to retrieve it or get it yourself if it is nearby. Office buildings, churches, schools, libraries, stadiums, airports, and shopping malls commonly have these devices mounted conspicuously.

All you have to do is open the box and follow the instructions. The device won’t shock the person administering the treatment. Certain U.S. cities and communities that have trained large numbers of people in CPR have bystander assistance rates better than 60 percent.

To increase North Carolina’s rate, Jollis and others are currently working on a program to teach CPR to every eighth-grader in the state, by training teachers to teach the technique to students.

Other efforts include teaching CPR to all heart attack victims and their families on discharge from the hospital, and to all employees of every medical center in the state -- accountants, administrators, and cafeteria workers alike.

Emergency Response

Emergency medical services (EMS) personnel and first responders (firefighters and police) have increasing responsibility under new guidelines.

Because most cardiac arrest victims receive neither bystander CPR nor defibrillation, it is crucial that emergency personnel arrive as quickly as possible to give lifesaving services. For a patient who has suffered cardiac arrest, even one minute can make the difference between life and death.

Research has shown that therapeutic hypothermia -- the intentional cooling of a resuscitated but unresponsive person’s body to 90 to 93 degrees Fahrenheit -- can minimize the brain inflammation and subsequent brain damage that often occurs when blood flow is restricted by cardiac arrest.

Emergency personnel can induce hypothermia with a simple IV of cooled saline solution. Some EMS units keep these bags in an ambulance refrigerator, while smaller EMS outfits just keep saline in a beverage cooler on ice.

Hospitals

The ideal scenario for a cardiac arrest victim is that bystanders save their life, EMS prevents further damage and transports victims quickly, and all of the state’s 122 hospitals are ready to deliver care to correct the underlying problem and to help the patient recover.

The reality is that not all hospitals have postcardiac arrest protocols in place to begin with. Duke and other major medical centers in North Carolina are working with smaller hospitals to establish a plan that will allow any hospital to provide advanced care in an informed manner.

They’re also focusing on informing patients as part of recovery care: educating both patient and family about the changes in the patient’s life lessens the chance that the patient will experience a second cardiac arrest.