Do you know what to do in a cardiac arrest?

Christian Eriksen, a Danish soccer player, recently collapsed in the middle of a game due to a cardiac arrest. He received CPR on the field while his teammates looked on.

Largely due to the excellent and prompt medical response that he received, Eriksen will make a full recovery.

He will also have an ICD (AKA implantable cardiac defibrillator) placed to protect him against future life threatening abnormal heart beats.

Look at the video of the scene. It’s pretty scary:

So while the life of a Danish soccer star doesn’t have that much impact on the rest of our day to day lives, this brings up an important question that might:

If you were in a situation where someone collapsed around you, would you know what to do to help that person?

What you do in an emergency matters more than you think

Having a friend, loved one, or even stranger collapse around you is terrifying. The normal response that most people have is to freeze up. The adrenaline kicks in and your thoughts go blank.

It’s easy to think that you can just call 9-1-1 and the experts will come in any take over.

But in the situation of a collapse like that, time really is of the utmost essence. And your actions matter a lot: the way that bystanders respond to these situations saves lives.

So I wanted to discuss what happens in this situation, how to recognize, and what you should do about it.

Let’s understand what’s going on here a bit more

When someone has a sudden collapse and is unresponsive, the most concerning medical explanation is a cardiac arrest.

A cardiac arrest means that the heart stops pumping blood to the rest of the body.

This can happen for reasons directly related to a heart problem - like a heart attack or an abnormal heart beat (called an arrhythmia).

It can also happen in response to something else going on in the body - like when your oxygen levels drop dangerously low, your heart can stop beating as well.

The reason that the cardiac arrest happens isn’t something you need to worry about in the moment. That’s something that will be diagnosed and treated when formal medical care can be provided.

And regardless of whether the cardiac arrest is the result of a heart problem or the response of the heart to something else, the treatment is the same.

What you - the bystander, the family, the friend - do is really important!

The reason that a cardiac arrest is so scary is that all of the vital organs need bloodflow to provide nutrients and oxygen.

Most of the organs can recover from this lack of bloodflow, with a really important exception: the brain.

When the brain is deprived of oxygen for even short periods of time, irreversible injury can occur. We’re talking time on the order of minutes.

The time sensitive nature of the damage means that what you do as a bystander witnessing a cardiac arrest can be the difference for the person suffering from the arrest between living a normal life and never getting off a breathing tube.

Not to be overly dramatic about it.

Here’s how you should approach these situations

In a cardiac arrest, bloodflow to the brain cuts off immediately because cardiac output drops to zero.

When the brain doesn’t have bloodflow, the result is that someone becomes unresponsive.

So your first step here is identification - a person with a cardiac arrest will either collapse or be on the ground unresponsive. You’re looking for someone on the ground or falling to the ground.

Next step is to check a pulse.

That’s all there is for your assessment - two questions:

  1. Is the person unresponsive?

  2. Do they have a pulse?

If the answer to both questions is no, then it’s time to call 9-1-1 and start CPR.

CPR can feel complicated, but it’s actually simple

The goal of CPR is to restore as much bloodflow to the brain as possible. So you, as a person who is doing CPR, want to artificially restore the contractility of the heart.

Chest compressions - and chest compressions alone - are all you need to concern yourself with.

If you do better with the written word than a video, read below. Performing high quality chest compressions is straightforward:

  1. Put the person on his or her back on a firm surface and kneel next to the person's neck and shoulders.

  2. Place the lower palm of your hand over the center of the person's chest, between the nipples. Place your other hand on top of the first hand. Keep your elbows straight and position your shoulders directly above your hands.

  3. Push straight down on (compress) the chest at least 2 inches but no more than 2.4 inches. Use your entire body weight (not just your arms) when doing compressions.

  4. Push hard at a rate of 100 to 120 compressions a minute. The American Heart Association suggests performing compressions to the beat of the song "Stayin' Alive." Allow the chest to spring back (recoil) after each push.

  5. Continue chest compressions until there are signs of movement or until emergency medical personnel take over.

The more complicated aspects of CPR are less important to remember - you don’t need to worry about compression/breath ratio, you don’t need to think about opening up the airway, you don’t need to do any pulse checks.

You just keep doing chest compressions until the person wakes up or medical personnel arrive.

If there’s more than one person around, you can do a bit more advanced work

If you aren’t alone with the patient at the time of the witnessed collapse, it opens up the possibility of doing a bit more.

First off, more than one person let’s you switch off who is performing chest compressions. In a hospital setting, we will switch the person performing CPR every 2 minutes. If you’ve never done it before, CPR is really tiring. Having someone to take over when you get fatigued ensures that the quality of chest compressions doesn’t wane with time.

Second, think about whether a defibrillator is present. If you’re in a public place, finding an automated defibrillator is a task that a non-CPR performing bystander can do. These are easy to use and readily available in many public places.

While someone continues high quality CPR, another person can open the defibrillator and follow the instructions. These are automated to detect fatal heart rhythms and provide an electric jolt that may restart the heart.

I don’t want to get too into the weeds of how to use these, since we’re already getting a bit long here. If there’s reader interest in this post, I may do a follow up on defibrillator use for the lay-person.

So, to sum things up:

  • If you witness someone collapse or find someone down, check to see if they’re responsive and feel for a pulse.

  • If there’s no pulse, call 9-1-1 and start chest compressions. Don’t stop until medical personnel arrive.

Now you’re prepared to help a friend, family member, or stranger in the case of an unexpected cardiac arrest.

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