Become a Link in the Chain of Cardiac Survival
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Become a Link in the Chain of Cardiac Survival

If someone you love suddenly went into cardiac arrest and stopped breathing, would you know what to do? More than 225,000 Americans die each year from sudden cardiac arrest, but with the right tools and citizen training, thousands could survive.

During sudden cardiac arrest, the heart muscle ceases pumping and quivers, a condition called ventricular fibrillation. Only 2%-5% of patients who suffer a sudden cardiac arrest outside of the hospital survive.

Lives Saved

Two years ago, while celebrating her 48th birthday, New York nurse Julie Lycksell suddenly collapsed and stopped breathing. Her friend asked someone to call 911, while her husband and a restaurant patron started cardiopulmonary resuscitation (CPR), and within a minute or two a policeman trained in using an automated external defibrillator (AED) arrived and administered life-saving pulses of electricity. Unlike most sudden cardiac arrest victims, Lycksell had no history of heart trouble, and doctors could not determine why she developed an abnormal heart rhythm.

"The doctor told me it was just a strange thing that happened to me," Lycksell says. "If the policeman hadn't had a defibrillator, I'd be dead."

In 1997, Utah entertainer Luis Chavez, 73, was setting up his musical equipment at a Utah ski lodge when he keeled over, suffering sudden cardiac arrest. Two resort guests shouted for help and began CPR. An employee grabbed an AED and followed the machine's directions. They saved his life.

Learning the Chain of Survival

Rapid initiation of the American Heart Association's chain of survival can save the lives of people who experience sudden cardiac arrest.

Here's what to do:

  • Call 911.
  • Start CPR.
  • Use an automated external defibrillator to shock the heart back into a normal rhythm.
  • Get the victim to the hospital where he or she can receive advanced medical care.

Performing CPR

Bystanders can provide early CPR, giving rescue breaths to the victim and compressing the chest to support circulation. Statistics show that the rate of survival is doubled when CPR is performed until someone arrives with a defibrillator.

The American Heart Association conducts classes to teach lay people how to administer CPR. International bystander-CPR advocate Mickey S. Eisenberg, MD, PhD, director of the University of Washington Medical Center's emergency medicine service, studied young people and adults older than 60 and found that they are able to learn the life-saving skill online and then successfully perform CPR on a mannequin.

Defibrillators: The Difference Between Life and Death

Early defibrillation plays a key role in improving the odds someone will survive sudden cardiac arrest without brain damage. The American Heart Association's revamped emergency care guidelines place a stronger emphasis on early defibrillation and improved access to AEDs. Heartsaver AED CPR classes include information about how to use the devices.

Two studies published in The New England Journal of Medicine report unprecedented survival rates of 53% after trained casino security guards administered CPR and AED, and 40% after airline flight attendants did the same. University of Arizona researchers reported that the high success rate at the casinos depended on no more than three minutes elapsing between time of collapse and defibrillation.

Prior studies have shown improved survival rates in communities where trained police officers, often the first on the scene of an emergency, carry defibrillators. Dr. Eisenberg believes many lives would be saved if a defibrillator was nearby and family members knew how to use it.

Dr. Eisenberg's research has shown that older adults can correctly use AEDs after watching a short video. Another University of Washington study showed that sixth-grade students could accurately place and activate the devices during a training session.

Cost Concerns

AEDs cost about $1,500 and currently are available over the counter, without prescription. Dr. Eisenberg anticipates that an increase in demand will drive the cost down, just as it has for other electronic equipment. Since late 2004, AEDs are available freely on the market, which fueled a discussion whether people with heart disease should consider getting them for home. Potentially it could save thousands of lives each year. Some critics, however, say that this may actually cause people not to call for help in time and over rely on these machines instead of concentrating on prevention and appropriate treatments.

Additionally, some physicians question the cost effectiveness of using AEDs. The National Institutes of Health and American Heart Association have begun a study to evaluate the feasibility and cost-effectiveness of training lay people and placing defibrillators in apartment buildings, shopping centers, office complexes, senior centers and sports venues.

Lycksell, who attributes being alive today to a defibrillator, says, "I'd like it to be in all public places, like golf courses and churches, any place there are a lot of people. Some people say it's not worth the money. But if only one life is saved, it's well worth it. I'm here to talk about it, because the Suffolk County Police Department made the investment."

RESOURCES:

American Heart Association
http://www.americanheart.org

Citizen CPR Foundation, Inc.
http://www.citizencpr.org

Learn CPR—CPR Information and Training Resources
http://www.learncpr.org

References:

Cardiac arrest. American Heart Association website. Available at: http://www.americanheart.org/presenter.jhtml?identifier=4481 . Accessed May 21, 2007.

Chen MA, Eisenberg MS, Meischke H. Impact of in-home defibrillators on postmyocardial infarction patients and their significant others: an interview study. Heart Lung. 2002;31:173-185.

Jorgenson DB, Skarr T, Russell JK, Snyder DE, Uhrbrock K. AED use in businesses, public facilities and homes by minimally trained first responders. Resuscitation. 2003;59:225-233.

Marenco JP. Automated external defibrillators are cost-effective on large and medium capacity commercial aircraft. Evidence-based Healthcare. 2002;6;58-59.

Murray CL, Steffensen I. Automated external defibrillators for home use. Issues Emerg Health Technol. 2005;1-4.

Page RL, Joglar JA, Kowal RC, et al. Use of automated external defibrillators by a US Airline. N Engl J Med. 2000:343:1210-1216.

Terence D, et al.Outcomes of rapid defibrillation by security officers after cardiac arrest in casinos. N Engl J Med. 2000; 343:1206-1209.



Last reviewed May 2007 by Marcin Chwistek, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.


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