Sudden cardiac arrest- how to tackle it
Recently, Australian cricket legend, Dean Jones succumbed to a Sudden Cardiac Arrest (SCA) in Mumbai. Dr. A.P.J. Abdul Kalam, the former President of India, too lost his life to a Sudden Cardiac Arrest. He collapsed while delivering a lecture at a reputed educational institution. Just like the families of these exemplary men, there may be many of us who have lost a close relative or a dear friend due to a sudden cardiac arrest.
SCA is a major cause of death around the world. In 2017, SCA caused about 3,56,500 deaths1 in the USA. In India, the estimated incidence of SCA should be between 5 to 10 lakhs per year, accounting for nearly 10 % of all deaths in India2.
Due to the COVID-19 Pandemic, most of us are experiencing reduced physical activity and increased mental stress. People are avoiding visiting doctors and hospitals for fear of exposure to the virus. This is invariably set to result in an increase in cardiac ailments and SCA. A major challenge is the fact that most of us are not informed enough about SCA. People may not know - how to respond when they witness a SCA. Therefore, let us learn a few things about SCA, which may help us save the life of a dear one.
The first question that comes to our mind is ‘What is ‘Sudden Cardiac
Arrest’? Is it the same as a ‘heart attack’? Sudden Cardiac Arrest is
not the same as a ‘Heart Attack’. A heart attack (myocardial infarction)
occurs when the blood supply to a part of the heart muscle is stopped
due to a blockage in the coronary artery. A heart attack usually causes
chest pain and or breathlessness; the heart muscle becomes weak and the
heart pumping reduces. If the heart attack is very severe, it may result
into a Sudden Cardiac Arrest.
Sudden Cardiac Arrest (SCA) on the other hand, is a condition when
the heart stops beating (suddenly & unexpectedly). This causes a
stoppage of blood flow to the body. If the brain does not receive blood
flow for more than three seconds, the person becomes unconscious. If
there is no blood flow to the brain for up to 2 minutes, the brain
starts to suffer from irreversible damage. If the heart is not restarted
in a few minutes by an active intervention, the person dies. Every
moment is precious and medical help needs to be provided on top most
priority. Else, the situation more often than not can be fatal.
But Do all SCAs result in death of a person? The answer
is No. Some simple steps may prevent death. The person (bystander) who
witnesses this catastrophe, must act quickly and responsibly. Almost 85 %
of SCAs occur outside the hospital. Hence it is important for everyone
to know the basics of Cardio Pulmonary Resuscitation (CPR).
Who are at higher risk for having an SCA? People
who are old and those who already have a heart disease, are at a higher
risk of SCA. But even then, it may occur in young and apparently healthy
individuals. SCA can occur at anytime, anywhere and to anyone.
Is there a difference between ‘Fainting’ and SCA? Yes.
Fainting or ‘transient loss of conscious’ usually occurs when the blood
pressure is low. The heart continues to beat. The victim regains
conscious spontaneously, within seconds. The common causes of fainting
are – severe emotional stress, severe physical exertion, severe pain,
loss of fluid volume (as in diarrhoea or acute bleeding), cerebral
stroke, irregular heartbeat or epileptic fit.
So, if someone faints, how do we know that this patient has SCA? What
should we do? When you witness someone fainting, the first step is to
make the victim lie down flat on the floor. Do not try to make him
sit-up or stand. A person who has a simple fainting episode will usually
regain conscious within 20 to 30 seconds. If the victim remains
motionless for more than 40 – 50 seconds, it is likely to be an SCA. The
first thing to do once you suspect SCA, is to shout for help from the
people around. If alone, make a phone call to emergency services. Make
sure the victim is lying flat on the floor. Give a firm tap on his
shoulder and call out loudly to him, to check for responsiveness. In
case, if there is no response, try to watch if he is breathing or not.
Try to check if he has a pulse. If you are unable to find his pulse,
immediately begin resuscitation by means of Chest Compression. As
illustrated in the figure, give chest compression, by firmly pressing on
the mid to lower part of the sternum (the area on chest between the two
nipples), at a rate of about 100/minute. The sternum should be
compressed about 5 to 6 cm.
What is an AED?
An AED is very simple life saving
device and can usually be used by a layperson having no prior know how
of the device. It is small, lightweight and easy to use. It has two
electrodes (pads like stickers – shown in picture) which need to be
connected to patient’s chest. The AED automatically analyses the cardiac
condition of the patient and gives ‘step by step voice command
instructions’, with audio & visual guidance. The machine does not
give a shock unless it detects that it is a cardiac arrest. Hence, with
the use of an AED, things cannot get worse than what they already are.
Even a non-medical person can deliver a shock to restart the heart.
Thus, an AED helps to save the life of the victim.
What is the chain of survival? The chain of survival
refers to a series of actions that when properly executed, reduce the
mortality associated with SCA. The "chain of survival" metaphor was
developed by Mary M. Newman in 1987. After calling for help, the
bystander should provide CPR immediately after the patient collapses.
Quality CPR (properly performed CPR) can keep the heart in a shockable
rhythm for some more time till one can access AED. Early defibrillation
(electric shock with help of an AED) is most likely to improve survival.
Does an AED really save life? AED is a very safe device
and is of great utility for saving lives. Without CPR, the survival
from SCA is only about 1%. If chest compression is given by a bystander,
the chance of survival improves to about 10 – 15%. If an AED is
available and used in time, then the chances of survival increase to 25 –
30 %.
Ideally speaking, AED should be
available at every public access area. In the developed countries, AEDs
are usually kept at airports, hotels, railway stations, malls, sports
complexes, etc. In India, AEDs are now slowly being made available at
airports, railway stations and five-star hotels. An AED is not
expensive, and it can be easily purchased and kept in office complexes
and residential societies. One small step today, can save a life
tomorrow!