CPR: The first response to cardiac arrest

Imagine you are at a wedding but the groom, who is about to say “I do” collapses at the altar. What would you do if you were among the audience? Scream? Create space for him? Call for an ambulance? 

Well, the first thing to think of is Cardiopulmonary resuscitation (CPR) since the man of the moment could be in deeper trouble than you may think. He may be undergoing cardiac arrest. 

CPR is a lifesaving technique that aims to keep blood and oxygen flowing through the body when a person’s heart and breathing have stopped. And it may be the line between the casualty’s life and death.

During a recent CPR training workshop by the African Register of Exercise Professionals at Mt Zion Hotel in Kampala, Kenyan fitness trainer, Ian Ngugi, told trainees that you can tell a person has suffered a cardiac arrest and needs CPR if they collapse, do not respond to touch or sound, or are not breathing and do not have a pulse. 

Ngugi, echoed other medics’ fear that the brain can only last four minutes without oxygen, before suffering permanent damage. Beyond 10 minutes after a cardiac arrest, chances of survival are low. So, effective and timely CPR can prevent this catastrophe and improve someone’s chances of fully recovering.

How it is done
Ngugi says before starting CPR, one must ensure the rescue scene is away from fire, traffic, or any other risky environment.

Ask the casualty loudly if they are okay. This will help you ascertain if they are responsive. Without a response, call for help or ask a bystander to do so.

Ask if there is an Automated External Defibrillator (AED), an easy-to-use medical device that can deliver an electrical shock to help the heart re-establish an effective rhythm.

Turn the casualty on their back and check if they are breathing by listening or seeing if their chest rises and falls. Check for the casualty's pulse near the area where the neck  joins the lower jawbone.

Without a pulse, start CPR. For adults, interlock your fingers, one palm above the other, with the heel of the lower palm in the centre of the casualty’s chest. Then press at the rate of 100-120 compressions per minute.

For children one to eight years, compress with one hand. For infants (below one year), use two fingers; the index and middle one. 

Open the casualty’s airway by gently tilting their head and chin upwards. 

Every after 30 compressions, you can give the casualty two mouth-to-mouth rescue breaths, each lasting about a second or use a CPR face mask, as you monitor the response. 

If their chest does not rise, continue CPR until medical help arrives. 

If the casualty begins to breathe, help them lie on their side until medical assistance is received.

Duration, risks 
Ngugi says the longest CPR he has ever perfromed lasted 66 minutes, and fortunately, the casualty recovered.
So, continue CPR until breath or heartbeat returns. And if one responder gets tired, another should immediately take over. 

The pressure exerted on a casualty’s chest during the compressions may crack some ribs or injure organs within the chest such as lungs and the heart. However, although hearing a bone crack can scare someone, especially one offering CPR for the first time, Ngugi says: “please do not stop because a broken rib is not as tragic as death.”

Survival rate
CPR saved the life of Denmark midfielder Christian Eriksen after suffering a cardiac arrest on the pitch against Finland at Euro 2020. 

However, the rate of survival due to CPR varies with a patient’s age, health status and the quality of CPR. Most success stories happen in hospitals, where emergency support is available.

Unfortunately, most cardiac arrests occur outside hospitals and in December 2023, the American Heart Association (AHA), put the overall survival rate for out-of-hospital cardiac arrest at around 10 percent.  

Where to train
Corporate and non-profit organisations, gyms, sports and fitness centres are increasingly equipping their staff with first-aid and CPR training. CPR training is simple, practical and takes two to three hours. 

The Uganda Red Cross offers internationally certified training, which delivers the most up-to-date, engaging and effective information that skills one for emergencies that require CPR. These trainings are open to staff and the general public. 

Do-Not-Resuscitate (DNR)
However important CPR is, some people choose to not have any life-saving measures performed on them in case of a cardiac or respiratory arrest. 

In most cases, people with terminal illnesses such as advanced cancer, dementia, may request for a do-not-resuscitate (DNR) order, a legally recognised order signed by a physician, to prevent responders from attempting CPR on them in case their hearts stop. 

Even other resuscitation tactics such as intubation, cardioversion and IV medication, are not allowed on casualties with a DNR. 

 A DNR is perceived as conceding the fight against death and should be respected, across the world by professional and non-professional caregivers.  

For easy identification, DNR patients carry bracelets, medallions and wallet cards from approved providers. Lately, in the USA, some have DNR tattoos. 

And Ngugi warns that if one has the proof of a DNR and you insist on doing CPR on them, they can sue you. 

He, however, says a mere medallion with the initials DNR, may not be enough. Those initials may mean something else. “So, without concrete proof of a DNR order, do the CPR.”

Spinal injury
According to www.nhs.uk, if you think a person may have a spinal injury, do not attempt to move them until the emergency services reach you. If it is necessary to open their airway, place your hands on either side of their head and gently lift their jaw with your fingertips to open the airway. 

Take care not to move their neck.

You should suspect a spinal injury if the person:
● Has been involved in an incident that is directly affected their spine, such as a fall from height.
● Complains of severe pain in their neck or back.
● Is not able to move their neck.
● Feels weak, numb or unable to move (paralysed).
● Has lost control of their limbs, bladder or bowels.