People often use the same term, heart attack, to describe two different conditions, cardiac arrest or loss of heart function and breathing, and myocardial infarction, or blockage of an artery to the heart causing muscle damage. Cardiac arrest can be caused by myocardial infarction, and victims are much less likely to survive a cardiac arrest.
Public awareness of cardiac arrest has grown since Buffalo Bills safety Damar Hamlin suffered such an arrest before millions of viewers on Monday Night Football, but it’s still important for people to know the difference and how to respond in each situation. In the case of myocardial infarction, persons who develop continued symptoms such as chest pain or tightness should seek medical attention by calling 911. In the case of cardiac arrest, Damar Hamlin and others are encouraging everyone to learn the symptoms and response. That’s why
Hamlin recently spoke on Capitol Hill in support of the bipartisan “Access to AEDs Act,” which would provide funding to allow more public schools to purchase AEDs and implement programs to prepare staff and students in the case they are needed.
James Jollis, MD, a cardiologist with
The Christ Hospital Physicians – Heart & Vascular, says he’s encouraged by the increased awareness of cardiac arrests and he appreciates having a public advocate such as Damar Hamlin, but, he says there is much more we can do in the Tri-State region.
“We have a great opportunity to save lives,” he says. “We know what works, so I would focus on what needs to happen to greatly increase the odds. Awareness is a start, but we need to be sure that resources and training are directed to where they can have the biggest impact.”
“As a start, every health system and emergency medical service agency in the region should actively provide data to the national Cardiac Arrest Registry to Enhance Survival,” he continues. “Without these simple measures that track each vital process in the chain of survival from recognition to hospital discharge, we will not know where to focus our efforts nor the impact of any interventions on saving lives. We cannot improve our system without ongoing data collection and feedback.”
The difference between heart attacks and cardiac arrest
A heart attack occurs when an artery delivering oxygen-rich blood to the heart is blocked. If it is not opened within the first hour, the part of the heart being deprived of oxygen begins to die. The heart usually continues to beat during a heart attack but can suddenly develop ventricular tachycardia best treated by responding medics.
A cardiac arrest on the other hand, occurs when the heart malfunctions and stops beating completely. The window for treatment and recovery for cardiac arrest is much shorter than for a heart attack, with a 10 percent increase in deaths for each minute of delay. According to the American Heart Association, about 350,000 Americans suffer cardiac arrest outside of the hospital each year, and only one in ten victims survives. In the best scenario, one for which we should all strive, if victim is treated within the first 2 minutes, the likelihood of survival greatly increases to 1 in 2. In this early period, victims are saved by bystanders or first responders.
Any chance of survival at all depends on the response of people and frontline public safety nearby, according to Dr. Jollis.
“With cardiac arrest, the most important decisions that impact whether a patient lives or dies happen before they get to the hospital,” he says. “How quickly, and how well bystanders respond can literally save a life, or at the very least greatly increase survival chances.” For all cardiac arrests, the vital role of 911 telecommunicators must also be recognized and supported. These highly trained professionals recognize the symptoms of cardiac arrest, rapidly dispatch first responders and paramedics, and begin instruction of cardiopulmonary resuscitation in a timely and parallel fashion.
In the event of a nearby cardiac arrest, Dr. Jollis urges bystanders to remember “four Cs.” These are:
1. Check to see if a person is responsive and breathing normally.
Unlike many cases of heart attack, a person with cardiac arrest will not be conscious or responsive.
“Check quickly to see if they are responsive by shaking them and yelling for them to respond,” Dr. Jollis says. “You should also check their breathing. If a person with sudden cardiac arrest is breathing at all, it will be agonal, or labored breathing. It may sound like gasping or gurgling.”
2. Call 911
“It’s usually first responders who are able to save a life in the case of cardiac arrest,” says Dr. Jollis. “Call 911 immediately or instruct others to do so while you move on to compressions. Every second counts, so if you suspect somebody nearby has suffered a cardiac arrest, don’t hesitate to call.”
Immediate “hands only” Cardiopulmonary Resuscitation (CPR) is important in the case of cardiac arrest. CPR guidelines no longer include a requirement for mouth-to-mouth resuscitation.
“Recent studies show that there is no additional benefit of mouth-to-mouth versus only delivering the compressions,” Dr. Jollis says. “There is enough oxygen in the blood to keep the brain and other organs alive for up to a few minutes, so it’s most important to deliver compressions to keep blood flowing through the body.”
Compressions should be done with the victim laying with their back flat on the floor. They should be forceful and delivered at a rate of 100 per minute. Place the heel of one hand on top of the other and place the heel of the bottom hand on the center of the victim’s chest. Lock your elbows and compress the chest forcefully, about two inches, and make sure you lift up enough to let the chest recoil.
Dr. Jollis emphasizes the importance of as many people as possible being trained in CPR.
“The national average is around 40 percent of victims receive bystander CPR,” he says. “We need that number to be at 60 percent or greater. Seventy percent of cardiac arrest occur in the home, reinforcing the need for wide-spread public training, particularly for those households with older persons or heart patients.”
However, Dr. Jollis points out that not being trained or certified should not stop you from delivering compressions if you’re near a victim of cardiac arrest.
“At that point you can’t hurt them, you can only save them,” he says. “Chest compressions aren’t complicated, nor should they be. If you’re unsure, you can easily find instructions online with your phone, and 911 operators are trained to provide instructions over the phone, so you’ll have help if you need it. It’s like having a coach right there, but it’s still easiest and best if you’ve taken the class. It’s a small amount a time that can save somebody’s life.”
4. Connect to an Automated External Defibrillator (AED)
The use of an AED greatly increases the victim’s chance at surviving a cardiac arrest.
Prominent placement of AEDs is becoming more frequent in businesses, schools, and other public locations. Unfortunately, Dr. Jollis points out that over half the time when needed, they are in locked buildings that cannot be accessed after hours or hidden away in offices or drawers. Whenever possible, he says that AEDs should be placed by the front entrance of a building, and ideally outside if circumstances and resources permit.
Immediate access to AEDs can save lives, and Dr. Jollis points out that they are applied to cardiac arrest victims by first responders or paramedics in 3 out of 4 cases. This is why he emphasizes an immediate call to 911 – to bring first responders equipped with the device to the scene. He also advocates for all first responders dispatched to a cardiac arrest to be equipped with AEDs.
“We’d save more lives if every first responder had an AED with them at all times,” he says. “Not only in their service vehicles, but in their personal vehicles. Those minutes they spend to go get an AED if they find themselves near a cardiac arrest victim can save a life. Yet I just sat in three meetings this week where police and fire departments stated they weren’t able to afford AEDs. They should be the first to get them.”
Like CPR, he urges quick action with an AED if one is available, even if you’ve never been trained.
“They’re designed for six-year-olds to be able to use,” he says. “Instructions on the device should be clear and easy to understand at any reading level. This is another example of you not hurting a victim. You can only help them.”
Dr. Jollis was a guest on a recent episode of the
Pound This Podcast with Amanda Valentine. Listen below as he covers additional topics such as signs and symptoms of cardiac arrest, advances in a national network of emergency cardiac care and how it can help patients survive, and risk factors for cardiac arrest and other heart disease.