Dr. Ajay Sharma : As I was growing up in India, I was very fond of an uncle who lived close by and used to play cricket and football with us. I kept contact with him as I went through stages of school, college and then medical school. The contact became a little less as I moved to the US but I would still meet him every time I came for annual visits or over the phone regarding his medical questions about his parents. His son called me one day informing about his sudden death. I was shocked as he was yet to turn 50. His son further elaborated that he complained of sudden onset of chest pressure and shortness of breath and was sweating all over. Within a few minutes, as they were preparing to go to the hospital, he collapsed. A small hospital was 200 yards away from their home. The medical officer said that the senior doctor had just stepped out of the hospital. No cardiopulmonary resuscitative (CPR) measures were carried out. He was pronounced dead on arrival. It is an irony that a big hospital with cardiac catheterization laboratory was about half a kilometer away.
Sudden cardiac death can be a presentation of a ‘heart attack’. Even though this would be an overwhelming situation for any family, it becomes extremely important to keep one’s emotions in check and act decisively. In such a scenario, make the patient lie down flat on his back and feel for the pulse which would be absent as there is no blood being pumped out by the heart. One family member should be dispatched to call for help. Depending on how many are there at the scene, roles can be divided for CPR.
If there is only one left with the patient he will have to deliver both mouth to mouth breaths (2 every 30 seconds interrupting chest compressions for that). If there are two persons around, one should start chest compressions and the other should deliver mouth to mouth breaths every 30 seconds without interrupting the chest compressions. Delivering proper chest compressions is paramount. Using the base of one hand and the other one on top of it keeping it over the lower half of the chest bone, apply pressure to cause the chest to compress it at least half an inch. This action should be repeated at a rate of about 100 times a minute. This can be very tiring and even 2 minutes of proper chest compressions can wear a person out. Hence, it is important to take turns for chest compressions (do not let your ego overpower you). If the chest compressions are inadequate, they will not be of any use. If someone else notices this, he or she should take over. Chest compressions start cardiac output which may establish some flow in the arteries of the heart. If there is an AED (automatic external defibrillator) available, apply the pads to the chest wall as drawn over the device. If shock is advised by the device, it should be done. If no device is available, continue doing CPR until the ambulance arrives.
Thousand of lives could be saved by acting in a timely fashion. It would be great if training for this could be provided at workplaces, schools, airports etc..
I still think about uncle. It was a clear cut case of heart attack and CPR could have saved his life or bought enough time for him to be taken to cardiac catheterization laboratory for coronary angiography and proper treatment. American Heart Association documents that up to 200,000 lives in the US can be saved in a year with proper CPR. Population in India is 3 times that of the US, hence the benefits of learning CPR will be multifold as well.
(Dr. Ajay Sharma is a Cardiologist in Boston)