Incidents in the news highlight the importance of emergency cardiac care.
Two recent high-profile instances of cardiac arrest have raised public awareness on the topic. In early January, Buffalo Bills safety Damar Hamlin went into cardiac arrest after a hit to the chest during an NFL game against the Cincinnati Bengals. Paramedics performed CPR on Hamlin for about nine minutes. Despite his grave injuries, Hamlin has made an incredible recovery.
Less than two weeks later, Lisa Marie Presley, daughter of Elvis and Priscilla Presley and a successful singer and songwriter, also fell victim to cardiac arrest. Presley was not as fortunate as Hamlin and died on Jan. 12 at the age of 54.
“High-profile cases like Damar Hamlin and Lisa Marie Presley, while scary and too often tragic, give us in the cardiovascular community a unique opportunity to educate the public about cardiac arrest,” said Kevin Kwaku, MD, PhD, Director of Cardiac Electrophysiology at the Heart & Vascular Center of Dartmouth Health’s Dartmouth Hitchcock Medical Center. “There’s a lot of misunderstanding about what cardiac arrest actually is, and not enough people are trained in life-saving bystander CPR or how to operate an AED, or automated external defibrillator. By increasing public awareness, we can save lives.”
One common misconception about cardiac arrest is that the term is interchangeable with myocardial infarction, better known as heart attack, Kwaku said. According to the American Heart Association, a heart attack is when blood flow to the heart is blocked, while cardiac arrest occurs when the heart malfunctions and suddenly stops beating. This can happen as a result of a heart attack, but often does not.
“A heart attack happens when the circulation to the heart is impacted, but cardiac arrest is related to the electrical signaling of the heart,” Kwaku said. “In a heart attack our colleagues in Interventional Cardiology re-establish blood flow to the heart with balloons and stents. In our subspecialty of electrophysiology, we may treat cardiac arrest victims with implantable defibrillators, medications, and sometimes, cardiac ablation. If you think of your heart as a house, interventional cardiologists are the ‘plumbers,’ and electrophysiologists are the ‘electricians.’ You need both to keep the house in good and working order.”
Cardiac arrest interrupts the heart’s ability to pump blood and leads to unconsciousness and if untreated, death. It occurs when an electrical malfunction in the heart causes a very rapid arrhythmia, called ventricular tachycardia or fibrillation in the heart’s lower chambers. Triggers can be heart attack, but also include certain genetic or familial conditions, electrocution, or as we have seen, even unfortunately timed impacts to the chest during sports games.
“For this reason, we strongly recommend that AEDs be available anywhere competitive sporting events take place,” Kwaku said. “Professional sports facilities and the majority of collegiate-level venues have them on hand. It’s also becoming more common in high school sports, but even sporting events with younger athletes can benefit from having an AED available. For example, there have been cardiac arrests in Little League baseball players who take a ball to the chest, as their sternums are not fully developed and as protective.”
An AED — automated external defibrillator — is a portable electronic device that can deliver an electric shock to stop an ongoing arrhythmia, allowing the heart to re-establish an effectively pumping rhythm. They are designed to be simple to use and by non-medically trained people, with audio and visual commands that walk the user through the steps to administer to the person suffering cardiac arrest.
“Many hospitals and community organizations regularly offer first aid courses that teach people how to use an AED and perform CPR. You can even learn how to do both through instructional videos online,” Kwaku said. “About 350,000 Americans annually suffer cardiac arrest outside a hospital setting, so learning these skills really does give anyone the opportunity to be a hero should the need arise.”
If you find yourself in a situation where you think a person may be suffering cardiac arrest, the American Heart Association offers the following advice:
• Yell for help: Tell someone nearby to call 911 or your emergency response number. Ask that person or another bystander to bring you an AED if there’s one on hand. Tell them to hurry — time is of the essence. If you’re alone with an adult who has signs of cardiac arrest, call 911 and get an AED (if one is available).
• Check breathing: If the person isn’t breathing or is only gasping, administer CPR.
• Give CPR: Push down hard and fast at least two inches at a rate of 100 to 120 pushes a minute in the center of the chest, allowing the chest to come back up to its normal position after each push.
• Use an AED: Use the AED as soon as it arrives. Turn it on and follow the prompts.
• Keep pushing: Continue administering CPR until the person starts to breathe or move, or until someone with more advanced training takes over, such as an EMS provider.