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November 8, 2022
Brush up on your knowledge of cardiac arrest and you may be able to help save someone’s life.
Cardiac arrest means an absence of cardiac activity — in essence, a person’s heart stops beating. While certain health conditions and other factors increase the risk of cardiac arrest, it can happen to anyone.
When someone has cardiac arrest, immediate medical attention — starting with cardiopulmonary resuscitation (CPR) — can be the difference between life and death. Here’s what you should know about cardiac arrest, including what to do if someone near you appears to be experiencing it.
About 90 percent of people who have cardiac arrest outside a hospital setting don’t survive it, according to the Centers for Disease Control and Prevention (CDC). Since about 350,000 people have cardiac arrest in non-hospital locations each year, that translates to hundreds of thousands of people dying from the condition in the United States annually.
“It’s thought that out of deaths in the United States, 13 to 15 percent are due to cardiac arrest,” says Eugene DePasquale, MD, a cardiologist at Keck Medicine of the University of Southern California in Los Angeles. That makes cardiac arrest one of the leading causes of death in the country.
Mild to severe brain injury caused by lack of oxygen to the brain is common in cardiac arrest survivors, who often need intensive rehabilitation once they’re discharged from the hospital, as noted in an article published in the Lancet in October 2021.
Between 30 and 50 percent of cardiac arrest survivors experience cognitive deficits as a result, according to an article published in Dialogues in Clinical Neuroscience in March 2018. Survivors are also disproportionately burdened by mental illness — about 40 percent have anxiety, 30 percent have depression, and 25 percent have post-traumatic stress disorder (PTSD) in the aftermath of cardiac arrest.
When someone collapses because of a heart condition, many people think it's a “heart attack.” But that’s not what cardiac arrest is at all.
Cardiac arrest and a heart attack are “completely different,” says Anezi Uzendu, MD, an interventional cardiologist and an American Heart Association volunteer. “With cardiac arrest, the heart stops beating, and you can’t wait for emergency services.” A person will be completely unresponsive, and you need to start CPR right away.
In contrast, when someone has a
In contrast, when someone has a heart attack — which happens when blood flow to the heart is blocked — they tend to experience symptoms like chest pain and shortness of breath, but they’re still conscious and responsive. It’s important to get immediate medical attention, but unlike with cardiac arrest, no treatment is required prior to arrival of emergency medical services for a heart attack.
Not only has Dr. Uzendu studied and treated cardiac arrest, he experienced it himself at age 25, while playing basketball with friends at a gym.
“Halfway through a game, I collapsed and didn’t have a pulse,” he says. “The great thing was that people there were trained — they knew CPR, and there was an AED [automated external defibrillator] available. They used the training they had to help save my life.”
Uzendu was healthy, considered himself an athlete, and had no medical history that suggested an elevated risk of cardiac arrest. Yet on that day, he would have died without the immediate attention he got first from his fellow basketball players and then from emergency services.
In many cases, though, cardiac arrest happens in people with known risk factors. A leading cause of cardiac arrest is coronary artery disease (CAD), according to Dr. DePasquale — a condition that can be treated and controlled.
Other health conditions that increase the risk of cardiac arrest include certain arrhythmias (heart rhythm disorders), as well as cardiomyopathies — heart disorders that make it difficult to pump blood throughout the body.
In fictional portrayals of cardiac arrest, a character often collapses while performing some kind of physically demanding task. In real life, a person may or may not be doing something physically taxing when cardiac arrest happens.
“There has certainly been attention to cardiac arrest among athletes,” says DePasquale. “When that does happen, it gets attention because it’s typically at a venue with a lot of people.” But cardiac arrest “can easily happen when you’re not doing anything or taking it easy,” he adds.
While cardiac arrest that happens in public places tends to get more attention, about 7 in 10 cases occur when a person is at home, according to the CDC.
CPR performed within the first few minutes of cardiac arrest can double or triple a person’s chances of survival, according to the CDC. Unfortunately, fewer than half of all people receive CPR from a bystander, according to Uzendu — and the numbers are barely different for people who have cardiac arrest at home versus in public.
It’s important for everyone in your household to know how to perform CPR if possible, Uzendu says. “Most of the time cardiac arrest is happening, it’s going to be someone in a household,” so you’re more likely to encounter a loved one who needs CPR than a stranger.
Before starting CPR, Uzendu says, you should check to see if the person is responsive by asking if they’re okay and tapping or shaking them. If they’re not responsive, check to see if they’re breathing normally. If not, immediately call 911 and start chest compressions.
Hands-only CPR consists of only two steps, according to the American Heart Association:
Uzendu laments that many people hesitate to perform CPR because either they don’t know how or when to do it, or they don’t feel comfortable doing it. “If someone doesn’t have a pulse or a heartbeat, you can’t make them worse,” he says. “You need to act.”
In addition to administering CPR, you should use an automated external defibrillator (AED) if one is available. AEDs are available in many public places, including schools and universities, airports and other transit hubs, large offices, malls, grocery stores, and gyms.
To use an AED, all you have to do at first is turn the device on. Almost all modern devices are equipped with an audio system to guide you through all the necessary steps, according to Uzendu.
Based on the instructions given by the AED, you’ll need to expose the person’s chest and put the device’s pads on it. The device will analyze the person’s heart rhythm and advice to give an electric shock if needed, as many times as needed. Many devices also tell you when to perform or pause CPR.
The American Heart Association emphasizes that a “chain of survival” is needed for a person to have the best chance of surviving cardiac arrest. The steps in this chain are calling 911, performing high-quality CPR, defibrillation, advanced CPR by medical professionals, hospital care, and recovery.
Many different hospital treatments may be promising for cardiac arrest patients, according to Uzendu — including use of an external device to pump blood, inserting a stent to treat any heart blockages, and cooling the person to protect their brain once normal heart rhythm is restored. But doctors are still figuring out how to maximize survival with the tools they have.
“A lot of these therapies might not be beneficial in everyone,” says Uzendu. “I think the next phase of research is going to be trying to figure out which patients benefit from which therapies.”
Since coronary artery disease (CAD) is a leading cause of cardiac arrest, one of the best ways to reduce cardiac arrest deaths is to make sure people get screened and treated for CAD, according to DePasquale.
“Coronary artery disease is something that there are excellent treatments for,” says DePasquale. “There are also risk factors associated with it, such as high cholesterol or hypertension. If you’re seeing your physician regularly, that’s something that could potentially be controlled.”
But as much as prevention matters, Uzendu emphasizes the importance of recognizing and responding quickly to cardiac arrest.
“Everyone who is able to should learn CPR, how to save a life,” Uzendu urges. “Early defibrillation and bystander CPR can change the trajectory of cardiac arrest.”