Two Hands are Enough
By Priyangwada Perera
What happens if your heart stops beating? If not for immediate first aid, 90 per cent of the time you will die. Nine out of 10 people won’t survive an out-of-hospital cardiac arrest. However, the condition is something that is often taken for granted. Nobody seems to panic at the statistics.
It never gets the attention cancer or some other noncommunicable diseases do. However, sudden or unexpected cardiac arrest is the third most common cause of death in the world. This accounts for 25 per cent of the 17 million deaths each year. There is only one way to prevent this. That is through Bystander CPR or Cardiopulmonary Resuscitation.
Just as the term indicates, it is emergency CPR that is administered by someone who is close to the situation physically but not a part of an official response team dispatched from emergency services. The global survival rate of Out of Hospital Cardiac Arrest (OHCA) patients who received CPR has shown an increase in the past 40 years. However, there is a clear indication of higher survival rates of post-OHCA patients who have received bystander CPR in the western countries.
Bystander CPR increases survival rates by three to four times. Dr. Haritha Dharmakeerthi, Consultant Anaesthesiologist at Colombo North Teaching Hospital, Ragama explained further. “Our heart is an organ of great importance. Beats around 100,000 times a day, it pumps out 7,000 litres of blood per day. The Heart helps oxygen which is essential to every cell,” he said. Out of all organs, the most sensitive to oxygen is the brain.
“For any reason if the heart stops, oxygen supply is cut off and the patient will collapse in 10 seconds. Furthermore, if the oxygen supply is cut off for three to five minutes, cells begin to die. If the lack of oxygen supply goes on for more than five minutes, the brain will suffer irreversible damage,” Dr. Dharmakeerthi emphasised. Unless Superman comes, who can take a patient to a hospital in less than five minutes, it is crucial to know how to give emergency CPR since reaching a hospital in less than five minutes is a near impossibility. Preserving the heart’s function is crucial. Here is where Bystander CPR or basic life support counts.
All rests on your hands
We have been hearing of younger and younger people dying of heart attacks. According to the most recent statistics of Centre for Disease Control and Prevention (CDC), about 2000 young seemingly healthy people under the age 25 in the United States die each year of sudden cardiac arrest. A cardiac arrest might happen anywhere, anytime. Even in Sri Lanka, we have become aware of younger people being prone to heart attacks, especially with the pandemic related deaths. Anyone young or old might suffer the same.
But there is hope. You might be the only person who can save a life. Yes, you can be the new superman powered by Bystander CPR. It is essential that the public is trained. The most common cause of heart attack Myocardial Infarction (MI) or heart attack. Usually it is the middle aged and old people who are more prone to heart attacks. But one might suffer a heart attack in a road accident-due to severe bleeding, drowning, poisoning or even in electrocution. It can even happen due to allergies. But how can an ordinary person save a life? You may ask.
Do not worry. Dr. Dharmakeerthi is adamant that anyone can. “You only need your two hands. This technique does not need specialised training or equipment. Anytime, anywhere, anyone can save a life, with very little practice. There are some simple steps you need to know.
They can be easily mastered,” he assured. The three steps of identifying, compressing the chest and calling for help should be remembered. Easier said than done, you may argue. However, if you are informed, trained and aware, you really can do miracles. “If someone collapses, you can immediately reach them. But be careful of your safety first. Be mindful of your setting. Are you in the middle of a road? is it the person drowning? is it an electrocution, can the person be COVID-19 positive?” Dr. Dharmakeerthi listed out a few things to be aware of.
With COVID-19 being a danger, you can wear a mask and gloves if you have. Here, identification is crucial. To find out whether the patient is responding or not, tap on the shoulder, call him loudly or even gently shake him. Next, you can look for responses. Are the eyes open? does he talk, show any movement or cough? These are clear signs of life. “If any of these signs are visible, it is not a cardiac arrest. None of this is possible in a cardiac arrest. But if there is no response, it can be a cardiac arrest,” Dr. Dharmakeerthi emphasised that a cardiac arrest cannot be handled on your own. You have to ask for help.
Resuscitation is the key
“Had it not been for COVID-19 Pandemic, you have to go closer to the patient and check whether he is breathing. You can keep your cheek and ear closer to the patient’s nose and mouth and check it. During the pandemic, if it is not someone from the family that you know closely, you are cautioned to feel the breath and observe whether the chest heaves up and down. If the person is not breathing, it is definitely a cardiac arrest.
“You must call 1990, they are very good and fast. Tell them the exact place and keep your telephone on speaker phone to guide them.” Dr. Dharmakeerthi even reminded the simple things that might be forgotten when in panic. Never undermine the fact that it is basic life support or cardiac compression is what is needed till help arrives. “Go to the person and kneel down. Interlock your fingers. Use the heel of your palm.
Keep yourself over the centre of the chest of the patient, but more on to the lower half of the sternum. Your hands should be perpendicular (vertical) to the chest. You can use your body weight in compression.” These are simple steps that can make a big difference, once followed correctly. Compression is also something that needs to be done in a particular manner. “Place the heel of your hand on the centre of the person’s chest.
Then place the other hand on top and press down 5 – 6 centimetres or 2 inches of depth, at a steady rate of 100-120 compressions per minute. That is two compressions per second.” Dr. Dharmakeerthi added. “Compression depth and rate are crucial and we ask them to count saying ‘1 and 2 and 3 and 4’ or ‘1001, 1002, 1003’ or even use Menike, Stayin Alive or Rowdy Boy beat. Continuous uninterrupted chest compression is the key. This is called compression only CPR.”
“You can close the patient’s nostrils with your hands. Take a normal breath and keep your mouth around the patient’s mouth and seal it. Lift the patient’s chin a bit, closing the nostrils with one hand, blow two breaths. Start compression again, give two breaths next. After 30 compressions give two rescue breaths. Start compression again. If there is a COVID-19 risk, we have to forget the rescue breaths. You can cover the nose and mouth with a cloth and continue with compression.” Resuscitation councils in the world are well recognised and well established bodies.
Anaesthesiologists and intensivists of Sri Lanka are the representative of ILCOR or the International Liaison Committee on Resuscitation. Therefore, they are all part of the programmes and training sessions conducted by the World Body. Restart a Heart Day which fell on the 16 October is part of the public education programme. In spite of having trained medical staff, lack of time and lack of manpower can have an adverse effect when spreading awareness.
That is the reason they opt for public training, including schools and children. Every day, they have three sessions via Zoom in Sinhala, Tamil and English mediums. During COVID-19 where keeping distance is crucial, they had to opt for online training. Dr. Dharmakeerthi is less satisfied with online training. They even trained 140 school children from Jaffna. (On restartaheartlk.org programmes will continue till 30 October) Statistics show that the most effective way to spread this is by educating children.
Going by this, they are also working on educating children, early on in life. A very keen and dedicated Representative of Restart a Heart Day and Kids Save Lives project, Dr. Nilmini Wijesuriya was also gratefully remembered by Dr. Dharmakeerthi. It is a combined effort. He insisted that this is trained by various organisations in the country. Intensivists, Emergency medical teams, and many others also continue to educate the public.