WEDNESDAY, Feb. 1, 2023 (American Heart Association News) -- When a heart stops, seconds matter. But too often, when someone has a cardiac arrest away from a hospital, people in a position to help don't.
Misunderstandings about CPR can keep people from acting. That costs lives. We asked experts to help clear things up.
You can't wait.
If you see a teen or adult suddenly collapse, call 911 and don't wait for professional rescuers, said Dr. Jose Cabañas, chief medical officer for Wake County, North Carolina.
Each minute that CPR is delayed decreases the odds of survival by about 10%, research has shown. But having a bystander perform CPR doubles or triples the chances of somebody surviving, said Cabañas, who helped write the American Heart Association's 2020 CPR guidelines.
The steps for responding to a cardiac arrest, according to the AHA, are:
- Check for responsiveness.
- Call 911 or, if other people are on hand, have a second bystander make the call. 911 operators can guide rescuers through CPR.
- Begin CPR while a second bystander retrieves an automated external defibrillator, or AED, if one is nearby. Do not stop CPR to go look for an AED.
To perform CPR, place the heel of one hand in the center of the chest. Place the other hand on top and interlock the fingers. Push straight down hard and fast at 100 to 120 beats a minute. (That's the rhythm of the Bee Gees' "Stayin' Alive." You can also have someone search Google for "metronome" and enter "110.")
You don't need certification.
Training is great, and refresher courses are important, said Dr. Elizabeth Hunt, a professor of pediatric critical care medicine at Johns Hopkins University School of Medicine in Baltimore. But you "absolutely" do not have to have a card to perform CPR.
"I advocate getting training," said Hunt, who helped write a 2022 AHA scientific statement on lay responders and CPR. "But it is not necessary to save a life."
Don't waste time checking for a pulse.
If you see someone collapse, Hunt said, shake the patient gently and ask, "Are you OK?"
If they are not breathing or are breathing with "agonal breaths," when breathing is abnormal or it appears the person is gasping for air, start CPR.
People used to be told to check for a pulse. "But lay providers don't need to do that," Hunt said. Find the spot in the middle of the chest – "essentially, between the nipples" – and start pressing hard and fast.
Don't be squeamish.
Roughly 350,000 U.S. adults experience an out-of-hospital cardiac arrest annually in the United States, according to AHA statistics. But bystanders, or lay rescuers, administer CPR in only about 40% of cases. Research shows people in low-income and predominantly Black neighborhoods are less likely to receive bystander CPR than those in predominantly white neighborhoods with higher income, and women are less likely to receive CPR than men.
Chest compressions might require opening or cutting away someone's bulky clothing or removing a bra to reach the middle of their chest or apply AED pads. "It is important that people also have an image of how they would do that," Hunt said, because even though it may be a little uncomfortable, they can save a life.
Don't fret about mouth-to-mouth.
If you're wary of breathing into a stranger, don't, Cabañas said. These days, training emphasizes hands-only CPR for the first few minutes, which has been shown to be as effective as conventional CPR with rescue breaths in the first few minutes after cardiac arrest in adults and teens.
Mouth-to-mouth resuscitation – two rescue breaths after every 30 compressions – is important, however, for infants and children and if someone's heart stopped because of choking or drowning, Hunt said. "But if you don't know how to do it, compressions-only is still great," she said.
Don't worry about hurting someone.
One of the biggest misconceptions about CPR, Cabañas said, is that you can harm someone in cardiac arrest.
"The biggest risk is not doing something," he said. Whether it's concerns about legality, propriety or breaking bones, "I would emphasize that there is actually more potential harm by not doing or participating in providing bystander CPR when somebody collapses in front of you." Good Samaritan laws protect people who step in to provide lifesaving care.
Hunt puts it this way: If someone's heart has stopped, "they're already dead." So any problems caused by CPR are not as bad as not doing CPR.
Don't be afraid to move them.
If someone falls in a twisted position, you might have to straighten them out to get them on their back, Hunt said. If they are on a bed or couch, it is best to lower them to the ground so that CPR can be performed on a firm surface.
You're likely to use it on someone you know.
Some people think they'll never need to use CPR, Cabañas said. They'll say, "My family's healthy," or they think it's unlikely they'll encounter anybody who needs help. "And that is not the case."
Research shows more than 70% of cardiac arrests happen in a home or private residence. So learning CPR should be part of any family's safety plans, Cabañas said.
Learning can be simple.
Taking a CPR course will help people know how to respond, Cabañas said.
"There's multiple ways to learn CPR these days," he said. You can learn the basics from a free AHA video and get hands-on training through a community center or fire department. (Some airports and medical centers have hands-only training kiosks.)
You're qualified to use an AED.
AEDs can shock a heart back into rhythm but, as with CPR, need to be used quickly. You should scout out where to find one in places you frequent.
If a place you visit lacks one, Cabañas recommended talking with the manager. If you acquire one for your own facility, register it with the local EMS system so that 911 dispatchers know where to direct people.
Some AEDs might say they are for trained personnel only. Ignore that, Hunt said. With voice and visual prompts "they were designed to be used by someone who's never seen them before," from sixth graders to senior citizens.
It's not all on you.
Saving people from sudden cardiac arrest takes a community effort, Cabañas said. "When we see jurisdictions and cities and countries that have a higher survival rate, it's because the community engages and the community is participating in those efforts."
That also means you don't face an emergency alone, he said. Other lay responders, 911 dispatchers, first responders and medical workers all are part of the chain.
"You're not alone," he said. "There's going to be other people that will be around to support you in that mission of trying to save somebody's life."
American Heart Association News covers heart and brain health. Not all views expressed in this story reflect the official position of the American Heart Association. Copyright is owned or held by the American Heart Association, Inc., and all rights are reserved. If you have questions or comments about this story, please email firstname.lastname@example.org.
By Michael Merschel, American Heart Association News