Chain of Survival Starts with Awareness and Preparedness

Beyond warning signs, there are a number of underlying causes that can trigger sudden cardiac arrest.

• By Joseph Hanson
• Jun 01, 2015

Since 2011, there has been a push underway to make CPR a universal skill of the nearly 500,000 residents of Sonoma County, California. The initiative, Save Lives Sonoma, has provided hands-only CPR training at grocery stores, shopping malls, schools, and at countless community events.

What this consortium of emergency health care professionals and emergency responders knows is that CPR saves lives. In actuality, people have been touting the life-saving powers of CPR since the 18th century, when the Paris Academy of Sciences recommended mouth-to-mouth resuscitation for drowning victims. Yet even in the modern era of CPR awareness, roughly since the late 1950s, survival rates for those experiencing cardiac arrest have hovered around 8 percent.

According to a 2015 report by the American Heart Association, 326,200 people experienced out-of-hospital cardiac arrest in the United States in 2011. Survival to hospital discharge was 10.6 percent. Even though nearly 40 percent of out-of-hospital cardiac arrests are witnessed by a bystander, just 31.4 percent of those victims survive. Many of these deaths occur because bystanders do not perform CPR—as many as 70 percent of Americans may feel helpless to act either because they don't know CPR or because their training has significantly lapsed.

Sudden cardiac arrest is the unexpected loss of heart function, breathing, and consciousness, typically resulting from an electrical disturbance in the heart that disrupts its rhythm. It's different from a heart attack, which is caused by a blockage that restricts blood flow, though a heart attack can cause cardiac arrest. Cardiac arrest often occurs with no warning. It's characterized by the following symptoms:

• Sudden collapse
• No pulse
• No breathing
• Loss of consciousness

Every Second Counts
Immediate action is critical if sudden cardiac arrest occurs. Unlike other organs, the brain doesn't have a reserve of oxygen-rich blood. Without a continual supply of blood, brain damage can occur in only a few minutes, and death or permanent brain damage can happen as quickly as four to six minutes. At 10 minutes, a person’s chances of survival are nearly zero.

During a sudden cardiac arrest, CPR keeps a supply of blood moving from the heart to the brain. Properly delivered CPR can double or even triple the rate of survival, but even those with CPR training often are hesitant to perform life-saving measures. Studies show retention of knowledge about CPR techniques can significantly decrease as soon as six weeks after training, with an entire degradation of knowledge as early as six months after.

In an effort to empower more people to act in an emergency, the American Heart Association in 2008 released new guidelines for CPR that promote a hands-only technique. Hands-only CPR is essentially chest compressions without the mouth-to-mouth breaths. This change was supported by published medical studies that showed hands-only CPR was as effective or, in some cases, more effective than traditional CPR in regard to survival rates from sudden cardiac arrest.

The AHA guidelines for hands-only CPR are as follows:

• In the event someone collapses unconscious near you, call 911.
• If the person isn’t breathing normally, immediately begin pushing hard and fast on the person's chest—about 100 compressions a minute—allowing the chest to fully rise between compressions.
• Continue administering chest compressions until an automated external defibrillator becomes available or emergency personnel arrive. (An AED is a medical device that administers a shock if necessary to restore the heart’s rhythm.)

In whats referred to as the chain of survival, there are five critical actions that can improve outcomes during a sudden cardiac arrest:

• Rapid recognition and activation of EMS via 911
• Quickly administering CPR
• Use of an AED
• Rapid delivery of advanced life support
• Early post-resuscitative care

The advantage of hands-only CPR over traditional CPR is that training isn't a prerequisite to rendering aid. Anyone can step in to save a life. That's the message of the Save Lives Sonoma campaign. It's also extremely relevant for businesses as they formulate or update their safety plans.

Some employers, though, are fearful of the liability issues that could arise from administering CPR. For example, pressing on the chest can cause soreness, broken ribs, or a collapsed lung. All 50 states have Good Samaritan laws, which generally grant a business and its employees immunity as long as they are acting in good faith. Plus, most people consider a broken rib a small price to pay in exchange for saving a life.

CPR Assist Devices
This new science of CPR has spurred innovative medical devices that simplify the process of CPR for life-savers. Like most AEDs, these CPR devices offer real-time training to users through voice prompts or other controls. They reduce human error by assisting users in performing quality chest compressions at the proper cadence and correct depth. Someone who is performing 100 chest compressions per minute for several minutes or more can quickly tire; a CPR device reduces fatigue associated with manual chest compressions. Like an AED, a CPR device should be an essential tool for safety-minded businesses to have on hand in case of an emergency.

Even with the advent of hands-only CPR and CPR devices, traditional CPR training continues to be an essential skill for everyone to learn. The AHA recommends traditional CPR for infants and children, as well as for victims of drowning, drug overdose, or for those who collapse from breathing problems.

The AHA is lobbying states to make CPR training a high school graduation requirement. To date, 21 states have passed laws to that effect, which means they are on track to train nearly 1.2 million future life-savers who will soon bring these skills into the workforce.

CPR often goes hand in hand with the use of an AED. In 2000, the federal government passed the Cardiac Arrest Survival Act to bring greater awareness to sudden cardiac arrest. All federal buildings are required to have AEDs. Requirements for AEDs in other public facilities, such as schools, vary by state. Oregon has one of the most aggressive AED programs in the country, requiring them at all public and private schools, colleges and schools of higher education, health clubs, and businesses with 50,000 or more square feet and at least 25 people congregating per day. At least 19 states have no state requirements for AEDs; 19 others require them in at least some schools.

SCA Symptoms and Causes
Even though most cases of sudden cardiac arrest occur without warning, sometimes symptoms precede an event. They can include fatigue, fainting, blackouts, dizziness, chest pain, shortness of breath, weakness, palpitations, or vomiting.

Beyond warning signs, there are a number of underlying causes that can trigger sudden cardiac arrest. Greater awareness of the causes and corresponding lifestyle changes will play a large role in reducing cardiac arrest incidents. Sudden cardiac arrest doesn’t typically happen in a person with a normal, healthy heart—70 to 80 percent of such events have a cardiac cause, according to the American Heart Association.

In fact, most cases of cardiac arrest occur in people who have coronary heart disease, which kills 380,000 people each year, according to AHA statistics. Their arteries, clogged with cholesterol, reduce blood flow to the heart, which can make it more difficult for the heart to register electrical impulses normally.

Besides family history, a number of other factors can lead to coronary heart disease and put individuals at risk of sudden cardiac arrest. They include:

• Sedentary lifestyle
• Smoking
• Drinking too much alcohol
• Obesity
• Diabetes
• High blood pressure
• High cholesterol

In addition, the incidence of cardiac arrest increases with age, especially after age 45 for men and age 55 for women. Men are two to three times more likely to experience sudden cardiac arrest.

Prevention is extremely critical to reduce the instances of sudden cardiac arrest because the prognosis after an event is often grim. Survivors may show signs of brain damage; some may be in a coma for a short period, others indefinitely. Some survivors may recover partial function; others will die in the hospital.

Sudden cardiac arrest can occur anywhere. Responsible businesses will take a multi-prong approach to advocating healthy lifestyles for their workers and also equip those same workers with the skills and the tools necessary to save lives—in and out of the workplace.

This article originally appeared in the June 2015 issue of Occupational Health & Safety.