The key to improving survival rates in cardiac arrest is public awareness of the problem and rapid action if a cardiac arrest occurs. Whenever a cardiac arrest is suspected 999 services should be contacted immediately and chest compressions started to maintain the flow of blood around the body, thereby supplying oxygen to the brain for vital minutes.
In about one third of patients with cardiac arrest resuscitated by ambulance services, the heart can be restarted with an electric shock from a defibrillator. Public access defibrillators are becoming increasingly common sights around the country, and can now be found in town centres, shops, railway stations, and other public places.
On the 16th of October each year the Resuscitation Council UK hosts “Restart a Heart Day”. This important event is designed to raise awareness of cardiac arrest and the need for immediate bystander action to commence cardiopulmonary resuscitation (CPR) and secure early use of a public access defibrillator, whenever one is available, to increase the chances of survival.
Throughout my medical career as a doctor working in the Accident and Emergency Department of the Bristol Royal Infirmary, and with the South Western Ambulance Service on the Great Western Air Ambulance, I have attended many patients in cardiac arrest. And whilst advanced medical care is important once the heart has been restarted a successful outcome depends on getting the basics right from the very start.
When a patient becomes suddenly unconscious due to cardiac arrest, they may continue to breathe for a short time in a slow, gasping, or noisy fashion. This early abnormal breathing can cause confusion but whenever a patient is unconscious and not breathing normally, cardiac arrest should be assumed, 999 services are to be contacted immediately, CPR should be started, and a defibrillator should be brought to the patient for use by bystanders or ambulance service responders as soon as possible.
Resuscitation training to deliver CPR has historically included rescue breathing (“mouth-to-mouth”), but this is not necessary for untrained responders who should focus on chest compressions alone to keep blood flowing to the brain. Where these events come together survival rates can exceed 40%, and this is achieved in some countries, however we have a long way to go to make this level of successful survival a reality in the UK.