Every year in India, thousands of people die from cardiac arrests. According to the National Crime Records Bureau, in the last 10 years, from 2012 to 2021, there had been a 54 per cent increase in heart attack deaths in the country.
A cardiac arrest is an unexpected loss of heart function, breathing and consciousness, in which the heart abruptly stops beating. Without any proper intervention, this condition could lead to imminent death.
The main symptoms of cardiac arrest are unconsciousness and unresponsiveness. Besides CPR, the patient, who is suffering a sudden cardiac arrest, should also be revived with a defibrillator, a small device called an AED.
However, a person can be revived with the help of a process called Cardiopulmonary resuscitation (CPR), which is an emergency lifesaving procedure.
How to give CPR the right way?
The process of doing CPR is important as it can double or even triple the chances of survival after cardiac arrest. According to the American Heart Association, CPR is essential as it keeps the blood flow active and extends the opportunity for a successful resuscitation once trained medical staff arrive on site.
India Today got in touch with Dr Bharat Vijay Purohit, Senior Consultant Interventional Cardiologist & Director of Cath Lab, Yashoda Hospitals, Hyderabad about educating people on the correct way of performing CPR on a patient who may have suffered a sudden cardiac arrest.
“When someone becomes unconscious, we start massaging their chest. But CPR is a whole process, it is not just about compression. It starts with identifying the patient who has become unconscious, till they have been handed over to the medical professional or taken to the hospital,” said Dr Purohit, sharing a step-by-step guide to conducting proper CPR on a patient with a cardiac arrest.
STEP 1: CALLING FOR HELP
When a person falls down due to sudden cardiac arrest, you need to check if the patient is unconscious or not. During this process, for example, if you see someone falling down at a mall or a public place, check if they are becoming unconscious. If they are, try to talk to them and keep them responsive and immediately, call for help. The emergency number for an ambulance across the country is 102. Remember that one person cannot do everything, so have 2-3 people around to call for help while the other tries to check the patient’s pulse.
STEP 2: ASSESSMENT
After this, you need to go close to the patient who has fallen down and check if they are breathing or not. Check their pulse in the neck region, mainly because that is closest to the heart, and gauge their breathing. Even if the BP (blood pressure) is low, you can still feel the pulse around the neck region. This process is called the assessment. Assessment should not take more than 10 seconds to check if the person is truly unconscious and there is no pulse.
STEP 3: COMPRESSION
If you don’t feel the pulse, you have to perform the next step, called compression. In this process, you need to artificially make the heart pump so you can feel the pulse again. This is done by squeezing it so that whatever blood is in the heart, will flow out into the body and the brain area to avoid damage. Since our normal heartbeat is 80-90 beats per minute, the recommended squeezing or compression of the chest should be 100-120 times a minute.
How to do chest compression the correct way?
Make the patient lie flat. “Usually, when a person falls down and lies flat, most people try to grab the head and lift it up. But the patient’s BP is already low. By lifting them up from the head area, you’re further reducing the blood supply to the brain. Rather than doing that, if you’re trying to help them, lift the leg so that the blood flows upwards to the brain,” said Dr Purohit.
While the patient is lying flat on the floor, you should kneel in front of them while the other person should stay near the head area. Compression takes place by applying pressure on the lower part of the sternum, which is the middle joint bone between the two sides of the chest. It is a bony area. Don’t try to compress on the left side of the chest because of the heart, because the rib in that area is flexible and it might break.
Avoid applying pressure on the left side and instead, compress the lower one-third part of the sternum, which is a partially T-shaped vertical bone that forms the anterior portion of the chest wall centrally. Apply pressure using the hard part of your palm.
“You should be straight and one palm should be on the other. Your hands should be straight as well. Make sure not to bend your elbows. If the elbows are bent, you won’t be able to push the bone down. It is recommended that you should not push the bone more than 5 cm or 2 and a half inches. Don’t try to compress extra and don’t try to compress less. You should push it down approximately 5 cm and then allow it to relax too. Once you allow the compression to relax, compress again,” shared Dr Purohit.
STEP 4: MOUTH-TO-MOUTH RESUSCITATION
During the process of compression, the other person should help with mouth-to-mouth resuscitation. This process involves giving oxygen to the patient.
First, pinch the nose of the patient and try to lift the chin and extend it backwards so that the air doesn’t go anywhere out during the process of resuscitation.
“Basically, you have to make an airtight area in the mouth, and give the patient adequate breath. After giving 30 compressions, you have to give 2 breaths. Each breath should be of 2 seconds,” added Dr Purohit.
Take a deep breath and fill your chest with air, then give the entire breath to the patient, simultaneously keeping the nose closed. “So, approximately 400-500ml of breath must be given. Then again you continue with the CPR. After 2 minutes, you need to exchange with the person who is giving compression. There should be two people, one giving the breath and the other doing the compression,” said Dr Purohit.
The person giving the compression should count from 1 to 30 while doing the compression and then relax. This is the time when the person near the head should give mouth-to-mouth resuscitation to the patient. Once the two breaths are given, the other person should start compressing the chest again.
STEP 5: AED (Automated External Defibrillator)
During the process of compression and resuscitation, another individual should look for an AED (Automated External Defibrillator), a device which checks the pulse.
AED is used to revive a person from cardiac arrest and automatically diagnoses the life-threatening heartbeat and pulse. AEDs, which are small devices, are simple to use and should be present at various public places such as malls, restaurants and hotels.
“AED will have an instruction the moment you switch it on. It will automatically instruct you what to do to check the pulse. We make it mandatory for all places to have it,” said Dr Purohit.
You have to connect the AED to the patient’s body and it “will tell you what the algorithm is of the heartbeat”.
It will check if the heart is beating regularly or completely stopped. Based on that, a shock will be delivered. Since there is a speaker on the AED, you only have to follow the instructions when the speaker asks you to deliver a shock by pressing a button.
When you can’t feel the pulse, it will ask you to continue performing CPR. This will give you enough time for the ambulance to arrive and take the patient to the nearest hospital. “In the meantime, the ambulance or any medical professional should arrive with advanced resuscitation measures, tubings, masks and oxygen and give the shock or whatever is required to put the patient in intubation and ventilation,” added Dr Purohit.
AWARENESS ABOUT CPR
Dr Purohit said that even though CPR is an important process in reviving a person from cardiac arrest, the awareness of it is very low. “If you can do proper CPR and know how to use an AED, you can save a lot of lives. We need to educate people about basic CPR and how to use an AED device because it is response-related in such critical times. Make sure that AEDs are installed in common public areas where they can be visible to people. Regular CPR classes should be conducted in educational institutions,” he said.