Sudden Cardiac Death (SCD) contributes to around 10% of overall mortality in India. Survival is directly linked to the amount of time between the onset of sudden cardiac arrest and defibrillation. A victim’s chances of survival are reduced by 7 – 10 % with every minute of delay until defibrillation. When bystanders provide immediate CPR and the first shock is delivered within 3 to 5 minutes, the reported survival rates from VF sudden cardiac arrest are as high as 48 to 74%”.
Available data suggest 32% of cardiac arrest victims get CPR from a bystander in the US. In India, the success rates are much lower and are around 1% because of a lack of awareness and the response time takes much longer due to traffic congestion on our roads. A rough estimate in our country shows the success rates are as low as 3-5% nationwide. In the US the American Heart Association has a mechanism to collect and study the data in order to review the CPR procedures and practices so that more lives can be saved.
If the success rate for CPR is to be improved awareness levels have to go up and more people need to get trained in for them to be able to provide care. The faster CPR is started chances of survival are high. As per Red Cross standards if a person has gone 4 minutes or more without a pulse or breathing and they have not been given CPR their chances of survival are greatly reduced, and even if they do survive they will most likely have severe brain damage.
CPR can sustain a person for a short amount of time but to be fully resuscitated they will need advanced care such as medication and electric shock.
The purpose of CPR is not to “start” the heart, but to circulate oxygenated blood, and keep the brain alive until advanced care (especially defibrillation) can be initiated. As many of these patients may have a pulse that is impalpable by the layperson, the current consensus is to perform CPR on a patient who is not breathing.
WHY TAKE ACTION?
- Failure to act in a cardiac emergency can lead to unnecessary deaths.
- Effective bystander CPR provided immediately after sudden cardiac arrest can double or triple a victim’s chance of survival.
- Sadly, less than 1% percent of people who suffer cardiac arrest outside the hospital survive, especially in rural India. Hence there is a dire need for medical education programs, training, and awareness.
- Hands-Only CPR (CPR with just chest compressions) has been proven to be as effective as CPR with breaths in treating adult cardiac arrest victims.
- The American Heart Association trains more than 12 million people in CPR annually, to equip Americans with the skills they need to perform bystander CPR.
Emergency Room inside Your Chest:
As a treatment option following a sudden cardiac arrest, once the patient’s condition stabilizes, Implantable cardioverter-defibrillator (ICD) may be recommended. Studies have proved that people who are at high risk of SCA can be identified using certain routine diagnostic tests. An ICD (implantable Cardioverter Defibrillator) is a device that can be implanted into these patients is the only foolproof solution available today. The ICD also called “an emergency room in the chest” is a battery-powered unit that is implanted near the collarbone. One or more electrode-tipped wires run from the ICD through veins to the heart. It constantly monitors the heart rhythm. If a rhythm that is too slow is detected it paces the heart as a pacemaker would. If it detects ventricular tachycardia or ventricular fibrillation, low- or high-energy shocks are sent to reset the heart to a normal rhythm. ICDs now also collect information for the physician to use by remotely diagnosing and programming the device to the exact needs of the patient, without the need for repeat surgery or hospitalization. For patients with ICDs, the first-year recurrence rate of sudden cardiac arrest has been reduced to 1 to 2 percent. While ICDs are a recent invention, it is necessary to identify patients at high risk for SCA and get them ICDs to help then jump back to life whenever they encounter one. Prevention is better than Loss.
(Disclaimer: The writer is Dr. Sai Sudhakar, Chief Interventional Cardiologist, Gleneagles Global Hospitals. Views expressed are a personal opinion.)