Register now for our free webinar hosted by Dr. Ben Bobrow on August 15 at 1 pm EDT: Boosting CPR Quality: Saving More Lives from Cardiac Arrest Inside and Outside the Hospital. After viewing the webcast, you can earn 1 hour of continuing education courtesy of ZOLL for a limited time.
There is a void in Mike Patten’s recollection of things—one moment he was going out to dinner with some friends after skiing, the next he was headed to the cardiac catheterization lab. He remembers nothing of his fall to the pavement or emergency helicopter flight to the hospital.
“It’s made me more receptive to my home life,” says Patten, a firefighter-paramedic with the Glendale Fire Department in Glendale, AZ. He has a wife and two daughters, ages 10 and 7. “I’m still trying to grasp the how and why of it.”
The “it” he speaks of is the sudden cardiac arrest (SCA) from which he was resuscitated one January evening in Tonopah, AZ. It was a most unlikely event: a 36-year-old with no history of cardiac problems collapsing in the presence of two friends who happened to be fellow paramedics. Their swift start of compression-only CPR clearly had a central role in saving his life.
Most victims of cardiac arrest do not share Mike Patten’s outcome. SCA occurs some 380,000 times a year in the United States,1 resulting in death in all but 7.6% of cases.2 A rapid response, including high-quality prehospital cardiopulmonary resuscitation (CPR) by emergency medical responders, is crucial. But without emergency dispatchers fulfilling their equally critical role in the “Chain of Survival,” survival rates to hospital discharge are dismal. The second link in the chain, bystander CPR, can double or triple the chance of survival.2 Yet this enormous opportunity to save lives is frequently missed for multiple reasons, including (but not limited to) bystander panic, fear, uncertainty, lack of confidence, fear of causing harm, fear of legal ramifications and aversion to mouth-to-mouth contact.3–9 In fact, bystander CPR is typically provided in less than half of cardiac arrest events in the United States.10 This article focuses on the critical intervention of dispatch-assisted CPR in an effort to highlight the recent American Heart Association scientific advisory statement on this lifesaving intervention.11
The first moments after arrest are incredibly decisive. EMTs may race to the scene, but the chance a cardiac arrest victim will live plummets by 7%–10% per minute. If your EMS system is like most across the country, the total response time (including time for call routing, call handling, travel to scene and time to victim’s side—Figure 1 shows typical urban EMS system response intervals) is 10–15 minutes. That makes bystander CPR a deal-breaker—if you don’t maximize rates of bystander CPR prior to your arrival, citizens are dying needlessly in your community. This is because bystander CPR supplies the life-sustaining blood flow to the victim’s heart and brain and can prolong ventricular fibrillation (VF) during those early minutes after collapse. This increases the chance that your trained rescuers can successfully defibrillate the victim’s heart and save his life.
Such success was achieved with Patten after he suddenly and unexpectedly collapsed while putting gas in his car in Tonopah.
“For being where we were in a rural setting…I really think (compression-only CPR) saved his life,” says T.J. Drescher, a firefighter and paramedic and one of Patten’s rescuers. “Nothing seemed out of the ordinary. Then we heard this thud on the car. We really thought he was joking around—he’s kind of a jokester—but then it clicked in our heads. It was definitely a scary experience.”
Bystander CPR was really the anchor link in the chain for Patten. Trained rescuers equipped with an AED were able to defibrillate his heart, but their success was no doubt prepared by the roughly 10 minutes of rapid, uninterrupted chest compressions he received soon after collapse.