The group gathered again in December for dinner at Dr. Bufalino’s home. “I had just stepped into the next room, when I heard one of our guests yell, ‘Help, it’s Dan!’ He had suddenly keeled over and fallen onto the coffee table. He had no pulse and had stopped breathing. Fortunately, there were three CPR-trained nurses present with me. Everyone mobilized. We started CPR within seconds. One person called 9-1-1 and stayed on the line to relay information. Joan, my wife, ran out to the garage and retrieved an AED (automated external defibrillator) I always keep in the trunk of my car.”
“We connected the AED and Dan’s EKG started running. The AED immediately began analyzing his heart rhythm and doing calculations. He still had no pulse. Those were the hardest moments for me. It seemed like the AED was taking a long time to do its work, even though only 15 to 20 seconds had passed before the AEDs vocal prompt said, ‘Shock advised.’ I hit the button and the AED delivered a shock. I felt for a pulse. No pulse. But less than 10 seconds later, I felt a pulse.”
“The amount of time that elapsed from the moment Dan collapsed to the moment we shocked him was about three or four minutes at most. By the time the paramedics came through the door a few minutes after that, Dan was sitting up and talking to us.”
Dan was transported to nearby Central DuPage Hospital in Winfield, Illinois, where he received an implantable cardioverter defibrillator. This small device can detect a life-threatening, abnormal heart rhythm and deliver a jolt of electricity to correct it. Today, Dan is active and remains amazed by his serendipitous circumstance: That his sudden cardiac arrest was witnessed and treated by a boyhood friend who is also a prominent cardiologist known for spearheading programs promoting CPR training and public access to AEDs.
Hearts Too Good to Die
The highest risk of death from sudden cardiac arrest is from out-of-hospital events. Instead of being steps away from emergency response teams of skilled doctors and nurses, these victims collapse and die in unexpected places.
Sudden cardiac arrest is a true medical emergency – a cardiovascular calamity of the first magnitude. Think Armageddon of the heart. It can be a stunning, frightening sight to behold. Victims can buckle over and lose consciousness in seconds. They may remain motionless or have seizure-like body movements. Breathing may be rapid and shallow at first and then cease. Blood pressure may plummet until no pulse can be felt over major arteries.
Unlike a heart attack, sudden cardiac arrest is caused by an electrical malfunction of the heart. A heart attack occurs when a blockage cuts off blood flow to the heart muscle. Certain conditions can damage parts of the heart that generate or conduct electrical impulses. Underlying medical conditions linked to sudden cardiac arrest include coronary artery disease, a history of heart attack, enlargement of the heart and congenital heart defects.
The most common abnormal rhythm or arrhythmia associated with sudden cardiac arrest is ventricular fibrillation. When this happens, the lower chambers of the heart – the ventricles – quiver or “fibrillate” and beat spasmodically. Circulation shuts down and oxygen-deprived cells of the heart, brain and other vital organs begin to die. Quickly.
Calculating the odds of long-term survival after sudden cardiac arrest is an exercise in stark mathematical simplicity. The rule of thumb is that for every minute without the benefit of CPR and defibrillation, the odds of survival diminish by 10%. So, without the noble intervention of a ready, willing and able bystander who witnesses a victim’s condition and initiates CPR with early defibrillation, the expected outcome is irreversible brain damage or death within 10 minutes.
Claude Back, one of the inventors of defibrillation, coined the phrase “hearts too good to die” to describe the structurally strong hearts of those who die after sudden cardiac arrest. The American Heart Association has long campaigned for people to be trained in CPR and AEDs as part of the Chain of Survival (call 911, start CPR, start AED, transfer to advanced care). Federal and state Good Samaritan laws give protection from liability claims to bystanders who initiate CPR and use AEDs.
The most important thing to understand about the Chain of Survival is that it works. In June, 1999, AEDs were mounted one minute apart in plain view at Chicago’s O’Hare and Midway airports. In the first 10 months, the American Heart Association reported 14 cardiac arrests occurred, with 12 of the 14 victims in ventricular fibrillation. Nine of the 14 victims, or 64% were revived with an AED and had no brain damage.
The Geography of Survival
In the U.S., the safest place to have a sudden cardiac arrest is Seattle, Washington, according to a study that tracked the outcomes of 20,520 episodes in 10 locations in Canada and the U.S. The study showed that the survival rate in Seattle was 16.3% compared with only 3% in Alabama, the results were published in the Journal of the American Medical Association, September 2008. What does Seattle do that Alabama and Pittsburgh (with a survival rate of 7%) or Toronto (5.5%) or Dallas (4.5%) do not?
Seattle teaches its citizens CPR community-wide; Seattle takes the Chain of Survival seriously. Very seriously.
“And so can we, urges Dr. Bufalino. In his role as Medical Director of Edward Cardiovascular Institute and Edward Heart Hospital, he has been a driving force behind getting 55,000 people trained in CPR since 1998 and getting hundreds of AEDs located at public places, parks, libraries and businesses in Naperville, Illinois and 13 surrounding municipalities. He currently supports a new initiative by the DuPage County Health Department in collaboration with Midwest Heart Community Foundation that will create a countywide campaign to increase the number of CPR-trained citizens and public access to AEDs.
To those who might be reluctant to perform CPR for fear of harming a victim if the chest compressions are done less than perfectly, his message is this: resist the impulse to hesitate. “At our training sessions, we tell people that bad CPR is better than no CPR,” says Dr. Bufalino.
The only thing better than rescuing a person in sudden cardiac arrest is preventing it from happening in the first place.
Article reprinted with permission, Midwest Heart Specialists, October 12, 2010