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Bystander CPR, Defibrillation Cuts Long-Term Odds Of Brain Damage, Death

When a bystander gives CPR or applies an automatic defibrillator to someone who has collapsed from cardiac arrest, the benefits persist for at least a year.

A Danish study has concluded that the two techniques lower the long-term risk of death from any cause, brain damage or nursing home admission by one third in people who are still alive 30 days after their cardiac arrest.

Most previous studies have looked at whether people who get CPR or defibrillation manage to survive or escape serious injury by the 30-day mark.

“This science provides the linkage to show that resuscitation is not just important in the immediate cardiac arrest phase, but it’s an important factor into whether they go back to their lives intact,” said Dr. Michael Kurz, associate professor of emergency medicine at the University of Alabama-Birmingham Medicine, who was not involved in the study.

“We were surprised to see that, once you select 30-day survivors, so many were still alive at one year and the majority of these survivors seemed to have a fairly good outcome,” study coauthor Dr. Kristian Kragholm told Reuters Health in a telephone interview. “If bystanders intervened by starting chest compression, survivors were less likely to experience brain damage or be admitted to a nursing home. And with an AED (automated external defibrillator), the benefit was even greater.”

For the public, it’s further evidence “of what you can do when you witness a cardiac arrest,” and why policy makers should be working harder to both require resuscitation training for the general public and make more defibrillators available in public places, said Kragholm, of Aalborg University Hospital in Denmark.

The study, published in the New England Journal of Medicine, used national registries to identify 34,459 people who had received some type of bystander resuscitation when they had cardiac arrest outside of a hospital. Only 8.3 percent survived for a month.

But with bystander CPR, the odds of subsequent death from any cause at one year among the 30-day survivors were 30 percent lower, the likelihood of brain damage or nursing home admission was 38 percent lower and the rate of all three outcomes combined was 33 percent lower.

With bystander defibrillation, the death rate was 78 percent lower, the composite of brain damage or nursing home admission was 55 percent lower and the odds for the combination of all three were also 55 percent lower. But the number of cases where a defibrillator was used was relatively small, even though the automated devices are becoming more common.

Over all, the risk of brain damage or a nursing home admission was just 3.7 percent if the cardiac arrest was witnessed by emergency medical service personnel. If bystanders used defibrillation, the rate was 8.4 percent. If bystanders used CPR alone it was 12.1 percent. The danger was highest – 18.6 percent – when no bystander resuscitation was done.

“This underpins the importance of the public to identify and respond to that emergency,” Kurz said. “Denmark has a very impressive bystander CPR rate. That’s one of the reasons the numbers in this article are so good.”

During the study, which ran from 2001 through 2012, the rate of bystander CPR went from 67 percent of the cases to 81 percent, and the rate of bystander defibrillation jumped from 2 percent to nearly 17 percent.

“Such increases are probably related to the multiple nationwide initiatives that have been taken in Denmark, including widespread mandatory and voluntary CPR training; widespread dissemination of automated external defibrillators; the introduction of health care professionals at emergency dispatch centers, facilitating dispatcher-assisted CPR; and the formation and linkage of an automated external defibrillator registry to the dispatch centers, enabling health care professionals to guide bystanders to the nearest automated external defibrillators,” Kurz said.

Bystanders themselves can also locate the nearest automated external defibrillator with the use of a smartphone application.

CPR education became mandatory in schools in 2005 and for people acquiring a driver’s license in 2006, according to Kragholm.

Kurz said that in the United States, defibrillators should be required in local building codes the way communities require fire alarms, smoke detectors and fire extinguishers.

By Gene Emery     Wed May 3, 2017      Reuters Health
SOURCE: bit.ly/2qgNUHP New England Journal of Medicine, online May 3, 2017.   www.reuters.com
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What to Do If Someone Is Having a Heart Attack: Must-Know First Aid

If you think someone is having a heart attack, taking action immediately can save their life.
Here, heart attack symptoms to look for and what to do next.

by Reader’s Digest Editors

A heart attack is caused by an obstruction of the blood supply to the heart muscle (usually by a clot in the coronary blood vessels). The outcome depends on how much of the muscle is affected and how quickly help can be given. If you think someone is having a heart attack, always call for help rather than waiting to see if the symptoms subside.

A patient is three times more likely to survive if he receives advanced medical help within an hour of having a heart attack.

Heart Attack Symptoms

These are the common signs and symptoms of a heart attack. A patient will experience some, but not necessarily all. If the pain subsides with rest, it could be angina (see below).

  • Suddenly feels faint or dizzy
  • Severe chest pain (persistent and vice-like, spreading up to the jaw and down one or both arms) that does not subside when the patient rests
  • Discomfort high in the abdomen (may feel like severe indigestion)
  • Breathlessness (patient may be gasping for air)
  • Fear (feels an impending sense of doom)
  • Pale, gray, clammy, or sweaty skin
  • Rapid, weak, and irregular pulse
  • Collapses, often without warning
  • Possible loss of conciousness

For a Conscious Patient

1. Ease strain on heart. Make the patient as comfortable as possible, in a half-sitting position, with his head and shoulders well supported and knees bent to ease strain on the heart. Loosen clothing at the neck, chest, and waist.

2. Call for emergency help. Keep bystanders away from the patient.

3. Give angina medication. If the patient has medication for angina, help him to take it. Keep him calm and encourage him to rest.

4. Give aspirin. If the patient is fully conscious, give him a full-dose (300 mg) aspirin tablet. Tell him to chew it slowly so that it dissolves and is absorbed into the bloodstream more quickly when it reaches the stomach. Aspirin helps to break down blood clots, minimizing muscle damage during a heart attack.

5. Monitor patient. Regularly check and make a note of consciousness, breathing, and pulse.

heart-attack

 

For an Unconscious Patient

1. Open airway. Check for breathing and be prepared to begin CPR.

2. Send for AED. Ask someone to bring an AED (automated external defibrillator), if possible, while you treat the patient. AEDs deliver a shock to correct an abnormal heart rhythm called ventricular fibrillation, which is the cause of some heart attacks. The machines are found in most public places, such as shopping centers and train stations.

3. Operate the AED. An AED is simple to use. Attach the pads as indicated on the machine; then the machine will talk the operator through the process. An AED will only deliver a shock if the patient’s condition indicates that it is necessary. If you have attached an AED to a patient, leave the machine switched on at all times and leave the pads attached, even if the patient recovers.

What Next?

Wait for the emergency medical technicians. The earlier a person receives advanced medical help, the greater the chances of survival.

A diagnosis will be confirmed at the hospital with an electrocardiogram (ECG) and blood tests. Advanced care may include a stay in the intensive care unit and treatment with drugs or even surgery. The aim is to minimize pain, restore the blood supply to the damaged heart muscle, and prevent complications.

If It’s Angina

If the pain subsides after the person rests for a few minutes, it is likely that it is an angina attack. This is a long-term condition in which the coronary (heart) arteries are narrowed, so that the heart muscle cannot get enough blood to meet its demands. Someone diagnosed with angina will have medication to use in case of an attack.

1. Reassure. Keep the patient calm; sit her down.

2. Assist with medication. Help the patient find her medication (usually a tablet or spray). If necessary, help her take it. If a patient has no medication at hand, call for emergency help immediately. Treat as described above.

3. Keep watch. The attack should ease within a few minutes. If the pain does not ease or the person has no medication, treat as a heart attack.

from Reader’s Digest Quintessential Guide to Handling Emergencies (Reader’s Digest Association Books)
source: www.rd.com