Sudden Cardiac Arrest CPR & AED Basic Life Support

sudden cardiac arrest
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A sudden cardiac arrest is a sudden cessation of the pumping action of the heart.

A sudden cardiac arrest is NOT the same as a Myocardial Infarction (heart attack), which occurs when the blood flow to the heart (or part of) decreases or stops, causing damage to the cardiac muscle. A Myocardial Infarction usually produces symptoms such as chest pain, or discomfort traveling into the shoulder, arm, back, neck, or jaw.

In Cardiovascular Disease a.k.a. Heart Disease, narrowed or blocked blood vessels may lead to a Myocardial Infarction, angina, or a stroke.

Sudden Cardiac Arrest ~ Facts

  • A Myocardial Infarction may lead to a sudden cardiac arrest
  • Heart disease is the most common cause of a sudden cardiac arrest
  • Individuals who suddenly fall and die eg. during shopping, swimming, running etc are presumed to have experienced a sudden cardiac arrest
  • 40% of the total amount of deaths of individuals less than 75 years of age are attributed to individuals suffering a sudden cardiac arrest without knowing that they have a cardiovascular disease

What Happens During a Sudden Cardiac Arrest?

  1. the heart stops beating in an effective way
  2. breathing stops
  3. blood flow within the body stops
  4. oxygen supply to the body’s organs stops
  5. the heart and the brain suffer irreparable damage
  6. the individual dies

CPR & AED Use For Sudden Cardiac Arrest

A Sudden Cardiac Arrest is identified right away during the primary assessment:

  • casualty is unresponsive
  • casualty is not breathing

DO NOT SPEND MORE THAN 10 SECONDS DOING THE ABOVE…TIME IS CRUCIAL!

  • 4 minutes post start of a Sudden Cardiac Arrest, brain damage starts to take place;
  • 10 minutes post start of a Sudden Cardiac Arrest, brain is dead.

NOTE: Do not confuse agonal breathing with normal breathing. During agonal breathing, the casualty’s chest doesn’t rise and fall. Agonal breathing is not breathing…it is in fact just a reflex.

How To Perform Artificial Ventilations

To perform artificial ventilations on adult casualties:

  1. pinch nose
  2. open airway
  3. take a normal breath
  4. seal your lips around the casualty’s mouth
  5. blow air in until the casualty’s chest rises
  6. allow the casualty’s chest to fall back
  7. repeat

To perform artificial ventilations on children and infants follow the above BUT seal your lips around both the casualty’s mouth AND nose.

The AED: Automated External Defibrillator

Contrary to what is believed by many, an AED’s shock doesn’t restart the heart. About 65% of casualties suffering a sudden cardiac arrest present with an abnormal cardiac rhythm known as ventricular fibrillation, where the heart quivers rather than beats as normal. This rhythm is fatal unless proper treatment is provided in a timely manner. A normal sinus rhythm can be restored following ventricular fibrillation by proper pressure through:

  1. Early CPR
  2. Early AED

Adult Basic Life Support Sequence

If casualty is unresponsive:

  1. open casualty’s airway using the head-tilt chin lift technique
  2. look, listen, & feel for breathing signs
  3. if unresponsive and not breathing call 112 or ask someone to do so & send for an AED
  4. start CPR (30 chest compressions : 2 breaths)
  5. aim for a chest compression rhythm of approximately 2 compressions per second using 2 hands (fingers interlocked) aiming for the middle of the breastbone and a depth of 5-6cm, allowing full chest recoil after each compression
  6. breaths should amount to approximately 1 second each
  7. remember to protect yourself from any vomit/bleeding by using available devices – face sheet & gloves
  8. use an AED if or when available whilst following its verbal instructions (continue CPR unless instructed by AED to not touch the patient)

Stop CPR if help arrives, if the casualty starts breathing again, if the scene becomes dangerous, or if you become too tired and there is no one else who can substitute you.

Infants & Children Basic Life Support Sequence

Paediatric guidelines are as follows…

In the case of individuals responsible for children such as paediatric nurses, educators following special cases, etc. and trained in paediatric basic life support:

  1. open child’s airway using the head-tilt chin lift technique
  2. look, listen, & feel for breathing signs
  3. give 5 rescue breaths
  4. if phone is promptly reachable call 112 immediately while starting CPR
  5. if phone is NOT promptly reachable do 1 min CPR before leaving to fetch a phone
  6. perform paediatric CPR doing 15 compressions : 2 ventilations
  7. use 1 hand for chest compressions in children up to 8 years of age and 2 hands in largely built children
  8. rate of compressions should be approximately 2 per second (100 – 120 per minute)
  9. depth of compression should be 1/3 of chest but never deeper than 6cm
  10. each breath should be approx 1 sec long providing an effective chest rise
  11. remember to protect yourself from any vomit/bleeding by using available devices – face sheet & gloves
  12. use an AED if or when available whilst following its verbal instructions (continue CPR unless instructed by AED to not touch the patient); IMPORTANT – on a child, one electrode is placed on the front of the chest, and the other is placed on the back, both parallel to each other

NOTE: INFANTS <1 YEAR = 15 chest compressions : 2 breaths (use 2 fingers only on lower half of breastbone); each breath should be approx 1 sec long providing an effective chest rise. IMPORTANT – cover mouth and nose with mouth for an effective breath but do not over-do it!

For those not trained in paediatric BLS or not confident enough, adult basic life support technique should be used, ideally giving 5 rescue breaths before calling for assistance.

Stop CPR if help arrives, if the casualty starts breathing again, if the scene becomes dangerous, or if you become too tired and there is no one else who can substitute you.

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Claire
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Author: Claire

Claire Galea is a mum of three currently in her final year following a Degree in Nursing at the Faculty of Health Sciences, University of Malta, as a mature student. Claire is keen about public education on health-related subjects as well as holistic patient-centered care. She is also passionate about spreading awareness on the negative effects that domestic abuse leaves on its victims’ mental, emotional, social and physical wellbeing. Claire aspires to continue studying following completion of her Nursing Degree, because she truly believes in lifelong education.