FROM June 15-21, in recognition of Cardiopulmonary Resuscitation (CPR) week, several articles appeared in the press aimed at educating the population about CPR and encouraging its widespread use to save lives.

This is commendable and every effort should be made to inform and equip citizens to take action in the event of a cardiac arrest. This assumes greater relevance in the context that nearly 90 per cent of cardiac arrests occurr at home, making it obvious that the chances of survival for a cardiac arrest victim is improved if someone in the household knows how to perform CPR.

However, in the discourse on CPR, what may be unstated is that CPR is often ineffective when used alone without electrical shock to restore normal rhythm (defibrillation), hence the abysmally low survival of only about 8-10 per cent for out-of-hospital cardiac arrests.

CPR is also, in most instances, not a cure but a bridge to therapy, as the underlying precipitant of the cardiac arrest must be addressed for a final resolution. Without addressing the cause, cardiac arrest is likely to recur and ultimately prove fatal. This is more so in the case of electrical abnormalities triggered by other events like a heart attack. An appropriate intervention with restoration of flow to the blocked artery in this instance would be the end goal.

CPR is performed emergently in an effort to manually preserve or restore intact brain function until further measures are taken to restore spontaneous breathing and circulation in victims of cardiac arrest.

Cardiac arrest is triggered by an electrical malfunction in the heart, resulting in irregular heartbeat and disruption in the pumping action of the heart. When this occurs, the heart is unable to pump blood to the brain and other vital organs resulting in unresponsiveness and death within minutes, unless cardiopulmonary resuscitation is commenced, ideally with defibrillation.

Sudden cardiac arrest is not the same as a heart attack. Sudden cardiac arrest occurs when electrical impulses in the heart become rapid or chaotic, which causes the heart to suddenly stop beating. A heart attack occurs when the blood supply to part of the heart muscle is blocked. A heart attack may cause cardiac arrest. Cardiac arrest could be reversed by the restoration of normal electrical activity and circulation.

When initiated, CPR must be continued until you see signs of life, until medical personnel arrive, or until death is pronounced.

Studies have shown that immediate CPR followed by defibrillation within three to five minutes of sudden cardiac arrest dramatically improves survival. In places, where CPR training is widespread and defibrillation by emergency medicine personnel follows quickly, the survival rate is substantially better. In the city of Seattle, for example, the survival rate is about 20 per cent for all causes and as high as 57 per cent for witnessed cardiac arrests with electrical shock administered.

While most heart attacks do not lead to a cardiac arrest, when a cardiac arrest occurs, heart attack is a common cause and must be in consideration, particularly in individuals with potential risk factors for coronary artery disease.

CPR serves merely as the foundation of successful restoration of spontaneous breathing and circulation, thus preserving the body for defibrillation and advanced therapeutic interventions aimed at life preservation. Though the outcome without CPR is almost uniformly fatal, used alone CPR will result in very few complete recoveries.

As we encourage training and widespread use of CPR in Jamaica, let’s also focus on the next steps to preserve the lives we resusitate. We must also embrace a systemic approach that ensures widespread access to defibrillation and advanced cardiovascular therapeutic interventions aimed at definitive restoration of circulation and life preservation.

Professor Ernest Madu, founder of the Heart Institute of the Caribbean, is an internationally acclaimed cardiologist and expert on innovative health solutions. HIC is a centre of excellence for cardiovascular care in the English-speaking Caribbean. Please send questions and comments to emadu@caribbeanheart.com.