• Become a Link in the Chain of Cardiac Survival

    IMAGE If someone you love suddenly went into cardiac arrest and stopped breathing, would you know what to do? Many Americans die each year from sudden cardiac arrest, but with the right tools and citizen training, thousands could survive.
    During sudden cardiac arrest, the heart muscle ceases pumping and quivers, a condition called ventricular fibrillation. A small percentage of patients who suffer a sudden cardiac arrest outside of the hospital survive.

    Lives Saved

    While celebrating her 48th birthday, New York nurse Julie Lycksell suddenly collapsed and stopped breathing. Her friend asked someone to call 911, while her husband and a restaurant patron started cardiopulmonary resuscitation (CPR), and within a minute or two a policeman trained in using an automated external defibrillator (AED) arrived and administered life-saving pulses of electricity. Unlike most sudden cardiac arrest victims, Lycksell had no history of heart trouble, and doctors could not determine why she developed an abnormal heart rhythm.
    "The doctor told me it was just a strange thing that happened to me," Lycksell says. "If the policeman hadn't had a defibrillator, I'd be dead."

    Learning the Chain of Survival

    Rapid initiation of the American Heart Association's chain of survival can save the lives of people who experience sudden cardiac arrest.
    Here's what to do:
    • Recognize that there is an emergency. If the person is unresponsive, emergency care should be started.
    • Call 911 or have someone else call.
    • If there is an AED available, get it (or have someone else get it) and follow the steps on the machine.
    • Start CPR by giving chest compressions. Push in the chest at least two inches at a fast rate of at least 100 compressions per minute.
    • If you are trained in CPR, after 30 compressions, open the person's airway and give two rescue breaths. Then, continue with the chest compressions. If you feel more comfortable, you can give the compressions without the breaths until the ambulance arrives.

    Performing CPR

    The American Heart Association conducts classes to teach lay people how to administer CPR. International bystander-CPR advocate Mickey S. Eisenberg, MD, PhD, director of the University of Washington Medical Center's emergency medicine service, studied young people and adults older than 60 and found that they are able to learn the life-saving skill online and then successfully perform CPR on a mannequin.

    Defibrillators: The Difference Between Life and Death

    Early defibrillation plays a key role in improving the odds someone will survive sudden cardiac arrest without brain damage. The American Heart Association's emergency care guidelines place a stronger emphasis on early defibrillation and improved access to AEDs. Heartsaver AED CPR classes include information about how to use the devices.
    Two studies published in The New England Journal of Medicine report unprecedented survival rates of 53% after trained casino security guards administered CPR and AED, and 40% after airline flight attendants did the same. University of Arizona researchers reported that the high success rate at the casinos depended on no more than three minutes elapsing between time of collapse and defibrillation.
    Prior studies have shown improved survival rates in communities where trained police officers, often the first on the scene of an emergency, carry defibrillators. Dr. Eisenberg believes many lives would be saved if a defibrillator was nearby and family members knew how to use it.
    Dr. Eisenberg's research has shown that older adults can correctly use AEDs after watching a short video. Another University of Washington study showed that sixth-grade students could accurately place and activate the devices during a training session.

    AED Locations

    AEDs are found in airports, shopping malls, casinos, community centers, and sports or medical facilities. AEDs can be somewhat costly and are available over the counter, without prescription. If you purchase an AED, be sure to get proper training on how to safely use it.


    American Heart Association http://www.heart.org/HEARTORG/

    Citizen CPR Foundation, Inc. http://www.citizencpr.org/

    Learn CPR—CPR Information and Training Resources http://depts.washington.edu/learncpr/


    Canadian Association of Family Physicians http://www.cfpc.ca/

    Canadian Public HealthHealth Unit http://www.phac-aspc.gc.ca/hp-ps/hl-mvs/index-eng.php


    American Heart Association. 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science: Part 1 executive summary. American Heart Association website. Available at: http://circ.ahajournals.org/cgi/content/full/122/18%5Fsuppl%5F3/S640. Accessed October 21, 2010.

    American Heart Association. Hands only CPR. American Heart Association website. Available at: http://www.americanheart.org/presenter.jhtml?identifier=3060861. Updated July 20, 2009. Accessed October 15, 2010.

    Cardiac arrest. American Heart Association website. Available at: http://www.americanheart.org/presenter.jhtml?identifier=4481. Accessed May 21, 2007.

    Chen MA, Eisenberg MS, Meischke H. Impact of in-home defibrillators on postmyocardial infarction patients and their significant others: an interview study. Heart Lung. 2002;31:173-185.

    Jorgenson DB, Skarr T, Russell JK, Snyder DE, Uhrbrock K. AED use in businesses, public facilities and homes by minimally trained first responders. Resuscitation. 2003;59:225-233.

    The links in the chain of survival. American Heart Association website. Available at: http://www.americanheart.org/presenter.jhtml?identifier=3012016. Updated April 21, 2008. Accessed April 11, 2011.

    Marenco JP. Automated external defibrillators are cost-effective on large and medium capacity commercial aircraft. Evidence-based Healthcare. 2002;6;58-59.

    Murray CL, Steffensen I. Automated external defibrillators for home use. Issues Emerg Health Technol. 2005;1-4.

    Smoots E. Practical prevention: how defibrillators in public places can save lives. EBSCO Health Library website. Available at: http://www.ebscohost.com/healthLibrary/. Updated March 14, 2011. Accessed April 11, 2011.

    Page RL, Joglar JA, Kowal RC, et al. Use of automated external defibrillators by a US Airline. N Engl J Med. 2000:343:1210-1216.

    Terence D, et al. Outcomes of rapid defibrillation by security officers after cardiac arrest in casinos. N Engl J Med. 2000; 343:1206-1209.

    10/15/2010 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php: Bobrow BJ, Spaite DW, Berg RA, et al. Chest compression-only CPR by lay rescuers and survival from out-of-hospital cardiac arrest. JAMA. 2010;304(13):1447-1454.SOS-KANTO study group. Cardiopulmonary resuscitation by bystanders with chest compression only (SOS-KANTO): an observational study. Lancet. 2007;369(9565):920-926.

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