Cardiopulmonary resuscitation: the vital role of the ‘first responder’ in cardiac arrest

From the Argentine Society of Cardiology (SAC), in conjunction with the Argentine Cardiology Foundation, arm towards the SAC community, they recalled that in a sudden cardiac arrest the heart stops, the person passes out, becomes unresponsive, and stops breathing.

This episode requires that several factors come together to achieve better survival. The American Heart Association has described these factors through the metaphor of a chain made up of 6 links, made up of the recognition of cardiac arrest, the call for an ambulance, performing CPRthe use of the automated external defibrillator (AED), ambulance care and definitive medical treatment.

Of those links, the first four have a fundamental role in ensuring that the person who suffers a cardiac arrest has the best chance of reaching the hospital alive.

“It is important to highlight the role of the most important person in managing this situation, who is what we call ‘the first responder’, an individual who witnesses the situation and recognizes it, and decides to act by doing cardiopulmonary resuscitation (CPR) , keeping the blood circulating until the ambulance arrives. He will also be the one who makes sure to call the emergency system (107 or the corresponding number in each province), by himself or by asking another to do so, complying with the first step of the chain link, “explained the doctor. Mario FitzMauricecardiologist, Director of the Arrhythmias Council and Director of Press and Communication of the Argentine Society of Cardiology.

The beginning of the compressions in the center of the chest will be the third link. Compressions should be strong and fast. Strong enough to plunge the victim’s chest at least 5 cm, and fast, with a frequency of between 100 and 120 per minute. This gets the blood to circulate. Dr. Fitz Maurice suggests remembering the Bee Gees song ‘Stayin Alive’ and keeping your rhythm, as it matches the tempo required for compressions.

“The fourth link is to use a defibrillator (DEA), which is a very easy-to-use device whose function is to deliver an electric shock (or whatever is necessary) to the chest of the person in cardiac arrest. It is very easy to use and is specially designed for anyone to use, without the need to be a doctor. If it is available on site, just by opening it or turning it on, the AED will give the instructions for use in Spanish and will produce an electric shock on the patient only if it corroborates that there is an arrhythmia (called ventricular fibrillation), which is what is causing the heart attack. When the heart has this serious alteration in its rhythm, it stops beating causing the blood to stop circulating. The electric shock causes the heart to stop trembling, reset, and start working again,” explained the doctor. Fabian GelpiSecretary of the Argentine Cardiology Foundation (FCA).

“It is important to point out that 90% of the time, sudden cardiac arrests are caused by this alteration in the heart rhythm and for every minute that defibrillation is delayed, survival decreases by 10%. Also, studies indicate that 70% of sudden deaths occur at home,” he added.

But there won’t always be a defibrillator available at the scene of the event: it’s estimated that you’re 200 times more likely to die from sudden death than from a fire, yet there are fire extinguishers almost everywhere (and it’s a good thing). there are) but very few have defibrillators, and also very few people are trained in CPR.

The bibliography and the specialists of the SAC and the FCA recommend in these cases to continue with the compressions until completing the fifth link in the chain of survival, which is the arrival of the ambulance, which will have all the necessary equipment to deal with the care of the patient to try to get him alive to the hospital.

The specialists highlight the importance of encouraging defibrillators to be widely available in places such as public spaces where the flow of people is considerable (schools, shopping centers, gyms, offices, and housing units, among others) or in general where they cannot be used. to defibrillate a person by the usual means within three minutes of the arrest.

“Different international studies report that if the first 4 steps are accomplished within three minutes of cardiac arrest, 80% of patients arrive at the hospital alive. This means neither more nor less than with a first responder who identifies the episode, calls the ambulance, starts CPR and uses an AED, we will increase the chances of the affected person reaching the hospital alive by 80%, if we compare with the almost zero opportunity that you will have if you do not receive any attention. That is why it is so important to get involved”, reflected the doctor FitzMaurice.

In numbers, it is proven that the community implementation of CPR training programs improves the chances of survival: among many other works, a recently published Swedish investigation observed that the survival of cardiac arrests that occurred outside the hospital in 2008 was 5%. and by 2015 it reached 20% after the systematic implementation of these programs.

In Argentina, the national law 27,159 (Sudden death – comprehensive prevention system) in its article 11 expressly exempts from all responsibility the person who is involved in a case of sudden death to perform CPR. That is why it is so important to get involved by learning this technique that we know saves lives. points Fabian Gelpi that “at FCA we promote the training of first responders by giving them the required training. We need neighbors, relatives, co-workers who signify the other’s chance of survival”.

It is estimated that in our country there are 45,000 sudden deaths per year, which is equivalent to one every 15 minutes, and they represent half of all deaths from cardiovascular disease.

“It is very difficult for the situation to get worse by getting involved, because there is nothing worse than being dead, the only way to make the situation worse is not to get involved,” the doctor concluded. FitzMaurice.

According to international studies, one or two sudden deaths per 100,000 people occur in people under 35 who are doing physical activity, mostly due to congenital heart disease. While, in people over 40 years of age, on the other hand, there is a sudden death for every 18,000 people who are doing a sport, especially due to coronary ischemia and serious arrhythmias.

As for the signs that should be alert and that may indicate a greater risk of sudden death, we can mention: repeated fainting, strong palpitations and chest pain, among others.

The Argentine Society of Cardiology (SAC) was founded on April 9, 1937, and since then, it has been chaired by the most eminent doctors in the specialty. He developed numerous works and communications providing scientific knowledge to the entire world.

It has more than 6,500 members incorporated in the following categories: holders, active, adherents, seconded, national correspondents, foreign correspondents, honoraries, for life, benefactors and assistants. It has 25 Scientific Councils that represent each of the subspecialties and 35 Regional Districts distributed throughout the country.

The Fundación Cardiológica Argentina is a non-governmental, non-profit public good entity, which is made up of professionals from different specialties who work on an honorary basis and thus make up the Executive Committee.

Since its creation, it has been training thousands of people, both doctors and the community in general, in cardiopulmonary resuscitation and the use of AEDs, and it is a pioneer in the country in disseminating the teaching of cardiopulmonary resuscitation.

It has a presence throughout the country through the Regional Districts of the Argentine Society of Cardiology. It is affiliated with the World Heart Federation and the Interamerican Heart Foundation.

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