6 ms·

If you witness a cardiac arrest, here's what to do

56 points by colinprince 2y ago

ggm 2y ago
Always good to do. Medicos I talk to say two things: you have to press a LOT harder than people think, and when they do it, cracked ribs are normal. And, its really sad, but it just doesnt work sometimes. A lot of times. Do it, but don't be surprised if it doesn't work. But do it. Helen Clark, ex PM of NZ tried to save her mountain guide friend up a hill, kept going for an hour or more. When I measure up prime ministers, this is the standard I look for.
- unsnap_biceps 2y ago
  Another thing said by medics that's stuck with me is "you can’t screw up CPR because the person is already dead"
- TechDebtDevin 2y ago
  Well dang, I guess in hospital success rates for CPR are <20% survival to discharge. Outside of hospital they are < 10% and quickly drop. Sort of terrifying, even though I've done CPR training many times for work I was of the impression that success rates were much higher.
  - dsymonds 2y ago
    It's low with CPR alone, but getting an AED involved (which should be accessible in most urban places these days) raises the chances to 50-70%.
    - bigfatkitten 2y ago
      They're cheap enough now for normal people to own one. I carry one in my car as well as a bleed kit, and some other bits and pieces I'm qualified to use (oropharyngeal airways and a bag valve mask respirator).
      - TechDebtDevin 2y ago
        They're $600 refurbished for anyone wondering.
        bigfatkitten 2y ago
        Depends on the country, but as low as $599 AUD ($378 USD) brand new. https://cellaed.io/au/products https://cellaed.io/au/products
    - epcoa 2y ago
      Look more carefully at that 50 to 70% figure. It is exaggerated (or at least misleading to directly compare) because the usually cited studies are assuming an arrest with a shockable rhythm (and timely, and correct AED application), but only 30 to 40% of out of hospital cardiac arrests have a shockable rhythm, so the overall survivability is not over 50%. Practically speaking even with an AED present its more like 20-30% and that is just survivability, not taking into account long term deficits.
  - mmooss 2y ago
    Where can I find those numbers?
- sklargh 2y ago
  Effective CPR is a team effort because it is physically demanding and requires a number of individuals to work other elements of the problem set (airway, medication and access, AED, relief for CPR practitioner, communication with emergency department, police etc...). There is an awful lot to do in these situations and the scenario balloons in players from the first rescuer to the receiving emergency department. The goal should really be continuous motion to a higher level of care vs. getting frozen in place. I will also note that it is pretty emotionally demanding, particularly given that it's likely to fail, and be coincident with someone else in distress (family member, friend etc...). This is an event you're going to want to put into a box and give yourself some time to work with.
- kurthr 2y ago
  You're a lot better off, if it's just a Heimlich. They don't say it, but probably much better, if you have access to an AED (most of that remaining 10%).
westurner 2y ago
From https://news.ycombinator.com/item?id=39850383#39863280 https://news.ycombinator.com/item?id=39850383#39863280 : > Basic life support (BLS) https://en.wikipedia.org/wiki/Basic_life_support https://en.wikipedia.org/wiki/Basic_life_support : >> DRSABCD: Danger, Response, Send for help, Airway, Breathing, CPR, Defibrillation > "Drs. ABCD" From "Defibrillation devices save lives using 1k times less electricity" (2024) https://news.ycombinator.com/item?id=42061556 https://news.ycombinator.com/item?id=42061556 : > "New defib placement increases chance of surviving heart attack by 264%" (2024) https://newatlas.com/medical/defibrillator-pads-anterior-posterior-cardiac-arrest-survival/ https://newatlas.com/medical/defibrillator-pads-anterior-pos... : >> Placing defibrillator pads on the chest and back, rather than the usual method of putting two on the chest, increases the odds of surviving an out-of-hospital cardiac arrest by more than two-and-a-half times, according to a new study. From SBA.gov blog > "Review Your Workplace Safety Policies" (2019) https://www.sba.gov/blog/review-your-workplace-safety-policies https://www.sba.gov/blog/review-your-workplace-safety-polici... : > Also, consider offering training for CPR to employees. Be sure to have an automatic external defibrillator (AED) on site and have employees trained on how to use it. The American Red Cross and various other organizations offer free or low-cost training.
pestatije 2y ago
whats the liability if you dont?
- JumpCrisscross 2y ago
  Legally or morally?
  - pestatije 2y ago
    legally, in Australia
    - kylecazar 2y ago
      I don't know of anywhere in the world where common law requires you to save someone in peril as a civilian
      - contrarian1234 2y ago
        If a toddler falls in to a fountain, you can just walk away?
        s1artibartfast 2y ago
        If it's not your toddler and not your fountain, sure. It might even be the smart move. depending on the good Samaritan protections in your jurisdiction, you might be open to liability if you try to help.
        deleted 2y ago
        [deleted]
        garaetjjte 2y ago
        Maybe true for common law, but definitely not everywhere. For example in Polish penal code: "Art. 162. §1. Anyone who does not provide assistance to a person in a situation threatening a direct danger of loss of life or serious damage to health, when he could provide it without exposing himself or another person to the danger of loss of life or serious damage to health, shall be subject to a penalty of imprisonment for up to 3 years."
nayuki 2y ago
Here is the non-lite version of the article: https://www.cbc.ca/radio/whitecoat/the-dose-cardiac-arrest-1.7136483 https://www.cbc.ca/radio/whitecoat/the-dose-cardiac-arrest-1...
- blondin 2y ago
  thank you!
- Springtime 2y ago
  Useful illustrative graphic in that version of the article for remembering the compression rhythm with a Bee Gees' song mnemonic and required depth.
  - leeoniya 2y ago
    > remembering the compression rhythm with a Bee Gees' song mnemonic i prefer the Queen song mnemonic :D
rkagerer 2y ago
A few years back while recertifying, I got interested in what the world record was for the longest successful CPR recovery. Found this incident that lasted 4 hours, involving someone who'd gone into hypothermia some hours before: http://www.cbc.ca/news/canada/british-columbia/christine-tink-newman-s-medical-miracle-revived-from-near-death-1.2591379 http://www.cbc.ca/news/canada/british-columbia/christine-tin... In this case, her lowered body temperature contributed to surviving long enough for rescue. CPR doesn't have the highest success rate, but it's worth knowing how to do as it can make a life or death difference.
- 0_____0 2y ago
  "They aren't dead until they're warm and dead."
M95D 2y ago
Survival rates when CPR is applied outsite a hospital is below 10%. About 1/3 of those 10% that survive will have permanent neurological disability and about 50% whish they died instead of having CPR. https://www.npr.org/sections/health-shots/2023/05/29/1177914622/a-natural-death-may-be-preferable-for-many-than-enduring-cpr https://www.npr.org/sections/health-shots/2023/05/29/1177914...
- spondylosaurus 2y ago
  A related, longer read: https://www.newyorker.com/news/the-weekend-essay/the-hidden-harms-of-cpr https://www.newyorker.com/news/the-weekend-essay/the-hidden-...
- onemoresoop 2y ago
  That still leaves a small percentage of those to survive and continue their lives, I’d say it’s worth it. My father was probably killed by CPR as we found out at autopsy that he had aortic aneurism, an aortic fissure that ruptured badly during CPR. And yet ER tried their best and was his only chance of survival.
harrylove 2y ago
Also learn the Heimlich maneuver if you can. It’s easy to learn and you don’t need to be certified. Never thought I’d need it but I saved my brother’s life many years ago. An outlier for sure given about 6,000 people in the US die from choking each year, but still. https://my.clevelandclinic.org/health/treatments/21675-heimlich-maneuver https://my.clevelandclinic.org/health/treatments/21675-heiml...
- OutOfHere 2y ago
  Heimlich maneuver is good, but it must be done right, and customized for the person. Doing it wrong can cause injury that can kill a person. https://pmc.ncbi.nlm.nih.gov/articles/PMC9108913/ https://pmc.ncbi.nlm.nih.gov/articles/PMC9108913/ https://pubmed.ncbi.nlm.nih.gov/37695097/ https://pubmed.ncbi.nlm.nih.gov/37695097/
OutOfHere 2y ago
This article fails to mention that if their lungs aren't breathing, you could also do two rescue breaths for every thirty compressions. This will also give you a break from doing all those compressions. Obviously call emergency services before you do anything at all.

56 points by colinprince 2y ago

ggm 2y ago

Always good to do. Medicos I talk to say two things: you have to press a LOT harder than people think, and when they do it, cracked ribs are normal. And, its really sad, but it just doesnt work sometimes. A lot of times. Do it, but don't be surprised if it doesn't work. But do it. Helen Clark, ex PM of NZ tried to save her mountain guide friend up a hill, kept going for an hour or more. When I measure up prime ministers, this is the standard I look for.

unsnap_biceps 2y ago
Another thing said by medics that's stuck with me is "you can’t screw up CPR because the person is already dead"
TechDebtDevin 2y ago
Well dang, I guess in hospital success rates for CPR are <20% survival to discharge. Outside of hospital they are < 10% and quickly drop. Sort of terrifying, even though I've done CPR training many times for work I was of the impression that success rates were much higher.
- dsymonds 2y ago
  It's low with CPR alone, but getting an AED involved (which should be accessible in most urban places these days) raises the chances to 50-70%.
  - bigfatkitten 2y ago
    They're cheap enough now for normal people to own one. I carry one in my car as well as a bleed kit, and some other bits and pieces I'm qualified to use (oropharyngeal airways and a bag valve mask respirator).
    - TechDebtDevin 2y ago
      They're $600 refurbished for anyone wondering.
      - bigfatkitten 2y ago
        Depends on the country, but as low as $599 AUD ($378 USD) brand new. https://cellaed.io/au/products https://cellaed.io/au/products
  - epcoa 2y ago
    Look more carefully at that 50 to 70% figure. It is exaggerated (or at least misleading to directly compare) because the usually cited studies are assuming an arrest with a shockable rhythm (and timely, and correct AED application), but only 30 to 40% of out of hospital cardiac arrests have a shockable rhythm, so the overall survivability is not over 50%. Practically speaking even with an AED present its more like 20-30% and that is just survivability, not taking into account long term deficits.
- mmooss 2y ago
  Where can I find those numbers?
sklargh 2y ago
Effective CPR is a team effort because it is physically demanding and requires a number of individuals to work other elements of the problem set (airway, medication and access, AED, relief for CPR practitioner, communication with emergency department, police etc...). There is an awful lot to do in these situations and the scenario balloons in players from the first rescuer to the receiving emergency department. The goal should really be continuous motion to a higher level of care vs. getting frozen in place. I will also note that it is pretty emotionally demanding, particularly given that it's likely to fail, and be coincident with someone else in distress (family member, friend etc...). This is an event you're going to want to put into a box and give yourself some time to work with.
kurthr 2y ago
You're a lot better off, if it's just a Heimlich. They don't say it, but probably much better, if you have access to an AED (most of that remaining 10%).

westurner 2y ago

From https://news.ycombinator.com/item?id=39850383#39863280 https://news.ycombinator.com/item?id=39850383#39863280 : > Basic life support (BLS) https://en.wikipedia.org/wiki/Basic_life_support https://en.wikipedia.org/wiki/Basic_life_support : >> DRSABCD: Danger, Response, Send for help, Airway, Breathing, CPR, Defibrillation > "Drs. ABCD" From "Defibrillation devices save lives using 1k times less electricity" (2024) https://news.ycombinator.com/item?id=42061556 https://news.ycombinator.com/item?id=42061556 : > "New defib placement increases chance of surviving heart attack by 264%" (2024) https://newatlas.com/medical/defibrillator-pads-anterior-posterior-cardiac-arrest-survival/ https://newatlas.com/medical/defibrillator-pads-anterior-pos... : >> Placing defibrillator pads on the chest and back, rather than the usual method of putting two on the chest, increases the odds of surviving an out-of-hospital cardiac arrest by more than two-and-a-half times, according to a new study. From SBA.gov blog > "Review Your Workplace Safety Policies" (2019) https://www.sba.gov/blog/review-your-workplace-safety-policies https://www.sba.gov/blog/review-your-workplace-safety-polici... : > Also, consider offering training for CPR to employees. Be sure to have an automatic external defibrillator (AED) on site and have employees trained on how to use it. The American Red Cross and various other organizations offer free or low-cost training.

pestatije 2y ago

whats the liability if you dont?

JumpCrisscross 2y ago
Legally or morally?
- pestatije 2y ago
  legally, in Australia
  - kylecazar 2y ago
    I don't know of anywhere in the world where common law requires you to save someone in peril as a civilian
    - contrarian1234 2y ago
      If a toddler falls in to a fountain, you can just walk away?
      - s1artibartfast 2y ago
        If it's not your toddler and not your fountain, sure. It might even be the smart move. depending on the good Samaritan protections in your jurisdiction, you might be open to liability if you try to help.
        deleted 2y ago
        [deleted]
        garaetjjte 2y ago
        Maybe true for common law, but definitely not everywhere. For example in Polish penal code: "Art. 162. §1. Anyone who does not provide assistance to a person in a situation threatening a direct danger of loss of life or serious damage to health, when he could provide it without exposing himself or another person to the danger of loss of life or serious damage to health, shall be subject to a penalty of imprisonment for up to 3 years."

nayuki 2y ago

Here is the non-lite version of the article: https://www.cbc.ca/radio/whitecoat/the-dose-cardiac-arrest-1.7136483 https://www.cbc.ca/radio/whitecoat/the-dose-cardiac-arrest-1...

blondin 2y ago
thank you!
Springtime 2y ago
Useful illustrative graphic in that version of the article for remembering the compression rhythm with a Bee Gees' song mnemonic and required depth.
- leeoniya 2y ago
  > remembering the compression rhythm with a Bee Gees' song mnemonic i prefer the Queen song mnemonic :D

rkagerer 2y ago

A few years back while recertifying, I got interested in what the world record was for the longest successful CPR recovery. Found this incident that lasted 4 hours, involving someone who'd gone into hypothermia some hours before: http://www.cbc.ca/news/canada/british-columbia/christine-tink-newman-s-medical-miracle-revived-from-near-death-1.2591379 http://www.cbc.ca/news/canada/british-columbia/christine-tin... In this case, her lowered body temperature contributed to surviving long enough for rescue. CPR doesn't have the highest success rate, but it's worth knowing how to do as it can make a life or death difference.

0_____0 2y ago
"They aren't dead until they're warm and dead."

M95D 2y ago

Survival rates when CPR is applied outsite a hospital is below 10%. About 1/3 of those 10% that survive will have permanent neurological disability and about 50% whish they died instead of having CPR. https://www.npr.org/sections/health-shots/2023/05/29/1177914622/a-natural-death-may-be-preferable-for-many-than-enduring-cpr https://www.npr.org/sections/health-shots/2023/05/29/1177914...

spondylosaurus 2y ago
A related, longer read: https://www.newyorker.com/news/the-weekend-essay/the-hidden-harms-of-cpr https://www.newyorker.com/news/the-weekend-essay/the-hidden-...
onemoresoop 2y ago
That still leaves a small percentage of those to survive and continue their lives, I’d say it’s worth it. My father was probably killed by CPR as we found out at autopsy that he had aortic aneurism, an aortic fissure that ruptured badly during CPR. And yet ER tried their best and was his only chance of survival.

harrylove 2y ago

Also learn the Heimlich maneuver if you can. It’s easy to learn and you don’t need to be certified. Never thought I’d need it but I saved my brother’s life many years ago. An outlier for sure given about 6,000 people in the US die from choking each year, but still. https://my.clevelandclinic.org/health/treatments/21675-heimlich-maneuver https://my.clevelandclinic.org/health/treatments/21675-heiml...

OutOfHere 2y ago
Heimlich maneuver is good, but it must be done right, and customized for the person. Doing it wrong can cause injury that can kill a person. https://pmc.ncbi.nlm.nih.gov/articles/PMC9108913/ https://pmc.ncbi.nlm.nih.gov/articles/PMC9108913/ https://pubmed.ncbi.nlm.nih.gov/37695097/ https://pubmed.ncbi.nlm.nih.gov/37695097/

OutOfHere 2y ago

This article fails to mention that if their lungs aren't breathing, you could also do two rescue breaths for every thirty compressions. This will also give you a break from doing all those compressions. Obviously call emergency services before you do anything at all.