Before the Buffalo Bills safety, Damar Hamlin suffered a cardiac arrest during a football game, most fans had likely never seen a player suffer a cardiac arrest on the field. The cardiac arrest of a professional athlete during competition is uncommon. Sudden cardiac arrest can occur to young, healthy-appearing athletes, as it did to Danish national soccer star Christian Erikson in 2021. Christian was resuscitated so promptly that he waved to the fans as he was being taken off the playing field. The possibility of sudden cardiac arrest among athletes or fans is a reason to teach life support skills to students, coaches, and trainers, and to keep life-saving equipment in schools and sports venues.
As we age, sudden cardiac arrest is more common. It is estimated that approximately 350,000 Americans die annually from sudden cardiac arrest. An American College of Cardiology infographic states that one American dies from cardiac arrest every 90 seconds.
Cardiac arrest is not the same as a heart attack or myocardial infarction. A cardiac arrest is an arrhythmia or heart rhythm problem. The most common, and most reversible, arrhythmia causing cardiac arrest is called ventricular fibrillation. If it is recognized and treated quickly, ventricular fibrillation can sometimes be reversed with an electric shock delivered by a defibrillator.
A heart attack is the death of heart muscle due to an interruption of blood flow to the heart. Reestablishing heart blood flow using medications and percutaneous coronary intervention with stents is the most effective form of treatment for heart attacks. A heart attack is the most common cause of cardiac arrest in older people. Cardiac arrest is the most common cause of death among patients who die from a heart attack.
Access emergency medical technicians (EMT) who have life-saving skills and equipment, using the 911 emergency system
Cardiac arrest usually leads to death, but resuscitation with recovery of normal heart and brain function is sometimes possible. The science and practice of cardiopulmonary resuscitation (CPR) have advanced significantly over the past 100 years.
- Cardiac resuscitation has evolved from physicians cutting open a patient’s chest and rhythmically squeezing the victim’s heart…to closed-chest compressions of 1 ½- 2 inches, at a rate of ~100 beats/ minute, which is roughly equal to the rhythm of the song Stayin’ Alive.
- Pulmonary resuscitation has advanced from the back-pressure arm-lift approach (Holger-Nielsen method) on a prone victim, to positive pressure using mouth-to-mouth or bag-mask, on a supine victim.
- Defibrillation can now be administered by healthcare providers or trained laypeople using an automated external defibrillator (AED). Automatic external defibrillators are often available in public facilities, such as cardiac rehabilitation facilities, gyms, schools, airports, and airplanes.
- Many people are successfully resuscitated from cardiac arrest, and leave the hospital with maintained heart and brain function.
More lives can be saved. The key to saving more victims of cardiac arrest is prompt, effective, cardiopulmonary resuscitation (CPR). Time is critical in both cardiac arrest and acute myocardial infarction. In both cases, ischemia, defined as inadequate oxygen supply to meet metabolic demand, leads to progressive tissue death. The greater the delay in either reestablishing adequate coronary blood flow for a heart attack, or reversing ventricular fibrillation in a cardiac arrest, the fewer victims will survive.
Learn Basic Life Support (BLS)
- Basic Life Support (BLS) can be learned from courses given by organizations like the American Heart Association (AHA), and from online videos.
- Basic Life Support classes teach that there are two main determinants of heart and brain survival after a sudden cardiac arrest:
- Time to effective, hands-only chest compressions (preferably < 4 minutes)
- Time to electrical defibrillation (preferably < 8 minutes)
Bystander-initiated CPR: Save a Life
There are a number of different conditions which can culminate in cardiac arrest. Every person is unique. The appropriate treatment differs based upon the underlying conditions and patient-specific factors. But these issues are best sorted out by medical professionals in a hospital. The first step is stabilizing patients and getting them to the hospital alive, so as to have a fighting chance. This is the work of emergency medical technicians (EMT).
Encouraging bystanders to promptly activate the 911 system, and begin effective chest compressions until the emergency medical technicians arrive could help save more lives. Bystander reluctance to perform mouth-to-mouth rescue breathing on a stranger can be overcome by eliminating the rescue breathing part of CPR for witnessed cardiac arrests. Time delays to assess and treat airway issues can lead to further tissue death and reduced survival. Respiratory arrests, such as after near drowning or drug overdose, differ from witnessed cardiac arrest. Respiratory arrests require attention to the victim’s airway and may necessitate positive–pressure (mouth-to-mouth or bag- mask) rescue breathing.
Although we are all unique, we humans have many things in common. A heartbeat, a pulse, and the fact that we will one day lose both are among our human similarities. Life is precious. Mortality is our common lot. Good medical care aims to extend life with quality for as long as is feasible, under the circumstances. Most cardiac conditions are palliated, not cured.
When you hear hoofbeats, don’t look for zebras
Medical emergencies require rapid initiation of lifesaving steps. For sudden cardiac arrest, these steps are:
- recognition (sudden collapse; unarousable; gasping or not breathing);
- access 911;
- hands-only chest compressions of ~2 inches delivered at 100 x/ minute;
- obtain and use an automated electrical defibrillator (AED) following the device prompts.
An arrest is not the time to speculate on causes or treatments that one has recently seen on the internet. Don’t waste time on the exotic, or that which cannot be changed. The care providers at the hospital can sort out the unusual causes and design an individual treatment plan.
- The American College of Cardiology, a professional organization of heart specialists or cardiologists, has an online site for patients called Cardiosmart with information about many cardiac issues, including sudden cardiac arrest and heart attack
- The American Heart Association sponsors courses on Basic Life Support (BLS) and Advanced Cardiac Life Support (ACLS). Basic Life Support is recommended for family and friends of diagnosed cardiac patients
- Different Drummer a cardiologist’s memoir of imperfect heroes and care for the heart, by Douglass Andrew Morrison, MD discusses some of the history of cardiopulmonary resuscitation (CPR) and heart attack (myocardial infarction) care
Douglass Andrew Morrison, MD, PhD
Douglass Andrew Morrison has been a physician, teacher, and clinical investigator for almost fifty years. He spent twenty-six years climbing the academic ladder to the level of professor of medicine at the University of Colorado and later at the University of Arizona. He is Board certified in internal medicine, pulmonary disease, cardiovascular disease, interventional cardiology, and echocardiography.
He is a Fellow of the American College of Cardiology. While serving as faculty at the University of Arizona and Cath Lab medical director for the Tucson VA, he earned a Ph.D. in epidemiology from the University of Arizona College of Public Health.
He has served on professional journal editorial boards and participated in the Food and Drug Agency’s cardiac device approval panels. He co-edited, with Patrick Serruys, two interventional cardiology texts: Medically Refractory Rest Angina and High-Risk Cardiac Revascularization and Clinical Trials.
Doug lives in Yakima, Washington, with his wife, Joanne.