Sudden cardiac arrest is a leading cause of death worldwide. It can happen without any signs or symptoms. But in some cases, patient may experience shortness of breath, chest pain, dizziness, fatigue, nausea and vomiting before or during an episode of cardiac arrest.
Cardiac arrest is reversible in most victims if it is treated within a few minutes. For a layperson, it is often difficult to recognize cardiac arrest. If someone suspects or see an unresponsive person the first and foremost thing is to call for emergency medical services. Begin Cardio Pulmonary Resuscitation (CPR) immediately and continue until professional emergency medical services arrive. If two people are available to help, one should begin CPR immediately while the other calls for help. Get an automated external defibrillator (AED) if one is available and use it as soon as it arrives. AED is not readily available in our country but more and more emphasis is being laid these days on their availability in public places. Also, due to scarce availability of ambulance services with trained personnel, CPR is often delayed. Cultural belief also make people hesitant to perform mouth-to-mouth resuscitation. The skill is difficult to acquire and its inappropriate use may result in more harm.
Considering all this, Indian society of anaesthesiologist (ISA) is now recommending compression only life support (COLS) especially for laypersons outside the hospital. Compression-only CPR is as effective as conventional CPR for cardiac arrest at home, at work or in public. Early chest compression and early transfer to hospital is of utmost importance. It can even be performed by family members who witness collapse of their near and dear ones. The method can be easily taught and training can also be imparted telephonically. Optimal outcomes with COLS can be ensured by early application of effective chest compression and finally early transfer of the victim to the nearest hospital. COLS has a series of predefined steps which need to be followed sequentially. It has to be effective chest compression which should be performed continuously till help arrives. The rescuer should come from front, facing the victim face, tap on the shoulder, speak loudly like HELLO-Are you alright? in a language the victim could understand. The victim should not be shaken nor neck movements done like tapping on face as it could cause further harm, in case cervical spine injury is also present. If the person is not responding, then the rescuer should do a simple maneuver of head tilt and chin lift to clear the airway of the person. Five cycles of thirty chest compressions should be given with both hands placed over the lower third of the sternum. Two mouth to mouth rescue breath should ideally be given after each cycle of chest compression. If the patient responds either by verbal response or by purposeful movement, or is breathing normally, then cardiopulmonary arrest is unlikely. Such victim needs to be monitored constantly and shifted to nearby medical facility at the earliest for further evaluation and management. If no response is elicited, the victim may be having cardiopulmonary arrest and would require further help. In any case, chest compressions should not be stopped in an unresponsive person till the ambulance arrives. If more rescuers are available then they should continue the chest compressions one by one so that the compressions are effective should one person gets tired.
Early recognition of cardiac arrest, immediate initiation of chest compressions and early transfer of the patient to the hospital is critical to ensure a successful resuscitation of a patient by a bystander or a layman.