Even though sudden cardiac arrest (SCA) is a preventable and treatable condition, most victims die because they do not receive effective help quickly enough. To survive SCA, it is critical for the victim to receive immediate cardiopulmonary resuscitation (CPR) and treatment with a defibrillator within five minutes. Since even the best EMS responders cannot always get to the victim in time (typical EMS response times are seven to eight minutes after receipt of the 9-1-1 call), survival generally depends on the help of bystanders who witness the victim’s sudden death and intervene without hesitation.
To improve SCA survival rates, it is vital for potential bystanders to be aware that SCA is a public health crisis and that survival from SCA depends largely on bystander intervention. Lifesaving bystander actions include calling 9-1-1, giving CPR, and using an automated external defibrillator (AED).
A recent American Heart Association (AHA) recommendation to use “Hands-Only (compression-only) CPR” aims to increase the likelihood that bystanders will help in sudden cardiac emergencies by reducing barriers to action.
The advisory is based on these concepts:
- Recent science suggests that chest compressions may be the most important aspect of CPR for victims of SCA in the first few minutes after collapse;
- Bystanders may be more likely to help if all they have to remember is to push hard and fast on the chest.
The AHA also asserts that bystanders may be more likely to help if they don’t have to provide rescue breathing. This rationale, however, has been disputed in the literature. Learn More
Bystander intervention in sudden cardiac emergencies involves a complex set of beliefs, attitudes and behaviors. According to Allan Braslow, PhD, an expert on bystander behavior in cases of SCA and an advisor to the SCA Foundation, “Helping someone who suffers sudden cardiac death is much more complex than kneeling down and starting CPR—even if it’s someone you know.”
For example, the following factors have a huge impact on intervention:
- Ambiguity of the situation: What is going on here? Is this really a life or death situation or could it be something else?
- Personal involvement: Does this situation affect me? What if I do the wrong thing? What if I hurt the person? Is someone else is better qualified to help?
- Touching a person who seems to be dead: Touching a person who seems to be dead can be very scary, whether this means giving chest compressions or mouth-to-mouth resuscitation. If the bystander knows the person, intervention may be automatic. On the other hand, emotional barriers may make intervention even more complicated.
Will the AHA advisory help? Some experts say it can’t hurt. Survival rates from SCA have languished at less than 10 percent for decades, despite multi-million dollar campaigns to promote CPR training and more recently, bystander use of AEDs.
Others say there is insufficient evidence to make this recommendation now, particularly since the AHA issues guidelines are reviewed every five years, and this change occurs between “official” guidelines recommendations. Might confusion about guideline changes midstream only serve to further reduce the incidence of bystander intervention?
What about SCA due to asphyxiation? Or in children? Will the general public be so confused they decide that not acting is the best course?
The answer remains to be seen. Certainly, what we know from research about bystander action in sudden cardiac emergencies can inform healthcare system planners. Clearly, the bottom line is that it is better to do something than to do nothing.
So if you are ever faced with such an emergency, do your best to help. If you observe a life-threatening situation that suggests SCA, it is better to act than to think there is nothing you could have done. When someone is already dead, you cannot make them worse off. Your actions can only help.
-Mary Newman, SCA Foundation
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