On January 15, 2008 the American Heart Association issued a statement calling for a more unified effort to increase public awareness of the importance of cardiopulmonary resuscitation (CPR) in saving lives threatened by sudden cardiac arrest.  The goal is to reduce the common barriers that cause bystanders who witness a cardiac arrest to refrain from performing CPR or offering other types of aid.  Since one of the main focuses of nursing practice is the education we provide to our patients and communities, it is prudent for us to consider our role of contribution to this renewed effort for public education.

Recent studies indicate that only 15 to 30% of out-of-hospital cardiac arrest victims receive bystander CPR.  Survival rates decrease by about 10% for every minute that the victim goes without CPR while waiting for emergency medical personnel to arrive.  Fast, effective CPR has the potential to more than double a victim’s chance for survival following a witnessed cardiac event.

There are approximately 166,200 deaths each year in the United States resulting from cardiac arrest occurring outside of a hospital setting.  Of these, 80% will occur at home and be witnessed by another family member.  Currently, our best line of defense is the following chain of survival:

(1) Early recognition of the emergency and phoning 911 for EMS

(2) Early bystander CPR

(3) Early delivery of a shock with an automated external defibrillator (AED) defibrillator if indicated, and

(4) Early advanced life support and post-resuscitation care delivered by healthcare providers

Momentum and support for placement of AEDs in public buildings has increased over the past decade.  This plays an important role in survival since many cardiac arrests are the result of ventricular fibrillation (Vfib).  The shock from the AED can be effective in correcting the arrhythmia.  It is, however, important to remember that an AED unit must be retrieved from its designated location.  Initiating CPR can keep the blood moving until the unit can be obtained and applied to the victim.  Following this chain of survival can increase survival rate as high as 49%.

The optimal goal is to significantly increase the number of bystanders who can and will provide CPR in an emergency.  Secondary to this is to improve the quality of the actual CPR given.

The most frequent barriers encountered among the general public include:

• Fear of infectious disease
• Fear of litigation
• Fear of poor performance

These barriers can be decreased through education, training and public awareness.

As nurses, we can renew our efforts to provide timely information to our clients and their families.  More effort should go into identifying individuals and families at risk and helping them understand the significant power of early action in saving lives, emphasizing that any action is better than no action.  While knowledge of technique and practiced, formed habits of intervention ease the stress of the situation, it is important that community members know where to turn for prompted help.  Perfect help may be best, but a best effort is always helpful.

Information should include the various types of CPR education available in their communities, including creative approaches such as the American Heart Association’s Family and Friends CPR Anytime™.  This individual training program provides an instructional video and an inflatable manikin allowing individuals and families to learn within the comfort of their own home.

Increased awareness concerning Good Samaritan laws can also reduce barriers.  It is worth noting that there is the option of providing continuous chest compression (CCC) without assisted breathing in situations where the victim is unknown to the bystanders or other times when mouth-to-mouth resuscitation is an undesirable action for the bystander.  While there is still controversy surrounding the overall theory of ventilation during cardiac arrest, CCC does offer blood circulation until professional help can be obtained.  Educating individuals about this option may increase the willingness of bystanders to initiate help for the victim.

Overall, it is still within the nurse’s power to save lives through education even when we, ourselves, are not present.

 

References:

American Heart Association.  Unified National Effort Needed to Save Lives by Increasing Use of CPR.  January 14, 2008.

Stiles, S. AHA Calls for “Creative” Strategies to Encourage Bystander-Initiated CPR.  Medscape Medical News. January 23, 2008.

 

 

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