Hugh Wong | Cardiac arrest – when every second counts

Cardiac arrest is a sudden, catastrophic medical emergency which occurs when the heart suddenly stops beating and blood is no longer pumping around the body effectively. This is usually manifested by the patient falling to the ground and becoming unresponsive.

Unlike a heart attack, which is caused by the blockage of a blood vessel supplying the heart, the cause of sudden cardiac arrest is most commonly the result of a malfunction in the electrical conducting system of the heart. This may cause the heart to beat irregularly (arrythmia) or stop beating all together (asystole). In these situations, the heart is only quivering, and, in others, the heart stops moving completely. When this occurs, there is a very narrow window of opportunity (minutes) to attempt to restart the heart, thus every second counts.

The rate of survival of patients who experience cardiac arrest outside of hospital is dismally low, less than 10 per cent. This is because of, even in developed countries with sophisticated pre-hospital emergency services, delays in initiating CPR. Research consistently shows that, for every minute that CPR and defibrillation are delayed, survival decreases by 7-10 per cent. If a defibrillatory shock is given within 3-5 minutes, survival can be as high as 70 per cent. If there is no intervention, there is little or no chance of survival.

When cardiac arrest occurs, vital organs become deprived of oxygen-rich blood. Within 4-6 minutes, irreversible damage to the brain, kidneys and the heart itself begins. If circulation is not restored promptly, and the patient survives, there is the risk of permanent brain injury. The phrase ‘every second counts’ is not just a cliché. It reflects the reality that the patient and healthcare providers face during cardiac arrest.

CPR

A critical factor in intact survival from cardiac arrest is the immediate initiation of cardiopulmonary resuscitation (CPR), which involves the bystander or healthcare worker immediately recognising cardiac arrest (the victim is unresponsive, not breathing, and pulseless), calling for help, then commencing chest compressions with the patient lying on their back. The aim is maintaining blood circulation to the brain and heart until advanced care arrives. This immediate bystander CPR is essential, as it may increase the patient’s chance of survival three-fold.

Many cardiac arrest cases occur outside of hospitals, in our homes, places of work, and on the street. This is the imperative for increased public awareness and training in CPR for laypersons, as these are crucial in improving survival rates from cardiac arrest. Realising that the person requiring CPR is most likely to be a member of your family, a friend or a co-worker should create the impetus for all of us to learn the skill. There is the option of learning to do chest compression only CPR. This is an accepted method of performing chest compressions only, and not having to give any breaths.

Another lifesaving tool is the automated external defibrillator (AED), which is a portable device that is designed to deliver an electric shock to the patient in cardiac arrest and to thereby restore a normal heart rhythm. When applied promptly to the victim, and the device senses that a shock is required, it will tell the operator to deliver the shock by pressing a button. This is called defibrillation. As said before, defibrillation within the first few minutes can improve survival rates up to 70 per cent. The Heart Foundation of Jamaica advocates for these life-saving devices to be mandated for government offices serving the public, as well as all venues in which crowds exceed 1,000 persons.

CHAIN OF SURVIVAL

Time is the most important element in what is called the chain of survival during cardiac arrest. The chain consists of early recognition and activation of the emergency response system, early CPR, rapid defibrillation (AED), effective advanced life support, post cardiac arrest care and recovery and rehabilitation. All the links in the chain are time-dependent. Any delay in one link can significantly reduce the chance of survival and good recovery.

The efforts to improve survival rates from cardiac arrest in Jamaica face many challenges. These include:

• Lack of Public Education- low knowledge of CPR, bystanders simply not knowing what to do

• Fear of causing harm and hesitation due to worry of making the situation worse or facing legal consequences

• Lack of AED availability- No public access defibrillation policy requiring AEDs to be available, and if available may not be accessible in a timely manner

• Cultural views and practices that lead to inappropriate interventions and delays in care

• Delayed recognition – Bystanders may misinterpret or ignore the victim’s condition.

• Absence of a formal EMS in most urban centres, leading to delays in transport

• Resour--challenged hospitals.

However, the initial response by bystanders sets the tone for the eventual outcome of the victim.

These challenges clearly highlight the importance of widespread training and public awareness campaigns. This advocacy and knowledge-sharing is a part of the Heart Foundation of Jamaica’s mandate.

In conclusion, the speed at which CPR and defibrillation are administered will determine whether the patient lives, suffers permanent brain damage, or dies. Every single second counts towards the difference between life and death, or between full recovery and lifelong disability. Increasing public awareness, training, and access to AEDs are essential to improving survival outcomes. Equipping communities with the knowledge and the tools can transform bystanders into lifesavers. Ultimately, a quick and effective response can save lives — proving that, in cardiac arrest, time is life, and every second counts.

Dr Hugh Wong is director of emergency cardiac care at The Heart Foundation of Jamaica. Send feedback to columns@gleanerjm.com