[uberuberuber]

Critical care medic here. Adult CPR at least has some evidence in its favor on a population level, but only as a bridge to using electricity. CPR alone is merely slowing deaths arrival.

There is NO evidence to support any of the commonly used advanced cardiac life support drugs in terms of functioning brain leaving the hospital. Epinephrine (for arrest, not shock or anaphylaxis), atropine, lidocaine, amiodarone, procainamide, digitalis, etc. Its electricity or bust.

Just one of many reviews on this: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4129833/

[w10-1]

"only as a bridge to using electricity"

The key point is that the AED (automatic electric defibrillator) will tell you if you have a shockable rhythm.

Many modern AED's can be used by untrained people, so if you see a cardiac arrest, find the nearest AED and deliver it and/or follow its (brief) instructions. Once you know this, you'll start tracking the last one you saw, and you'll find them more ubiquitous than you realized (and start advocating for one in your office).

(And if you are doing CPR, the breathing part is less important than the chest compressions. Blood flow is more important than oxygenation. But always/only follow current guidelines/training.)

[bsder]

> (And if you are doing CPR, the breathing part is less important than the chest compressions. Blood flow is more important than oxygenation. But always/only follow current guidelines/training.)

The problem is that this advice is situational.

If electrocution is what caused the cardiac arrest, it is much better to give breaths than compressions. The heartbeat system resets itself before the respiratory system. The problem is then that the heart is back, uses up all its energy reserves, but there is no oxygen to replenish and the heart goes back into arrest.

[7a1c9427]

> If electrocution is what caused the cardiac arrest, it is much better to give breaths than compressions. The heartbeat system resets itself before the respiratory system. The problem is then that the heart is back, uses up all its energy reserves, but there is no oxygen to replenish and the heart goes back into arrest.

Can you provide a reference or citation to this claim and practice?

It is always much better to give "conventional CPR" (breaths and chest compressions) if suitably trained.[1] If not suitably trained you are more likely to a) perform CPR and b) do it effectively if not providing mouth to mouth breathing.[2][3] You can argue about the nuance of particular patient groups where there is potentially a statistically significant benefit of providing conventional CPR over compression only.

Under no circumstances are there benefits to providing rescue breaths without chest compressions (as your comment seems to recommend).

[1]: https://pubmed.ncbi.nlm.nih.gov/21273279/ [2]: https://pubmed.ncbi.nlm.nih.gov/7726702/ [3]: https://pubmed.ncbi.nlm.nih.gov/17420082/

[bsder]

I think it was a while ago down a rabbit hole from the "Kiss of Life" picture talking about respiratory arrest. However, I can't find a substantiated source anymore so I will absolutely defer to your sources.

[FireBeyond]

> Many modern AED's can be used by untrained people, so if you see a cardiac arrest, find the nearest AED and deliver it and/or follow its (brief) instructions.

AEDs are specifically designed to be used by untrained people.

Don't bother doing anything with ventilation unless it's a pediatric patient who arrested specifically because of an airway issue (foreign body, near-drowning). We (EMS) will ventilate with high flow oxygen and intubate on our arrival, but even for us, it still comes a distant second to compressions and electricity.

With adults, blood can remain sufficiently oxygenated for cellular respiration/metabolism for about 8 minutes of compressions. Survival rates for adult CPR as a rough average go down about 10% for every minute of compressions required.

[elevaet]

What's the fastest way to find the nearest AED?

[jdietrich]

In most countries, by asking the emergency dispatcher when you call for an ambulance. Start chest compressions, get someone to call for an ambulance, then worry about finding an AED.

[stbede]

At least where I live, it's a requirement in order to operate a business. If you go anywhere and ask for their AED and they don't have one they can be shut down.

[truculent]

In the UK, many old phone boxes have been converted to house defibrillators:

[0]: https://www.independent.co.uk/news/uk/home-news/red-phone-bo...

[1]: https://www.communityheartbeat.org.uk/convert-phone-box

[7a1c9427]

Depending on your country the GoodSAM app potentially has good mapping/coverage of AED locations: https://www.goodsamapp.org/aed

[kej]

There's an app for that: https://www.pulsepoint.org/download

[brianwawok]

As far as I can tell, many modern CPR classes dropped the breath part. Just focus on the chest part.

[thaumaturgy]

Sort of. CPR classes are divided into, at least, "CPR" and "BLS". Your basic CPR class may be a hands-only training, but the BLS classes still include rescue breathing and AED use, along with infant care.

[grogenaut]

Took a BLS course in the last year in the US (PNW)... they barely covered breathing. I'm not actually sure, from taking it, when I would do breathing. They did a lot on the AED. I should re-watch the video.

[thaumaturgy]

Ah. I have a current AHA BLS cert. My understanding is, do breathing if you think there is a clear airway, and you have the appropriate PPE depending on the fluids on/around the person's mouth, and either you are doing compressions because there is no pulse or there is a pulse but the person is not breathing on their own. If you do choose to do rescue breathing, it's important to watch for chest rise to ensure that you're not breathing into their stomach, which is ineffective and will induce vomiting if the person regains consciousness.

There is a decision tree there that some people may be uncomfortable with in an emergency.

I welcome corrections from people with better training than mine.

[Encrypt-Keeper]

I renew my AHA BLS cert every other year as a requirement for my EMT certification. You do breathing when you have a second rescuer available to do compressions.

[lazyasciiart]

I just did my cert in the PNW this month - there was plenty of time spent on breathing, but also emphasis that doing compressions is the important part. Interestingly, the instructor thought this change was mostly due to amateurs being far less comfortable with giving breaths and being likely to refrain from CPR altogether if they thought it was necessary to do the breathing.

FWIW I have done it by video during covid and in a live class before and after, and I did find it much more engaging and memorable in person. It was surprising to realize that, but simply having the additional sense memories seems to have made a big difference to retaining the information.

[dreamcompiler]

EMT here. I've had exactly one save in my career from CPR without external defibrillation. That save happened only because of epi, and the patient was disconnected the next day because of brain death.

So yeah, CPR is great but if you don't also have an AED, it's just theater.

Caveat: If you call 911 [in the USA] they will bring an AED! So don't let the fact that you don't own an AED stop you from starting CPR. Just be sure somebody calls 911 also.

[Daub]

Glad you said this. I have delivered cpr twice: once to my lecturer at school, the other to a stranger in the street. Both times they died. The experience of seeing people freak out when they saw their loved one dying completely devastated me out. Still now the memories are painful.

I told my father, who worked in medicine. He recommended that unless there was a defibrillator nearby, I walk away next time I see someone having a heart attack.

[JshWright]

Just to be clear, a "heart attack" commonly refers to a myocardial infarction (part of the hear tis being deprived of blood, generally due to an obstruction in a coronary artery). Someone in the early stages of a heart attack will generally (but not always) experience chest pain/etc, anxiety, shortness of breath, etc.

A heart attack can lead to cardiac arrest, where the heart stops beating effectively and the patient loses consciousness. Cardiac arrest is the scenario you're talking about (where CPR is indicated)

[Daub]

Thanks for the clarification.

[snowwrestler]

> So yeah, CPR is great but if you don't also have an AED, it's just theater.

There’s at least one scenario where this is less true: drowning. An otherwise healthy person, pulled promptly from the water but not breathing, has a chance of being revived with CPR.

There are a lot of drowning situations where an AED or EMT are far away, and CPR should definitely be attempted.

[dreamcompiler]

True. And drowning is one of the few CPR scenarios where early ventilation may be more important than early chest compressions. Follow medical direction and local guidelines to be sure.

[LorenPechtel]

If it's just theater without an AED then why was it done before the AED came about?

[dreamcompiler]

Manual defibrillators have existed decades longer than automatic ones. Even without an AED immediately available, CPR is useful as long as someone has activated EMS (i.e. called 911). EMS always carries a defibrillator (whether automatic or manual) and CPR buys the patient time until EMS arrives.

My point more precisely should have read "CPR with no possibility of prompt defibrillation is mostly theater."

[sacnoradhq]

TLDR:

1. AEDs should be everywhere.

2. CPR isn't perfect but it works sometimes.

-----

1. Get an AED if you can and keep it near your home and/or vehicle.

2. Just don't expect complete recovery miracle revivals like the movies.

[JumpCrisscross]

Would it make sense for households with those at risk of heart attack to invest in an AED?

[robbiep]

The most common cause of sudden cardiac death is blocked left anterior descending artery.

Generally this is unknown until it happens.

It kills 250,000 Americans every year.

It would make the most sense for people above 50 with a family history of heart disease to have a CT coronary angiogram or for those above 40 to have a Cardiac Calcium Score to risk stratify for future CTCA.

Distributing AEDs is infrastructure heavy and indiscriminate because you don’t know who actually needs one.

[tomatocracy]

In the UK, in addition to what the sibling comment mentioned about phone boxes, a lot of workplaces now have AEDs on site (eg I know mine does) and they're also common at large-scale events. I don't know if there are any statistics on how much good they've done but that seems like quite a sensible approach to me as you can presumably get quite a lot of population coverage quite cheaply.

By contrast, a CT coronary angiogram I suspect is rather more resource heavy - in particular I suspect having enough qualified cardiologists to interpret the results (not just having CT machines and staff to administer the test) might be a bottleneck (anecdotal, but having had one myself due to family history of heart disease, I had a longer wait for results after the scan than to get the scan itself).

[robbiep]

It’s risk stratification vs preventative care. You don’t WANT someone to have a heart attack and require the AED, because you’ve only got a 5-20% chance of making it out of hospital.

These things are not équivalant!!!

Risk stratification for AEDs at work and public events, whereas screening should increasingly be part of the plan particularly if you have a family history (defined as 1 or more relatives who died younger than 65 from a heart attack)

CTCA doesn’t require a cardiologist, just a radiologist, but a cardiologist referral makes it free (in australia) otherwise it’s $500. Which is pretty good really

[gerdesj]

Quite a lot of people/families can find £500-1000 for something important. The more that can, the cheaper it will become.

AEDs/Defibs are just an expensive battery powered thing, that we just don't bother to discuss. With around an hour or less training, you can expect to be at least 10x more effective than the best CPR. CPR is horrible to deploy and very complicated but I will if I have no choice.

[robbiep]

They’re not equivalent though! An AED means your heart muscle has been absolutely trashed and will never be the same again. Plus, there’s still the issue of who actually needs an AED in their house, and if you know that, they’ve probably got an IED.

Whereas if you can for the same cost have a scan after being reviewed appropriately, you can avoid the heart muscle trashing. That is nothing short of a miracle in terms of the extension of lifespan available

[Aeglaecia]

can you provide sources for AED trashing the heart muscle ?

[sacnoradhq]

There's a cardiologist dark joke about this.

We should be sending ~10 million more patients to the cath lab prophylactically to get a baseline.

[moffkalast]

Well as long as it only kills Americans, then the simple solution is to emigrate /s

[jdietrich]

Generally not, for two reasons.

Firstly, the people most at risk of cardiac arrest are unlikely to regain any meaningful quality of life after resuscitation. An AED might bring a very elderly and/or very ill person back from the dead, but more often than not they'll be just barely alive afterwards, which is not an outcome that most people would choose for themselves. People who are close to the end of their natural lives would benefit much more from serious conversations about end-of-life care than expensive gadgets and false hope.

Secondly, most of the risk of cardiac arrest in younger and relatively healthier people is preventable. If you're not a frail elderly person but you consider yourself at risk of cardiac arrest, it's very likely that you're at least one of: obese, sedentary, hypertensive, poorly-managed diabetic. Before you go out and buy an AED, give some serious thought to what kind of state you'd be in after surviving a cardiac arrest and to whether you'd rather take meaningful action to improve your health now.

Some people with cardiac abnormalities might be good candidates for an at-home AED, but they'd generally be better candidates for an ICD. A young and otherwise healthy person with a condition like LQTS, Brugada or severe HCM is at very real risk of sudden cardiac arrest, but the most likely trigger for that arrest would be strenuous physical exercise - something that most of us don't do in our own homes.

[rdmirza]

Even better is installing an implantable cardiac defibrillator (ICD) in those at high risk.

[noughtme]

> at high risk.

Before an event? I’m not sure what insurance would cover this. I don’t really want open heart surgery before I need it.

[Calavar]

Plenty of insurance plans cover ICD implantation because it is recommended by the American College of Cardiology for specific situations:

1. moderately to severely reduced systolic function of the heart due to a heart attack that persists > 40 days after the heart attack

2. severely reduced systolic function of the heart of any cause that does not improve after 3 to 6 months of pharmacologic therapy

3. personal history of sudden cardiac death with a persistent risk factor

ICD implantation is not open heart surgery. It is a relatively quick procedure that is done by a cardiologist rather than a cardiothoracic surgeon.

[plugin-baby]

> personal history of sudden cardiac death with a persistent risk factor

Personal history, or family history? Maybe this is a technical term? As a non-medic I can’t imagine there are many people who have a history of sudden death AND a persistent risk of it happening again.

[Calavar]

Personal history.

"Many" is relative. We are talking about a fraction of a percent of the general population, but if you are looking specifically at the population of people who have some form of long standing heart disease, it's not terribly rare. I don't work in cardiology specifically, and even so I encounter one or two patients a year who have had an ICD placed for reason #3.

Persistent risk factors include things like or overgrowth of muscular heart tissue (which has dozens of causes, but the most common is severe, long standing coronary artery disease) or scarring of the heart after a heart attack.

Persistent risk factors are not rare at all. The thing is that most people who fall into bucket 3 also fall into buckets 1 or 2. So in an ideal world they would have already seen a cardiologist and had an ICD placed before they ever had an episode of SCD. And of course many of those who do have SCD don't survive long enough to have an ICD placed.

If you are interested in reading more, you can search for "secondary prevention of sudden cardiac death" or "secondary prophylaxis of sudden cardisc death." There are some good review articles available online.

[gerdesj]

I would say yes. Some of the answers here are referring to population stats and you are worrying about your particular circumstances, which is different.

If someone you come across (family, stranger, whatever) keels over you need to, without proper medical knowledge, diagnose the issue and then administer appropriate treatment. Oh and could you do it within a couple of minutes please.

CPR should be a last resort - it can be rather barbaric. A defib has a way better chance of success and won't break your ribs.

A defib costs around £1000 or so. Hopefully that money is wasted.

[dreamcompiler]

More important: Call 911 and start CPR. 911 will always bring a defibrillator.

[ericd]

At $1k, it’s not a no-brainer, but it’s also not that expensive in the context of the risk it counters.

[stbede]

They are about $500 on the cheap end if I'm not mistaken.

[FireBeyond]

Same here. And yup. Early effective compressions and early access to defibrillation.