In the 2010 AHA Guidelines for Cardiopulmonary Resuscitation in the United States, there is indeed a reference to [cough CPR], which is recommended as Class IIb, Evidence Level C, and is described as follows: [cough CPR] can be considered in the following situations: for example, patients in cardiac catheterization room, in conscious, supine position and ECG monitoring conditions, if the patient can be instructed
Driving alone in the wild, you suddenly feel stuffy in your chest and almost unable to breathe. A sharp pain spread from your chest to your chin and arms. Your whole body became inexplicably nervous and you felt like you were going to faint. Shit! There is no first aid medicine on the bus, you want to shout [help], but there is no shop in front of the village or behind it, there are no pedestrians or vehicles in the past, and the cell phone has no signal…
What should I do at this moment?
First of all… don’t panic!
Quickly cough loudly and hard!
Some people wonder: Can active cough actually be used to save lives? In fact, this is based on science.
When sudden cardiac death occurs, All have a short awake period (about 10 seconds). Cough in this short period of a few seconds can quickly oxygenate the brain and prolong the awake time. Because cough will increase the pressure inside the thorax, squeeze the heart, accelerate the heart contraction and increase the amount of blood discharged, thus promoting the blood circulation of the whole body, delivering oxygen from the blood to the brain and keeping oneself awake.
We need to clarify two questions: Is cough really effective? If it is effective, is it really feasible?
First, cough cardiopulmonary resuscitation, Is real and effective, And referred to in authoritative guidelines, The pathophysiological mechanism analyzed above is also basically correct. Cough-CPR is mentioned in the 2010 and 2015 AHA guidelines for cardiopulmonary resuscitation in the United States. But the guide is also very clear: Cough cardiopulmonary resuscitation studies are only available in patients with ECG monitoring during cardiac interventional surgery. Once malignant arrhythmia occurs, the surgeon will immediately let the patient cough effectively before losing consciousness. Such cough can sometimes terminate the arrhythmia. Although some patients cannot terminate, it can prolong the time to maintain consciousness (up to 92 seconds).
However, not all patients have an effective cough, It can be seen that this cough still needs to have a certain level. Therefore, Effective implementation of cough cardiopulmonary resuscitation, Several conditions must be met: Involved in the operating room, In the presence of a professional doctor, There is sufficient ECG monitoring, other perfect first aid equipment, and when the patient’s consciousness is very clear, he can actively cooperate with the doctor’s guidance. It can be said that [timing, geographical location, human harmony] is indispensable. For most people outside the hospital or even without ECG monitoring in the hospital, they have no idea that arrhythmia occurred in what.
The awake period described above is about 10 seconds, This is the total time from the occurrence of malignant arrhythmia-the heart loses its ability to pump blood-the interruption of cerebral blood flow. Cough resuscitation should be carried out at the beginning of malignant arrhythmia. Most people will not have any symptoms when malignant arrhythmia occurs. It was only when the heart lost its pumping function and the brain was ischemic that it suddenly fainted. Therefore, cough cardiopulmonary resuscitation is not feasible. Therefore, the guidelines clearly state that cough cardiopulmonary resuscitation cannot be used for patients with slow response, and should not be taught to ordinary rescuers. It seems that this [side-of-the-way] technology is really not suitable for dissemination to the general public.
So, how to face cardiac arrest (sudden cardiac death)? Prevention is far more important than cramming for the last minute. It would be much easier to say that watching a few moves online can save cardiac arrest.
First of all, we must establish the concept that [prevention] is far better than [treatment]. The prevention of cardiac arrest (sudden cardiac death) mainly focuses on 5 groups of people:
1. People who survived previous cardiac arrest;
2. Patients with severe heart disease (such as advanced heart failure) at high risk;
3. Primary prevention of patients with organic heart disease (abnormal cardiac structure);
4. Patients with hereditary arrhythmia have a family history of sudden death;
5. Primary prevention for the general population, including those who may have hidden heart diseases but have not been found before.
Regular health check-ups, To include electrocardiogram and cardiac color Doppler ultrasound, If an abnormality is found, It is necessary to actively consult with professional doctors, Some of the family members died suddenly when they were young and middle-aged. It is even more necessary to go to cardiovascular specialties, especially arrhythmia specialties, Perfect the relevant examination. For patients with heart disease, regular outpatient review is very necessary, try not to live alone at home. For those who live under great pressure, when finding symptoms such as repeated palpitation, sudden fainting and extreme fatigue, they also need to actively seek the help of specialists.
However, if cardiac arrest really occurs, how should it be handled?
As just mention, From the beginning to the loss of consciousness before cardiac arrest, There may be no special symptoms and it is difficult for individuals to save themselves, but family members, colleagues or other witnesses may provide key help. Timely and effective cardiopulmonary resuscitation is the most important measure to save patients with cardiac arrest. In order to better protect the people around you, actively participating in cardiopulmonary resuscitation training is the best way.
References:
1. Douglas L. Mann, Douglas P. Zipes, Peter Libby. Braunwald “s Heart Diease A Textbook of Cardiovascular Medicine, Tenth Edition. [M] Saunders. P853-p854
2. American Heart Association Guidelines Update for Cardiopulmonary 2015
Resuscitation and Emergency Cardiovascularized Care. Circulation. 2015; 132 [suppl 2]: S315-S589.