If your heart stops…let it be at the craps table

Ah…ah…ah…ah…Stayin’ Alive.

The moment your heart stops pumping blood is the moment you stop being alive.

Every minute that passes without intervention exponentially decreases your odds of ever living again. Five minutes after a cardiac arrest, your chances of recovery are 10 percent. And by 10 minutes your odds of life are zero.

Medicine has made amazing strides in treating and managing heart failure in the hospital, but unfortunately, most of our hearts will ultimately stop somewhere out on the street, or in our homes, or in a Starbucks. And the only one who can keep you alive during those crucial first few minutes is a bystander. A stranger, a neighbor, your child, anyone willing to perform CPR. Newly minted doctor Avir Mitra explored the subject of bystander CPR and some of the advances that could help more people survive cardiac arrest in the future.

The story begins with Amanda Pitt, a 4th grade school teacher in Philadelphia.

“Okay, so I was about half way through a run,” Amanda recalled, “and there’s a big space next to me, and a car pulled into it. I could immediately see that there was something wrong with the person in the passenger seat. I don’t know whether she was having a seizure.. something really strange was happening with her. And then she looked like she went unconscious.”

What happens when you’re worried that someone may be in serious trouble, that they may be in cardiac arrest?

Amanda asked, “Do you need help?”

The driver said yes.

“They opened the car door and pulled the person out onto the ground, who was kind of stiff and unconscious and her lips were turning blue,” said Amanda.

What would you do if you were in her shoes right at that moment? The sad truth is, if you’re like the vast majority of us, you would do nothing. You wouldn’t save this person’s life.

“Unfortunately, they say about over 1,000 people die a day due to sudden cardiac arrests in the United States. And in the US they have a poor chance of surviving because people aren’t doing CPR, and they’re afraid to do CPR,” notes Jon Erbayri, the program director for EMS education at the department of Emergency Medicine at Drexel University College of Medicine.

Jon believes there are three main reasons why people hesitate to do CPR: “One is fear of failure, not really being sure of what to do.” The second is fear of infection. “And lastly is the fear of litigation.”

Think about all the advances we as a society have made in cardiac care—bypasses, stents, transplants, quicker ambulance to hospital times, statin drugs, aspirin—we’ve cut the amount of people dying of cardiac causes by a lot.

But the weak link, it turns out, is us—the bystander who could utilize CPR to keep someone alive till an ambulance arrives.

“And unfortunately,” adds Jon, “it’s tracked very well here in the U.S., that if you were to have a cardiac arrest outside of the hospital, you have a very bleak chance of surviving. [The rate of survival is] anywhere as low as eight percent.”

Statistically, the national average for surviving a cardiac arrest is about eight percent. Looking at that another way, if your heart stops you have a 92% chance of dying right then and there and never making it to any modern medicine at all. Those are dismal numbers in this era of modern medicine, and according to a lot of experts in the field, they could be a lot better.

We know this because there are certain special places in the country where you have a much better chance of surviving a cardiac arrest. (You’re probably thinking I’m talking about a hospital right? Or maybe the white house? Nope.)

“So there was a study in casinos that found that if you have a cardiac arrest in a casino you actually have a 75 percent chance of actually surviving that cardiac arrest,” notes Jon. Even hospitals don’t do that well.

“The reason is, they have cameras everywhere so they actually see when someone collapses,” added Jon. “And then all the security guards and dealers are trained in CPR and how to use a defibrillator.”

(Mental note: if you think your heart’s going to stop, get on a slot machine ASAP.)

But how do we make the outside world more like a casino?

Jon notes: “There are other areas of the country that are higher than the national average. Seattle, King County Washington. Their 2014 statistic is they save 62 percent of people who have an out of hospital witnessed cardiac arrest, which is outstanding.”

Why King County and not other places?

“In the state of Washington, to graduate high school you have to have CPR training, it’s a law,” states Jon. So Washington state addressed the first concern—fear of failure—by exposing every high school graduate to CPR at least once. And Jon’s second concern—the fear of infection—well that’s being countered by a new type of CPR that is showing great results and may soon become the norm. It’s called hands-only CPR.

“They removed mouth to mouth for patients. So that kind of took away the fear of infection, so you don’t have to worry about getting any body fluid on you if you’re doing hands only CPR,” says Jon.

All the “icky” mouth to mouth is gone, plus no remembering ratios of compressions to breaths. With hands only CPR, you just do chest compressions because it turns out compressing the chest also squeezes the lungs and moves some air, and people can survive for a while with the oxygen they already have, as long as their heart (or your hands) are pumping the blood around. In fact, studies have shown that survival rates are higher among those that who receive chest compressions vs chest compressions and rescue breathing.

And as for the third fear—the fear of litigation—Good Samaritan laws cover people who try to help in an emergency.

“You won’t be sued if you are to help in an emergency situation,” says Jon.

Okay, so we’ve got three good ideas that could save lives immediately: CPR training for all students (which, by the way, became law in New Jersey and Delaware this academic year), hands-only CPR, and good Samaritan laws that are already in effect. But along the way I started hearing about a possible fourth solution—an app called PulsePoint created by a retired California fire chief named Richard Price. His creation was born from tragedy.

“I was out to lunch one day, and heard a siren, saw the crew coming in, passing through the street right front of me, and to my surprise they pulled up right in front of the restaurant where I was eating,” states Price. “And right next door, somebody had a cardiac arrest. They were just feet from me, literally 20 or 30 feet away from me. But I was unaware of it. So even as the firechief, trained in CPR, I wasn’t aware of that great need so nearby.”

Think about that—you could have the world’s best CPR instructor next door to a cardiac arrest, but they would never know.

“So after experiencing that and thinking about how the firefighters knew about that cardiac arrest when I didn’t, it was because they were dispatched to it. They had radios and they didn’t need to see someone in need. I didn’t have a radio at the time but I always had my cell phone with me.”

And the idea hit him. A GPS enabled app could be the perfect tool to alert CPR trained people of a nearby cardiac arrest.

“We didn’t know if it was possible to actually accomplish it,” said Price.

But, with the help of interns from the Northern Kentucky University, paid in Doritos, Pepsi’s and housing, as he puts it, he built PulsePoint. The app interfaces with the local 911 dispatcher via software installed on the dispatcher’s computer. Now when the 911 dispatcher alerts the ambulance of a cardiac arrest, that same message gets pushed to PulsePoint users who are near the arrest.

“You know, you’re here, the patient is here, and here are the AEDs around you,” says Price. (AED’s, by the way, are defibrillators—publically located pads that can deliver a shock to the heart to reboot it). CPR keeps the patient alive till help arrives, but an AED, if used properly, could actually fix the heart right then and there. Anyway, the point is, the app is an attempt to bring the solution to the problem.

As for Amanda Pitt, whose jog was interrupted by an unresponsive woman in the passenger seat of a nearby car…

“Well I helped the guy pull the woman onto the curb so we could look at her, so we laid her out on the pavement, her lips were blue, and she clearly wasn’t breathing. And so I started doing mouth to mouth resuscitation and then someone who was directly across the street who happened to be working out at Crossfit, saw what was going, and ran over to help and started doing compressions.”

“It’s hard to tell time in these kind of situations, so I’m not sure exactly how long this was going on,” continues Amanda, “but then she started to kind of gasp, so we stopped and just sort of watched her. She was sort of gasping randomly for what seemed like a couple minutes, and then she started to breath normally and woke up.”

Amanda’s quick thinking created a situation that only happens eight percent of the time.

“As soon as the guy saw that she was alive again, the driver, it was clear that he wanted to get her in the car and get away. Because I’m pretty sure that this person had had a drug overdose, and so he wanted to get out of the scene of the crime!”

Well maybe that’s not the Hollywood ending we were looking for, but it’ll do.

Jon, for his part, travels every year to the Pennsylvania state capitol in Harrisburg, lobbying his local politicians to include CPR training in high schools, like they do in Washington State. He says every politician regardless of party completely supports the idea, and that they’ll…you know…be in touch. Year after year, little seems to change.

So Jon and his Drexel University EMS colleagues have taken it to the streets, literally, with a program they call “Sidewalk CPR.”

“We’ll set up a little station or table with CPR mannequins,” says Jon, “and be like ‘Hey, you wanna learn how to save someone’s life?'”

Learn how to save a life in a minute? Well it turns out I do, in fact, have time for that. And I’m signing you up for the lesson too. So here’s the one minute tutorial on how to save a life. You ready?

Jon describes the process: “Okay, so basically what we’re going to do is just a quick two steps. So if you see somebody who is laying on the ground and not moving, you need to call 9-1-1. That’s your first step, to call from your cell phone or send someone else to call 911 and say there’s a man down. And then you’re gonna come over and you’re actually going to lift up their shirt and see if they’re breathing. If they’re not breathing, you’re going to put your hands right in the middle of their chest and just start pushing hard and fast.”

How fast? The ideal speed is ironically the exact tempo of “Stayin’ Alive” by the Bee Gees, so that should be your CPR theme song.

“So you just keep doing that until help arrives, and you could possibly save this person’s life. It’s as simple as that,” concludes Jon.

Welcome to the future of CPR —clean, simple, easy, and hella retro.