Roanoke Times
Copyright (c) 1995, Landmark Communications, Inc.
DATE: MONDAY, April 2, 1990 TAG: 9003310300
SECTION: EXTRA PAGE: E-6 EDITION: METRO
SOURCE: Jane E. Brody
DATELINE: LENGTH: Long
My motivations were simple. I did not want to have to stand by helplessly and watch someone die if there was something I could do to help.
I also realized that chances are the person in need of rescue would be someone I knew - a friend, perhaps, or a member of my family.
Two years later, my husband developed severe chest pains and, as I drove him to the emergency room at 2 a.m., I mentally reviewed what to do if he should lose consciousness. But it turned out that I did not have to apply my CPR training until two weeks ago.
I was snorkeling with some fellow travelers in the Pacific off a remote island, and we suddenly realized one man in the group was missing.
It took what seemed like an eternity, but was probably about 10 or 15 minutes, to find him. He was afloat, face down with his mask in place, unconscious, not breathing and with no discernible pulse.
As he was lifted into the small boat, someone did a Heimlich maneuver to try to clear his airway of vomit and his lungs of seawater, and we immediately began CPR.
I did mouth-to-mouth resuscitation while five people took turns doing cardiac compression.
The cramped quarters on the boat made one-person CPR, which is now taught as preferable, physically impossible.
Since I was taught to keep CPR going until medical help arrived or a physician pronounced the victim dead or I was too exhausted to go on, we maintained our rescue attempt for three hours as the boat raced to a landing strip.
The plane arrived just as rigor mortis made it impossible and obviously useless to continue.
I learned later that because he had been lifeless in warm water for more than 10 minutes, there was probably no way we could have saved him without severe brain damage.
And without advanced life support to shock the heart back into action within 15 or 20 minutes, the chances of his survival on CPR alone were slim.
Though deeply saddened and drained by the traumatic event and physical effort, I also learned a lot from the experience.
I learned that even after 14 years without a refresher course, I remembered enough CPR to provide reasonable life support. I got air into the lungs with each attempt, and between respirations I was able to instruct novice volunteers to do what I believe was effective cardiac compression.
Also, I learned that despite self-doubts about being able to do CPR on a real person, when faced with a life-and-death emergency I did not panic, faint, wretch or run out of stamina.
I learned, too, that I could handle defeat. I did not feel like a failure because the man died.
But I also learned that I should have taken a CPR refresher course long ago.
Since my initial training, some of the techniques of basic life support have been modified - for example, the rate of chest compressions is now faster - and, without intervening practice, I had forgotten most of the supporting facts and several of the steps. I have now signed up for a six-hour refresher course.
Unfortunately, while more than 5 million Americans are trained in CPR each year, only a fraction maintain their skills and knowledge through refresher courses.
Studies show that even physicians and nurses forget much of what they learn about CPR within six months of training.
To foster longer-lasting retention, the techniques and method of teaching CPR have been simplified in recent years.
And improvements have been made to increase the chances that CPR will maintain an adequate blood supply to the brain and other vital organs until a machine called a defibrillator can electrically shock the heart back into action.
Experts say CPR is "as simple as A-B-C": A for opening the victim's airway (this sometimes requires a Heimlich maneuver to remove an obstruction), B for breathing your own exhaled air into the victim's lungs, and C for inducing circulation by pressing on the victim's chest to pump blood from the victim's heart.
CPR is readily learned from written material and from demonstrations and practice on a mannequin, which can show whether you are doing it correctly.
Most people can learn enough to save a life in one three-hour session.
Although at first only physicians and emergency medical aides were taught CPR, the importance of training lay people soon became apparent.
In most cases of sudden heart failure it simply takes too long for a trained professional to get to the scene in time to save both life and brain function. Within four minutes of no circulation, the brain begins to die.
Seattle, Wash., the first community to teach CPR to lay people on a large scale, demonstrated in the early 1970's that when a bystander initiated CPR, chances of survival increased as much as fourfold.
In Seattle, the survival rate when CPR is started by a bystander is 43 percent, as against 21 percent when CPR is not started until emergency help arrives.
But Seattle also showed that it was not enough to simply train a lot of people in CPR.
For the emergency technique to be truly lifesaving, there must be a rapid-response emergency medical system that can get to the scene in 10 minutes or less.
In addition, the emergency team must be able to administer an electrical shock to the heart to jolt it back into a normal rhythm. In general, in cities with a quick-response emergency medical system and a large numbers of citizens who can do CPR, the survival rate averages 25 percent as against only 5 percent where these are lacking.
Even when CPR is done correctly and enables the person to survive long enough to leave the hospital, there is a chance of permanent brain damage.
The severity of damage is determined by how long the brain lacked an adequate blood supply.
Other risks to the victim are usually less significant, such as broken ribs from too vigorous or improperly placed chest compressions. But the alternative to a broken rib, after all, is death.
The risks to lay rescuers are considerably less. For example, the chances of contracting AIDS, hepatitis or other infectious diseases in mouth-to-mouth resuscitation are "extremely low" and should not inhibit individuals from learning or performing CPR, according to Dr. Joseph P. Ornato, a member of the American Heart Association's subcommittee on emergency cardiac care.
Ornato, a cardiologist at the Medical College of Virginia, noted that lay rescuers are most likely to perform CPR on someone they know, not a stranger on the street who might be infected with a dangerous organism that can be transmitted by blood or saliva.
Thus far, there has been no documented instance of transmission of the hepatitis or AIDS virus in mouth-to-mouth resuscitation, the American Heart Association says.
by CNB