Health Insights

Did you know roughly 70 percent of out-of-hospital cardiac arrests happen in homes? It’s an important figure to know, says the American Heart Association, and National CPR and AED Awareness Week is the perfect time to dive in deeper.

In 2007, the AHA collaborated with the American Red Cross and the National Safety Council to designate a National CPR and AED Awareness week. Congress unanimously passed a resolution to set aside the first week in June to spotlight how lives can be saved if more Americans know how to perform CPR and how to use an AED.

The expert team at UC Health is here to help. Highly trained physicians, advanced nurse practitioners and sub-specialty care providers work with researchers from the University of Cincinnati College of Medicine to uncover breakthroughs in cardiovascular medicine. In the areas of heart, pulmonary and vascular research and care, our services are known nationally for discoveries and contributions leading to compassionate therapies and treatments that help patients every day.

UC Health is the first and most experienced adult heart transplant program in Greater Cincinnati and Northern Kentucky and has earned a reputation for delivering innovative and breakthrough heart disease treatment, from left ventricular assist devices (LVADs) to transplants, and now endoscopic cardiac valve surgery.

Heart attacks and sudden cardiac arrest are two emergencies in which bystanders can immediately jump in and make a difference, often helping to save lives. You just need some basic knowledge and willingness to act.

What’s the difference between sudden cardiac arrest and a heart attack?

Heart attacks and sudden cardiac arrest are two very different medical emergencies. People often confuse the two, but understanding the difference could save someone's life.

The heart is a big muscle that pumps blood throughout the body. A heart attack happens when blood flow to part of the heart muscle gets blocked, usually by a blood clot in a coronary artery. The person suffering from a heart attack is typically conscious and can talk, though they're experiencing severe chest pain. Think of it like a plumbing problem: the pipes are clogged, but the heart is still beating.

The heart also relies on its electrical system to make sure it beats when it’s supposed to. Sudden cardiac arrest occurs when the heart's electrical system malfunctions and the heart stops beating effectively. It's like the heart's electrical system has short-circuited completely.

The key difference is that heart attack victims are usually awake and responsive, while cardiac arrest victims collapse and become unresponsive within seconds. With a heart attack, you have time to call 911 and get the person to a hospital, but cardiac arrest is an immediate life-or-death situation where every second counts - that's when you need to start CPR right away.

If you’re a bystander, how can you tell the difference?

Heart attack: Person is conscious, can speak, complaining of chest pain, may be sweating or nauseous, still breathing normally.

Sudden cardiac arrest: Person suddenly collapses, unresponsive to voice or touch, not breathing normally (gasping or no breathing), no pulse, skin may turn blue or gray.

Heart attack: Person may be clutching their chest, asking for help.

Sudden cardiac arrest: Person cannot respond or ask for help, appears unconscious or "lifeless."

What causes cardiac arrest?

Cardiac arrest – or the sudden loss of heart function – can be caused by a variety of factors. They include:

• Coronary artery disease. CAD restricts blood flow to the heart, leading to heart muscle damage and potentially chaotic electrical signals in the heart.
• Cardiomyopathy. This condition weakens the heart muscle, making it less efficient at pumping blood and increasing the risk of irregular heart rhythms.
• Heart failure. When the heart can't pump enough blood to meet the body's needs, it can disrupt the heart's rhythm and lead to cardiac arrest.
• Heart valve disease. Damaged heart valves can disrupt blood flow, leading to increased strain on the heart and potentially chaotic electrical signals.
• Arrhythmias. Irregular heartbeats, caused by malfunctioning electrical signals, can be a direct cause of cardiac arrest.
• Heart attack. A heart attack can trigger sudden cardiac arrest, especially if it leads to a dangerous arrhythmia.
• Congenital or inherited heart defects. Often diagnosed in infancy or childhood, some congenital or inherited heart defects can cause disruptions to the heart’s rhythm.

There are many non-cardiac causes of cardiac arrest too:

• Trauma. Severe injuries, especially to the chest, can cause a lack of oxygen and disrupt the heart's electrical activity.
• Electrocution. Electrical shock can directly damage the heart's electrical system.
• Drowning. Lack of oxygen due to drowning can lead to cardiac arrest.
• Choking. Obstruction of the airway can prevent oxygen from reaching the heart.
• Severe physical stress. Extreme stress, like strenuous exercise, can trigger cardiac arrest in individuals with underlying heart conditions.
• Drug use. Drugs like cocaine and amphetamines can increase heart rate and blood pressure, potentially leading to dangerous arrhythmias.
• Certain medications. Some medications, like narcotic painkillers, can also disrupt the heart's rhythm.

What is CPR?

Chances are you’ve seen CPR performed on TV or in the movies. CPR stands for “cardiopulmonary resuscitation.” It’s an emergency lifesaving procedure performed when the heart stops beating. According to the American Heart Association, 350,000 people die from cardiac arrest in the United States every year. Immediate CPR can double or triple the chances of survival after cardiac arrest.

Hands-only CPR is, quite simply, pressing hard and fast on the person’s chest to keep blood flowing when the heart has stopped pumping. CPR training is easy and even children can learn how to do it. Community organizations like the American Heart Association offer CPR training, as does UC Health.

How do I perform CPR?

CPR training is the surest way to feel confident if you ever need to perform it on someone. There are different training courses offered in the community, from free, 10-minute training on compression-only CPR, to more comprehensive courses that certify you in CPR.

The most basic steps of CPR are:

1. Check for responsiveness and normal breathing. Not responsive? Not breathing? CPR is needed.
2. Call 911.
3. Compress hard and fast on the center of the chest until help arrives.

How fast should you perform compressions? Read on for some popular songs that have the right beat for CPR, so you know you’re performing compressions often enough.

What is an AED?

An AED is an automated external defibrillator. It’s a portable machine that delivers an electric shock through the chest to the heart when it detects an abnormal rhythm and changes the rhythm back to normal.

You’ve probably seen manual defibrillators used on TV shows or in the movies too, when a clinician has an unconscious patient and says, “Charge to 200! Clear!” before applying paddles to a patient’s bare chest and delivering an electrical current that shocks their heart back into rhythm.

In a hospital, trained experts evaluate the patient and make rapid decisions including which electrical charge setting to select to use on the patient. AEDs on the other hand are designed for almost anyone to be able to use. Pads connect to the chest of the person in cardiac arrest and the AED uses voice prompts, lights and text to tell the rescuer the steps they need to take. The AED determines if electrical shock is needed or not.

How do I use an AED?

If you need to use an AED, follow these steps:

1. Turn on the AED and follow the voice prompts.
2. Remove all clothing covering the chest.
3. If necessary, wipe the chest dry.
4. Peel away the backing from the pads and attach the pads to the person’s bare chest. Use the illustration on the pads.
5. Plug the pads connector into the AED, if necessary.
6. The AED will check to see if the person needs a shock and will automatically give one or tell you when to give one. While the AED is analyzing, make sure no one is touching the person.
7. No shock needed? Resume CPR.
8. Shock needed? Make sure no one is touching the person, press the shock button, then immediately resume CPR.
9. Continue CPR until emergency medical personnel arrive.

Where can AEDs be found?

AEDs are being installed in more and more public spaces. You’ll often find them hanging on the walls of shopping malls, stadiums and arenas, convention centers, hotels, swimming pools, airports, businesses, airplanes and doctors’ offices. Look for them in areas where people gather, like cafeterias, near elevators, on the walls in main hallways or in dining areas.

First-response vehicles like ambulances, law enforcement vehicles and many fire engines also carry AEDs.

As you seek to be someone who can help in an emergency, start by increasing your AED awareness. Make note of where AEDs are located when you’re in public places.

What is the Chain of Survival?

Knowing the “Chain of Survival” can help you understand the role you can play in helping someone survive cardiac arrest. The six links identified by the American Heart Association for the adult out-of-hospital Chain of Survival are:

1. Recognize cardiac arrest and call 911.
2. Perform CPR as soon as possible. Emphasize chest compressions.
3. Use an AED.
4. Advanced resuscitation performed by first responders, emergency medical services or other healthcare providers.
5. Care for the person after cardiac arrest.
6. Recovery. This includes additional treatment, rehabilitation and psychological support.

A strong Chain of Survival can improve chances of survival and recovery for victims of cardiac arrest.

Why is it important to use an AED and/or perform CPR?

UC Health makes it a priority to provide resources and training to improve pre-hospital care and to help the public prepare to take action in the event of a medical emergency, like a heart attack or sudden cardiac arrest. As the region’s only verified Level 1 trauma center for adults, we’re dedicated to ensuring that everyone in our community has access to the highest level of care—whether that’s inside or out of the hospital.

Without CPR, brain damage or death can occur in minutes. The average EMS response time is nine minutes, even in urban settings, and after 10 minutes, there is little chance of successful resuscitation. The American Heart Association estimates that effective bystander CPR can double or triple a person’s chance of survival.

AEDs are a critical part of responding to cardiac arrest. According to the American Heart Association, a person’s chance of surviving drops by seven to 10 percent every minute a normal heartbeat isn’t restored.

CPR combined with using an AED provides the best chance of saving a life. If possible, use an AED every time you perform CPR.

When should you perform CPR vs. use an AED? (Hint: you need both for cardiac arrest.)

You should use both CPR and an AED together when someone is in cardiac arrest. They work as a team, not as alternatives to each other. The key is recognizing when someone needs either intervention: if a person is unresponsive and not breathing normally (or not breathing at all), you start CPR immediately and get an AED as quickly as possible. Don't wait around trying to decide between which one to use.

Here's the typical sequence:

1. Start CPR right away while someone else calls 911 and locates an AED.
2. Once the AED arrives, attach the pads while continuing chest compressions until the device is ready to analyze.
3. The AED will tell you whether a shock is needed. If it says, "shock advised," everyone steps back and you deliver the shock, then immediately resume CPR.
4. If it says, "no shock advised," you skip the shock but keep doing CPR.

The AED is specifically designed to detect heart rhythms that can be "reset" with electricity, but even when it can't shock, the heart still needs CPR to circulate blood to vital organs.

How can the right beat help me perform CPR?

The key to performing CPR is to deliver chest compressions firmly and quickly. Think about the beat of some of your favorite songs. Some songs are slow, some are fast, some are in between.

Thinking of a song with a rhythm of 100 – 120 beats per minute helps you maintain the proper compression rate. One favorite from the UC Health CPR educators? “Stayin’ Alive” by the Bee Gees, it’s around 104 beats per minute.

What are some of the favorite songs of UC Health’s cardiovascular and emergency services teams for CPR?

If you’d like more ideas for songs that have the right beats per minute for CPR, the team of experts at UC Health likes the American Heart Association’s “Don’t Drop the Beat” playlist on Spotify.

With 195 songs spanning 12 hours, it’s a great list of diverse songs that get a seal of approval from our expert CPR educators. Some of the songs on the list include:

• “Poker Face” by Lady Gaga
• “Can’t Stop the Feeling” by Justin Timberlake
• “Call Me Maybe” by Carly Rae Jepson
• “I Wanna Dance With Somebody” by Whitney Houston
• “Billie Jean” by Michael Jackson
• “Eye of the Tiger” by Survivor
• “Country Girl: by Luke Bryan
• “Ring of Fire” by Johnny Cash
• “Take a Chance on Me” by ABBA

With songs that span decades and genres, consider saving the playlist and listening to it when you’re exercising, running errands or working around your home. You’ll familiarize yourself with the beat you may need to save someone’s life. 

How can UC Health help me with CPR or AED training?

Take10 Cincinnati is a grassroots effort involving citizens, rescuers and physicians designed to educate the community about compression-only CPR, an easy-to-learn technique that can save lives.

Developed by Take Heart Austin and brought to Cincinnati by UC Health, Take10 is free, 10-minute training on hands-only CPR.

Other resources in our community for CPR and/or AED training include:

• UC Health – CPR training and AED training
• UC Blue Ash College – CPR/AED workshops
• American Heart Association – First aid courses, plus CPR and AED training

Take Your Life-Saving Skills to the Next Level

Download the PulsePoint Respond app. This 911-connected app alerts you when someone nearby is in need of CPR. If you're trained in hands-only CPR, you can opt in to receive these alerts and help save lives in real time. Join a life-saving network and make an immediate impact in your community

What should you do next?

Knowledge is power when it comes to emergency preparedness. The more people in our community who receive CPR training, the better chance we all have of surviving a sudden cardiac arrest.

If you’re interested in setting up training at your business or community group, visit: https://www.uchealth.com/heart/education-and-training/community-education/.