The American Heart Association's advisory statement advises that "All victims of cardiac arrest should receive, at a minimum, high-quality chest compressions (i.e., chest compressions of adequate rate and depth with minimal interruptions)". Trained or untrained bystanders should at least call the emergency medical response system (call 112 on a cell phone or 10177 on a landline in South Africa), and start and continue high-quality chest compressions by pushing hard and fast in the centre of the chest, minimizing interruptions.
The American Heart Association suggests that when a trained or untrained bystander witnesses the sudden collapse of an adult, at a minimum, "hands-only" CPR should be initiated. Akin to and in support of both the American Heart Association and the European Resuscitation Council viewpoint, the Resuscitation Council of Southern Africa advises that CPR should follow the 2005 Guidelines for CPR and Emergency Cardiovascular Care, alternating 30 chest compressions with 2 mouth-to-mouth ventilations. Only in the situation where rescuers are unwilling, unable or not confident to give mouth-to-mouth breaths should chest compression-only CPR be performed. It is better to do compression-only CPR than no CPR at all.
Bystanders who witness the sudden collapse of an adult should immediately assess the patient for a response. If the patient does not respond in any way, the Emergency Medical Services (EMS) should immediately be activated. Call 112 on a cell phone or 10177 on a landline to access the EMS. The victim should be placed on a firm, flat surface and in the absence of normal breathing, 2 mouth-to-mouth breaths can be given. Once these 2 breaths have been administered, the victim's chest should be compressed, using the palms of both hands placed on the centre of the chest between the nipples, 30 times at a rate of 100/minute (almost 2 compressions per second). Alternate 30 chest compressions with 2 mouth-to-mouth ventilations. Continue these cycles until an Automated External Defibrillator (AED) arrives and is ready for use or until the EMS arrives.
If however, the rescuer is unable or unwilling to do mouth-to-mouth breaths, then chest compression-only CPR is the next best option. Pushing hard and fast in the middle of the victim's chest, with minimal interruption, is the most vital part of the CPR effort.
CPR at its simplest requires a rescuer to:
- Call for help immediately if the victim is unresponsive,
- Push on the chest if the victim is not breathing normally, and
- Recharge the heart with an Automated External Defibrillator (AED) when one is available.
This "Simply CPR" approach, advocated by Professor Efraim Kramer of the Division of Emergency Medicine at the University of the Witwatersrand, reinforces the key concepts crucial to effective CPR. These are easily learnt and practiced, and everyone in the community and the healthcare setting is strongly advised to seek training to learn CPR.
This Statement calls attention to the dire need to know how to perform CPR. It is a life-skill that should to be taught to everyone, so that more people can help a victim of sudden cardiac arrest, to indeed help save a life! If a bystander does nothing in this situation, the victim will die. If one is willing, trained and confident, give the person 2 breaths after every cycle of 30 chest compressions. If one is unwilling or unable to give the mouth-to-mouth breaths, as the next best option chest compression-only CPR is acceptable and will be significantly more beneficial that attempting nothing at all. Something as simple as continuous chest compressions may be that's needed to give the victim their life back.
The Resuscitation Council of Southern Africa promotes CPR training to the public and health professions alike. Because effective CPR can double or triple a victim's chance of survival, this skill demands training and practice. Please consult the Council's website, www.resuscitationcouncil.co.za for further details of a Training Centre or Instructor in your area. You will not forget the day you were unable to assist a victim in sudden cardiac arrest! You can make a difference - learn CPR.
Martin Botha, Vice Chairman
Resuscitation Council of Southern Africa
Cell: 082 522 0033
Tel: 011 478-3989
Fax: 011 678-5087