Saving Victims of Heart Attacks

Many persons whose hearts have stopped for up to five minutes or so are now physically fit and able to do all the things that they did before their heart attack. Swift action by persons who were near at hand saved them. They knew what to do. Would you know? Could you save a life?

It is not as difficult as you may think. In some places many of the general public are being taught the very effective lifesaving procedure called cardiopulmonary resuscitation, or CPR for short. It is a combination of external heart massage and artificial respiration. If you have the opportunity, it would be fine to receive a course of instruction in this procedure. However, by carefully considering the directions provided here, you may be able to save the life of a heart-attack victim—perhaps someone you dearly love.

If you find a collapsed person, there are certain preliminary steps that you should follow before beginning CPR. But you should act quickly, because an unconscious person can live for only about four to six minutes without breathing.

First, you should determine if the person is really unconscious. It could be embarrassing to start lifesaving procedures on someone who is only sleeping! So gently shake the person’s shoulder and ask: “Are you OK?” If he does not answer, check to see if he is breathing, since he may have only fainted. Do this by placing your ear close to his mouth, with your face turned toward his chest. If he is breathing, you should be able to feel his breath in your ear, and perhaps observe chest movements.

If there is no indication of breathing, it is important to open his air passage. Sometimes the tongue of an unconscious person sags backward in the throat, cutting off this vital air passageway to the lungs. Opening the airway to the lungs may be all that is necessary to restore breathing, and this is usually not difficult.

With the unconscious person lying on his back, use one hand to lift up the back of his neck gently. This will cause the head to drop backward, extending the neck. Put your other hand on his forehead and roll his head back fully, until it will go no farther. You may be surprised how far back the head will go with full extension. Having done this, the chin will be pointing almost straight upward, with the crown of the head resting on the floor. In this position the jaw and the tongue are drawn forward and the airway in the throat is cleared.

If this quick clearing of the airway does not restore breathing, begin immediately to give artificial respiration. Using your hand that is on the victim’s forehead, pinch the victim’s nose shut while, at the same time, keeping the heel of the hand in place to help to maintain head tilt. Keep your other hand under the victim’s neck (or under his chin), lifting up. Then open your mouth wide and place it directly on the mouth of the victim, and give four quick, full breaths in rapid succession. You will see his chest rise as his lungs expand.

Next, quickly check for the victim’s pulse, which tells you whether his heart is beating. The best place to locate the pulse is in the carotid artery, the major artery in the neck. To find it, take your hand from the back of the neck and slide its index and middle fingers into the groove beside the voice box. If there is no pulse, the heart has stopped and, in addition to artificial respiration, you must also provide artificial circulation to save the victim.

Artificial circulation is accomplished by closed-heart massage. This is a relatively simple procedure of compressing the chest. These compressions actually force the heart to pump blood. This often prompts the heart to begin beating again on its own. But, of course, oxygen, too, must continue to be provided, since the circulating blood is useless if it is not picking up oxygen from the lungs.

Thus, what the rescuer must do is to carry on the vital functions of breathing for the victim and at the same time forcing his heart to pump his blood. Even if the heart does not start beating on its own, if you can keep up CPR until medical help arrives, the victim may be saved. There have been cases where the breathing and the pumping of blood has been carried on artificially for hours before the victim’s own system was prompted to take over these functions.

[Box/Picture on page 9]

Exactly how should CPR be performed? A brochure from the American Heart Association gives the following concise directions:

“Kneel at the victim’s side near his chest. Locate the lowest portion of the sternum [the victim’s breastbone]. . . . Place the heel of one hand about 1 to 1 1⁄2 inches [2.5 to 4 centimeters] away from [that is, above] that tip. Place your other hand on top of the one that is in position. Be sure to keep your fingers off the chest wall. You may find it easier to do this if you interlock your fingers.

“Bring your shoulders directly over the victim’s sternum as you compress downward, keeping your arms straight. Depress the sternum about 1 1⁄2 to 2 inches [4 to 5 centimeters] for an adult victim. Relaxation must follow compression immediately and be of equal time. A rhythmical, rocking motion helps insure the proper length for the relaxation cycle. Remember, do not remove your hands from the victim’s sternum while allowing the chest to return to its normal position between compressions.

“If you are the only rescuer, you must provide both rescue breathing and cardiac compression. The proper ratio is 15 chest compressions to 2 quick breaths. You must compress at the rate of 80 times per minute when you are working alone since you will lose compressions when you take time to interpose these breaths.

“When there is another rescuer to help you, position yourselves on opposite sides of the victim. One of you should be responsible for interposing a breath after every fifth chest compression. The other rescuer, who compresses the chest, should use a rate of 60 compressions per minute.”