Anything Can Happen, Anyone Can Help

Every year in the UK, the NHS ambulance services attempt resuscitation in over 30,000 people, yet less than 1 in 10 people survive hospital discharge¹.

Anything can happen

Sudden cardiac arrest is a life-threatening emergency that can affect anyone at any time and is characterised by the unexpected and abrupt loss of effective heart activity. This critical event occurs when an electrical malfunction in the heart disrupts its normal rhythm, rendering it unable to pump blood effectively. As a result, the heart’s ability to circulate oxygen-rich blood throughout the body is severely compromised, leading to an immediate and profound impact on the individual’s health.

During a sudden cardiac arrest, the heart either ceases to beat altogether, known as asystole, or begins to quiver erratically in a condition known as ventricular fibrillation. This chaotic electrical activity prevents the heart from pumping oxygenated blood to the brain, lungs, and other vital organs. This sudden loss of effective heart function causes the affected person to lose consciousness almost instantly, as the brain is rapidly deprived of oxygen.

It is important to note that sudden cardiac arrest is different from a heart attack, although the two conditions are often confused, a heart attack occurs when blood flow to a part of the heart muscle is blocked. While a heart attack can damage the heart and potentially lead to cardiac arrest, the heart usually continues to beat during a heart attack. In contrast, sudden cardiac arrest is an electrical problem that causes the heart to stop beating altogether, or to beat ineffectively, leading to immediate collapse and loss of consciousness.

The consequences of sudden cardiac arrest are dire if not promptly addressed. Within minutes, the lack of oxygenated blood flow can lead to irreversible brain damage, and if left untreated, death can follow within a matter of minutes. The window for successful intervention is extremely narrow, which is why immediate action is crucial. The administration of CPR (Cardiopulmonary Resuscitation) can help maintain some circulation of blood, buying precious time until a defibrillator can be used. Without prompt CPR and defibrillation, the lack of blood flow can result in irreversible brain damage and death within minutes.

What is CPR?

High-quality CPR plays a critical role in sustaining life during cardiac arrest by maintaining the flow of oxygenated blood throughout the body. This continuous circulation is vital for delaying tissue death and extending the crucial window of time during which successful resuscitation is possible. When CPR is performed effectively, it helps ensure that essential organs, particularly the brain and heart, continue to receive the oxygen and nutrients they need to function. This preservation of organ function is crucial until the heart’s normal rhythm can be restored, whether through advanced medical interventions or the use of a defibrillator.

The effectiveness of CPR lies in its ability to mimic the heart’s pumping action, pushing blood through the circulatory system to deliver oxygen to the body’s tissues. In the absence of a functioning heart, CPR acts as a temporary life support, buying precious minutes that can make the difference between life and death. By maintaining blood flow, CPR helps to prevent the rapid deterioration of vital organs, particularly the brain, which can suffer irreversible damage within minutes without oxygen.

In recent years, there has been a significant push towards the adoption of hands-only CPR, which involves performing chest compressions without mouth-to-mouth breaths. This approach has been advocated for several reasons. Firstly, hands-only CPR simplifies the process, making it more accessible and less intimidating for bystanders who may be hesitant to perform full CPR due to concerns about giving rescue breaths. Studies have shown that hands-only CPR can be just as effective as conventional CPR in the first few minutes of a cardiac arrest, especially if the arrest occurs in a public place⁴. This method is particularly important in increasing the likelihood that bystanders will intervene quickly and confidently, without the fear of performing the technique incorrectly or hygiene concerns.

Despite the clear importance of CPR during a cardiac arrest, a significant portion of the population remains unprepared to act. In the UK, 43% of adults—nearly 23 million people—have never learned this lifesaving skill⁵.

What is a defibrillator?

An automated external defibrillator (AED) is a portable, lifesaving machine that detects dangerous abnormal heart rhythms that cause sudden cardiac arrest and delivers an electric shock. This shock is called defibrillation, it is delivered to stop the heart’s irregular rhythm and helps it to re-establish a regular rhythm. You may hear an AED referred to in a number of ways, defibrillator, defib, PAD (public access defibrillator), heart restarter, and external defibrillator. However, they all refer to the same thing.

Why do you need a defibrillator?

When someone experiences sudden cardiac arrest, immediate action is not just important- it is essential for survival. In these critical moments, the use of a defibrillator can mean the difference between life and death. Every minute that passes without defibrillation reduces the chances of survival by approximately 10% making prompt intervention crucial². Sudden cardiac arrest can strike anyone, anywhere, at any time. Alarmingly, around 15% of out-of-hospital cardiac arrests occur in the workplace. Yet, despite the clear risk, only 44% of workplaces are equipped with a defibrillator³.

A recent study in Oregon revealed that individuals employed in physically demanding industries, such as those requiring strenuous activities, working at heights, or operating heavy machinery, are at a heightened risk of cardiac arrest⁷. However, even seemingly low-risk environments like offices aren’t exempt, as factors such as stress, high-pressure deadlines, and sedentary lifestyles can also contribute to heart complications.

The NHS Ambulance Service strives to reach category 1 emergencies, which includes sudden cardiac arrest, within an average response time of 7 minutes. However, the most recent data from June 2024 shows that the average response time had extended to 8 minutes and 21 seconds⁶. By this time, if no bystander CPR or defibrillation has occurred, the chance of survival drops to approximately 20%². The increase in ambulance response times underscores the critical importance of having readily accessible defibrillators, especially in the workplace, where cardiac arrest is not uncommon.

Who Can Help?

Anyone can help during a cardiac arrest, and the sooner help is provided, the better the chances of survival are. In a cardiac emergency, time is critical, despite this, many people hesitate to use a defibrillator, fearing that without training, they might cause further harm to the victim or even put themselves at risk. However, this concern is unfounded. Defibrillators are specifically designed to be used by laypersons, meaning you don’t need any medical background or training to assist someone in cardiac arrest.

Modern defibrillators are designed to be intuitive and easy to use, even in stressful situations. They provide clear, audible instructions that guide you through each step of the process, from placing the adhesive pads on the person’s chest to delivering a shock if needed. Many defibrillators also include visual prompts and diagrams, making it even easier to follow the instructions. For example, some models, like the ZOLL AED 3, ZOLL AED Plus, and the Powerheart G5 offer real-time feedback on the quality of chest compressions, providing visual and audio prompts to ensure you are delivering the best possible care.

How Can You Help?

Steps to Follow If Someone Collapses:

Assess the Situation:

Before attempting to help, ensure the area is safe. Once safe, approach the person and check for a response. If they are unresponsive, not breathing properly, and show no signs of life, they may be in cardiac arrest. Shout for help immediately.

Call for Help and Begin CPR:

If others are present, ask someone to call 999 and request an ambulance while you start CPR, or have someone else find and bring a defibrillator if available.
If you cannot perform CPR due to a disability or other reasons, ask someone else to do it while you call for help and locate the defibrillator.

If you’re alone, put your phone on speaker and start CPR while talking to emergency services.

Do not leave the person to search for a defibrillator yourself.

To perform CPR, kneel beside the person and place the heel of one hand in the centre of the chest. Place your other hand on top, interlock your fingers, keep your arms straight, and lean over the person. Press down hard, about 4-6 cm, allowing the chest to rise fully between compressions.

Push at a rate of 100-120 beats per minute.

Continue CPR until:

Emergency help arrives and takes over.
The person shows signs of life and starts breathing normally.
The defibrillator instructs you to stop.
You become too exhausted (if there is another rescuer, switch, when possible, to avoid this.

When a helper returns with the defibrillator, have them turn it on and remove/cut through clothing to expose the chest while you continue CPR. They should also wipe away any sweat and follow the defibrillator’s audio and/or visual instructions.

Attach the defibrillator pads to the person’s chest as shown in the instructions. The defibrillator will analyse the heart’s rhythm. Stop CPR and ensure no one is touching the person.

Follow the defibrillator’s prompts:

If a shock is needed, ensure everyone stands back, then press the shock button when instructed. Continue CPR afterwards as directed.
If no shock is needed, continue CPR for two minutes before the defibrillator reanalyses.

If the person shows signs of life (e.g., coughing, opening eyes, speaking, or breathing normally), place them in the recovery position, leaving the defibrillator attached and monitoring their level of response. Be prepared to give CPR again if necessary.

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