(47) Research on HEALTH: first aid (CPR).

This is Research on HEALTH month on Researchista. It is when Researchers from different medical fields bring their best knowledge and expertise in few words to explain their Research findings and to hopefully help you overcome certain health questions or problems you might have. Please say hi to Sebastian! 

Hi there!

I studied Medicine at the Maastricht University (2010-2016) and became a member of Taskforce QRS (CPR instructor) in 2012. My first cardiopulmonary resuscitation was on a ward in a small town in Germany, where I was at the time following an internship. At that moment, I was a CPR instructor for nearly 3 years and I thought I knew all the steps perfectly. But nothing could prepare me for the real thing….. ☺

 

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Sebastian Sanduleanu, PhD student at Maastricht University

So, what to do when someone has a heart attack? First, let’s distinguish some key concepts:

“Cardiac arrest”

A “cardiac arrest”, not to be confused with a “heart attack” is when the heart stops beating (Figure 1). A heart attack may lead to a cardiac arrest.

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Fig. 1: Cardiac arrest vs. heart attack. Source: http://www.healthzone.org

If a cardiac arrest occurs, blood will stop circulating around the body and breathing will likewise cease within several minutes. Without a supply of oxygen, the cells in the body start to die. Especially brain cells are highly sensitive for low blood oxygen concentrations, after about five minutes of no oxygen brain cells will begin dying leading to brain damage and death.

Other key conceptual differences regarding symptoms:

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Source: http://www.positivemed.com

“CPR”

Cardiopulmonary resuscitation, commonly known as CPR is one of the key elements of first aid. The purpose of CPR is by chest compression to keep oxygenated blood flowing through the body in order to keep the vital organs alive.

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Fig. 2. The BLS/AED algorithm Source: http://www.slideshare.net/adis23/cpr-prezentacija

It is important to know that CPR itself will not restart someone’s heart, it just keeps them alive until a defibrillator (Figure 3) arrives. This is a device which delivers an electrical shock to the heart in order to restart it. These defibrillators are, aside from hospitals, commonly found in sports parks, shopping malls, schools and near to crowded areas. Access is restricted to authorized users, from ambulance workers, (para-) medics to civilians trained in CPR (with a so called BLS = Basic Life Support certification).

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Fig. 3. The automated external defibrilator (AED)

CPR numbers in the Netherlands

Around 10.000 people in the Netherlands face a cardiac arrest outside the hospital every year. A major influence on the survival rate is the high percentage of bystanders, which had already begun CPR before the arrival of the first ambulance (>75%), the connection of an automatic external de-fibrillator (AED) and a shockable heart rhythm early. These findings have been summarized in the chain of survival (Figure 4).

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Fig. 4. The chain of survival.

The survival in the Netherlands is on average 23%, one of the highest in Europe. If there is a shockable rhythm start, the survival rate can be as high as 44%.

For those living in Maastricht: QRS Taskforce Maastricht, purpose and background
In order to improve the survival chances for sudden cardiac arrest (SCA) victims, Taskforce QRS Maastricht (Qualitative Resuscitation by Students), was founded in 2006 by medical students of Maastricht University3. In 2012 a new approach in CPR training, called Maastricht Quantity-orientated Resuscitation Session (M-QRS), was developed that focuses on the number of trained students per training. By comparing the new with the old approach quantitative growth could be assessed. Until now more than 12,937 secondary school students have now been trained by ERC-certified (European Resuscitation Council) CPR instructors with this efficient M-QRS approach. In comparison, a theoretical maximum of 6,469 could have been trained by means of the old approach. Sign up for CPR-training with Taskforce QRS: A civilian rescuer is a CPR trained volunteer that is contacted by 112 emergency rooms per SMS or via a special phone application to directly or after picking up an AED (automatic external defibrillator) go to the location of a victim of a cardiac arrest and to start CPR. Interested? Click on the link! 

(more at: Ghossein, A., Amin, H., Sijmons, J., Olsthoorn, J., Weerts, J., Houben, V. (2014). Taskforce QRS. European Heart Journal, 35(45), 3149-3151).

Heart physiology

The heart pumps oxygen and nutrients around the body through your blood. Waste products, e.g carbon dioxide and urea are removed through your circulation by respectively the lungs (diffusion) and the kidneys (urine filtration). In your lungs, oxygen enters your blood stream and carbon dioxide (a waste product) is removed in a process known as gas exchange (Figure 5).

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Figure 5. Gas exchange in lungs (Pearson, 2013).

All the cells in your body are dependent on oxygen, aside from nutrients to survive. This oxygen is used as energy source in the powerhouses of the cell, the mitochondria in a biochemical activity called metabolism.

 

 Post written by Sebastian Sanduleanu, MAASTRO Clinic, Maastricht University, Maastricht

 

 

With love for Research,

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