Transcription:
CPR & AEDs

Joey Wahler (Host): Cardiopulmonary resuscitation or CPR and an automated external defibrillator or AED can save lives. So we're talking about the importance of having this crucial knowledge and equipment. Our guest, Dr. Neel Khanna, he's Medical Director of the Cardiovascular Institute at Montefiore St. Luke's Cornwall.

For more information, please visit montefioreslc.org. That's montefioDeslc.org. This is Doc Talk presented by Montefiore St. Luke's Cornwall. Thanks for listening. I'm Joey Wahler. Hi, Dr. Khanna. Thanks for joining us.

Neel Khanna, MD, MPH (Guest): Happy to be here.

Host: to meet Great to have you with us. So first, generally speaking, when someone is suffering from cardiac arrest, how much of a difference can CPR or AEDs make really between life and death right?

Guest: Exactly. Yeah. CPR and AEDs, which we'll talk about, can make the difference between life and death and really can prolong life and have people be resuscitated in a pretty short period of time. Basically, CPR is a way to keep the body and the blood and oxygen flowing through the body enough to keep your vital organs alive and healthy. And most notably, that's your heart, your kidneys and your brain, obviously, to keep your brain function stable. So CPR can really bridge the time needed and keep those organs well and alive until you can get additional help from EMS or from an in-hospital setting.

Host: So, for whom would you say it's most important to have CPR knowledge and a defibrillator on hand?

Guest: Well, I think in the grand scheme of things, the hope of the medical community is that eventually every adult will be proficient in CPR. It's extremely important and you never know where you're going to need it. We've seen cases of people in subway stations, obviously in supermarkets. The classic example is even in an airplane or a gym. Gyms are classic examples of this because obviously people are working out and people with underlying heart conditions can potentially experience a myocardial infarction or just an abnormal heart rhythm while they're exercising. And those type of heart rhythms are more easy to bring back to a normal rhythm if they get the appropriate treatment with CPR and AEDs. So primarily, we hope that all hospital employees obviously, all gym employees and people who are with patients at high risk in rehab settings, in nursing homes, they should all be proficient in CPR and get certified that way.

And also in the use of AED, especially if one is present at the institution that they're working at. But generally speaking, the goal is for everyone to be proficient in CPR, which means chest compressions, giving breaths if you're able to, if you have more than one person. The more people that are proficient in CPR, the more lives we will see saved in the long term.

Host: Sure, and I will ask you some more details in a moment. How about parents, especially those of younger kids who may have an undiagnosed heart issue, how important for them to have this knowledge or this equipment?

Guest: It's very important. And you know, the CPR and resuscitation techniques in children are a little different than adults, obviously, because they're smaller, their chest can take less impact. Especially we see this with choking victims. The way the that we treat an adult who's choking with like a Heimlich maneuver, for example, is different than if it were a baby, obviously.

So, it's very important. There are parent associations out there that teach CPR, and even like I mentioned, in a child who's choking, just being proficient in CPR if it's needed is good to keep the child at least having blood flowing until emergency medical staff can come.

The first step always we tell patients who are in the community or people who are in the community, is to first contact emergency medical staff. Call EMS, call 911, and then get started on your CPR so that you can actually bridge that time gap waiting for emergency contact to arrive.

Host: And then perhaps they can walk you through over the phone, whoever you're talking to, while you're waiting anything that you may need to know in between too, right?

Guest: Exactly, yes. Contacting EMS and obviously it's more helpful if there are more than one person or people available because one person can be on the phone and one person can be engaging in resuscitation. But yes, they will provide the necessary instructions. Now, they're not going to teach you obviously, the technique over the phone to perform CPR, which is why it's so important for people to become proficient at that.

And there are multiple courses in the community that are given out and also simply watching some videos online can make the difference if a loved one were to go down and not have a pulse. You know, even watching simple videos online can tell people exactly what to do, to potentially help them and save their lives.

Host: Well, you've touched on it, so let me ask you a little bit more about that. In order to in fact, learn CPR, Doc, where can people, generally speaking, find a course, take a course, and what's involved? What are the basic steps involved in completing that?

Guest: Well, as medical professionals, we our nursing staff and even physician assistants and LPNs we're all mostly certified in basic life support, which is just, basic CPR, which is chest compressions, giving breaths, being able to recognize if someone has a pulse. One resource that I tell a lot of people in the community to look at, is your local library, local libraries, local post offices. They often post timings where they give CPR courses. Now to get official certification, often, organizations like the Red Cross, are giving official courses and they're also online courses too. In this day and age, often all you have to do is just Google CPR courses near me and you can see really excellent opportunities for you to get certified. As medical professionals, we get certified and we have a card that we carry around. To become proficient though, just attending a course, like I mentioned, can get you proficient enough where if you're needed in an emergency situation, you can help out.

Obviously, health professionals are held to a different standard. Because we're in situations where we may have to use this multiple times a month in order to help patients who are suffering. But, I always tell people, like I mentioned, look at your local community centers, your local libraries, post office, and often on their bulletin boards, you will see that there are courses in your area where you can become proficient with this.

Host: Gotcha. So let's switch gears and talk defibrillator, where can someone get one and how do you learn how to use it? But first, briefly, please, for those uninitiated, what actually does it do for those listening that have heard the term and may not even be familiar?

Guest: Yes. CPR. The concept of CPR is to keep oxygenated blood flowing through the body so that your vital organs will continue to receive blood and oxygen when your heart is not pumping. When someone has a cardiac arrest, their heart is no longer pumping oxygenated blood throughout the body. So basically with chest compressions, we are doing that for them. And that's the basic hallmark of CPR is to basically keep that blood and that oxygenated blood flowing. Now some people, especially those people suffering from an abnormal heart rhythm, from the bottom part of the heart called ventricular fibrillation, or ventricular tachycardia most often present with people who are having a heart attack. For example, if someone says, I'm having chest pain and then collapse, it's very likely that they're in one of these abnormal rhythms. If you look at cardiac arrests in gyms, the vast majority of them are because they're having abnormal heart rhythms called ventricular tachycardia or ventricular fibrillation.

In those situations, CPR is still the hallmark. You start chest compressions on that patient to keep the blood flowing, but then as quickly as possible, you locate your closest AED defibrillator, and you attach it to the chest. It will automatically analyze the rhythm that the patient or the person who is suffering is in.

And if it is one of these abnormal heart rhythms, it will deliver a shock. If used within the first five minutes of this happening, it is very successful. We see it in the hospital all the time, and it will shock someone back into a normal rhythm and you can often see that person wake up right away, they may regain a pulse right away.

Now, within the CPR algorithm, you still do chest compressions for a couple of minutes to make sure that there is no breaks in the chest compression, but often with just one defibrillation or one shock with electricity, the heart is basically restarted. We recently saw that, it was in the national news with one of the football players who collapsed after being struck in the chest. He was most likely in an abnormal heart rhythm. And if people did not start CPR right away and then administer a defibrillation shock, which he did get on the field; he may not be living or would not be totally mentally intact as he is now.

Host: Absolutely. Great point there indeed. So a couple of other things, one, with CPR and an AED, from your experience Doc, how much peace of mind for people comes with knowing that they're armed with this information or this equipment in case it's needed so that they don't run into a situation where they watch someone suffer needlessly and only then realized they could have done something if only they were better prepared?

Guest: You know, it's very, very important. As physicians, especially cardiologists, we often see people who come to the hospital in cardiac arrest, and I can tell you it's night and day, the outcomes from when a patient was treated by their family member with CPR and when they were not. Their neurologic outcomes or the type of recovery that they make, it's night and day. When they get effective CPR close from when they collapse, these patients often do very well because it gives us time to localize what the problem is, and keep their organs alive and healthy in the meantime. So it gives a lot of peace of mind to people and it really makes a huge difference. I can tell you, in areas where there's a high risk of cardiac arrest, like gyms. It's really made a difference in the way that the staff is trained and in the health outcomes of people who collapse in gyms. It really has made a big difference. Those staff are trained to know exactly where the AED is and if someone collapses to attach it right away. And it's made a huge difference.

I know myself, personally, I've seen some patients who've collapsed in public areas like gyms with a cardiac arrest, and airports, I've seen multiple patients who have collapsed at local airports and they've all had pretty good outcomes because the staff was trained to know CPR number one, and number two, where their AED was and they were able to administer a pretty prompt defibrillation and get that heart restarted.

Host: And so in summation, just to kind of put a bow on that if you will, it really is kind of the ultimate selfless act to be prepared really as a society, right, in case someone else needs assistance.

Guest: Exactly. Our ideal outlook on this, is that there would come a time when basically close to a hundred percent of our population knows basic life support, and knows how to do effective chest compressions, how to identify if someone is pulseless and has collapsed, and how to get the necessary attention and help, but also in the meantime, provide necessary life support for those patients.

It really will make the difference between someone living a good quality of life or living and potentially not living. And so if we make those programs more readily available to people and people take it on their own shoulders to get trained appropriately, and it really only takes a couple of hours to get effective training, it can really make a huge difference.

Host: Well said indeed. Well, folks, we trust you're now more familiar with CPR and AEDs. Dr. Neel Khanna, thanks so much again.

Guest: Thank you for for having me.

Host: And for more information about the Cardiovascular Institute, please visit montefioreslc.org. Again, that's montefioreslc.org. If you found this podcast helpful, please do share it on your social media.

And thanks again for listening to Doc Talk presented by Montefiore St. Luke's Cornwall. Hoping your health is good health. I'm Joey Wahler.