Amanda Wilde (Host): Sudden cardiac arrest can quickly become fatal. Stay tuned for what to know, who's at risk, and how to reduce your chances of cardiac arrest. Our guest is Cardiologist Dr. Jeanne Wei. This is UAMS Health Talk, a podcast from the University of Arkansas for Medical Sciences. I'm Amanda Wilde. Dr. Wei, thank you so much for being here.

Jeanne Wei, M.D., PhD: Thank you, Amanda. I'm delighted to be here to talk about a topic that is so important that we need to, if we can, share with everybody as much as possible because it's requires moments to make a difference between resuscitation success or not.

Host: Cardiac arrest is still one of today's most common causes of death. What causes cardiac arrest?

Jeanne Wei, M.D., PhD: Yes. So cardiac arrest is when the heart is not able to propel the blood forward. And two major causes are if there's some kind of mechanical blockage where the heart can't pump the blood out, or if there's an electrical rhythm that makes it so that the heart is not able to maintain electrical mechanical activity. So if you have a severe arrhythmia such as ventricular tachycardia or ventricular fibrillation, the rhythm is so rapid that there cannot be any synchronized mechanical activity. So there is going to be no blood going forward from the heart. And soon, because there's not enough oxygen, to the brain and elsewhere in the body, severe circumstances will occur.

And if there's not a restoration of the oxygen and the blood flow, we're looking at very dire outcomes.

Host: So how quickly does someone need to receive treatment after experiencing a cardiac arrest in order to improve their chance of survival?

Jeanne Wei, M.D., PhD: Yes, so you have three to four minutes. If your brain does not get oxygen and blood flow within three to four minutes, you are going to sustain severe damage and sometimes it can be irreversible completely. So, everything must be immediate as soon as possible. So if you see somebody who is unconscious, they're not arousable, you have to quickly feel the pulse, feel if there's something, and if not, you have to initiate treatment immediately.

Host: You just mentioned unconsciousness, what are the most common symptoms of someone experiencing a cardiac arrest?

Jeanne Wei, M.D., PhD: Well, that's what it is, 50 percent of them don't know that they're going to have one. Okay? But if you notice somebody who is unresponsive and you feel that there's no pulse or you can't feel a pulse quickly, you have to initiate treatment. And the treatment comprises cardiopulmonary resuscitation, which is when you put pressure on the chest, you put one hand on top of the other hand, if you will, and you go to the breastbone, okay, you know, the breastbone, you press on it because you're going to need to mediate compression so that the blood can be pumped forward by your hands because the heart is not moving the blood forward.

You have to do that ASAP. At the same time, you tell somebody to call 911. At the same time, you tell somebody to get the defibrillator.

Host: Okay, so the most important thing to do is to act quickly with CPR

and then defibrillation, if you can. And obviously you're calling 911.

Jeanne Wei, M.D., PhD: Yes. And sometimes electrocardioversion, if you can get the electrocardioverter sooner, it's even better because if they're having ventricular tachycardia or ventricular fibrillation, the sooner you can cardiovert, the lower the energy is that is required. So let me tell you about this.

If you can, right when they start to go into cardiac arrest, you can convert the ventricular tachycardia with a chest thump. Now, I'm talking about a fist you put on the chest and you pound on it. That gives you about five joules of energy, and it's enough to convert somebody if you can do it immediately.

And what I can tell you, and I published about this, and actually, it's the only time I was ever featured in Vogue magazine.

Host: Hmm.

Jeanne Wei, M.D., PhD: Okay? And it had to do with the fact that I recommended that people can also convert themselves once they realize that they're in jeopardy and have this arrhythmia, they can convert themselves by coughing.

When you cough, you generate about 5 joules of energy. So, for those people who have arrhythmias, and they know, and we can advise them accordingly, the minute they feel that they're getting the arrhythmia; if they cough, they can convert the rhythm. I have had patients who was driving and they realized that they quick pull over and they sit there and they cough and they cough and they cough and they're able to maintain perfusion of the brain.

Sometimes they convert to normal sinus and then they quickly drive somewhere and then they are able to be resuscitated and lucky for them and lucky for us this is a way for you to do it yourself, but you've got to do it right away.

Host: And that can give you enough energy to get yourself to medical care?

Jeanne Wei, M.D., PhD: Well, if you've done it before and you're somebody who's had these ventricular arrhythmias, and you're a young person too. Yes it happens. I've taken care of patients who were able to do this. Of course now because we have the cardioverters, you know, the defibrillators, it'll kick in too. But if you don't have one, then you gotta do it yourself.

Host: So for someone who has survived a cardiac arrest, what are some of the potential long term consequences?

Jeanne Wei, M.D., PhD: Well, I'm so glad you brought that up because the prognosis is not good at all. If you have a cardiac arrest outside of the hospital, and say it's in your home, your chance of survival are about six percent. On the other hand, if you have a cardiac arrest in the hospital, it's better. It's a little more than 20 percent.

That's not great, but it's better than six. So the reason for this is because if it's not done immediately, and you know, people don't always know what to do because they panic. You're losing the potential for preserving your brain.

Host: Now, how can people reduce their risk for experiencing cardiac arrest? Are there any ways to reduce your chances of experiencing a cardiac arrest?

Jeanne Wei, M.D., PhD: Absolutely. Thank you for asking. First of all, don't smoke. Quit smoking. Second of all, see your doctor regularly. Third of all, engage in regular physical activity. Fourth of all, keep a healthy weight, don't become obese, and six of all always have a healthy diet as well. So, you know, we're talking no smoking, minimize alcohol, you know what I'm saying, do all the right things, and chances will be that you'll reduce the chance of you ever having a sudden cardiac arrest, especially if you go to your doctor and you follow directions and you take your medications.

Host: I was just going to ask, are there medications we should know about?

Jeanne Wei, M.D., PhD: Yes, you should take the medications that help you to keep the arteries in your heart muscle open if possible, okay? You should also take medications that will reduce your chances of having ventricular tachycardia or ventricular fibrillation. This means that you got to go see your doctor and they're going to give you the medicines and you better take them.

Host: Now, you have seen the entire evolution of this field. What are some advancements you're seeing in medical technology that improve outcomes for people who experience cardiac arrest?

Jeanne Wei, M.D., PhD: So, in the very beginning, success was not very good. And I'm talking about when the pioneers started it, and this was when I was in training at Johns Hopkins Medical Center; it was at the very beginning and my mentors were the ones who developed all this and because of all of the details that have been developed, it's become easier.

Now, in terms of what new technologies have been developed, okay, I can tell you one of which is the point of contact using ultrasound. So now, it's easy for us to have portable ultrasound and echocardiogram so we can see the flow of blood. It makes such a big difference. And we can see if we're pressing sufficiently or not, because you, you don't want to press too hard because then you crack the whole rib cage, which I have seen.

So the other thing is, we now also, besides having the cardioversion, the electrocardioverter, we also have the ECMO, okay, E-C-M-O, and it's Extra Cardiac Membrane Oxygenation, okay? And what we're able to do then is to help you to exchange your oxygen and carbon dioxide and get you to have full oxygen. It makes such a big difference, and this is something actually I published about a few years ago.

Host: This technology is really amazing and ever evolving. Dr. Wei, thank you so much for the insights on cardiac arrest and what we can do to prevent it.

Jeanne Wei, M.D., PhD: And thank you so much, Amanda. I enjoyed talking with you.

Host: Same here. That was Dr. Jeanne Wei, Cardiologist at the University of Arkansas for Medical Sciences. To make an appointment at UAMS, call 501-686-5311. If you found this podcast helpful, please share it on your social channels and check out the entire podcast library for other topics of interest to you.

This is UAMS Health Talk, a podcast from the University of Arkansas for Medical Sciences.