The collapse and successful resuscitation of footballer Fabrice Muamba thrust out-of-hospital cardiac arrest and cardiopulmonary resuscitation (CPR) into the media spotlight.
The story is inspiring, given that Mr Muamba appears to be making a full recovery with no neurological deficit. In contrast is the tragic story of Piermario Morosini, another professional footballer, who died following a cardiac arrest during a match in the same month.
Despite the similarities between these cases, direct comparisons should not be drawn because circumstances will differ. What is known, though, is that survival to discharge from out-of-hospital cardiac arrest is poor at approximately 5%.
The Resuscitation Council (UK) describes four linked interventions that contribute to a successful outcome following a cardiac arrest. These are early recognition of deterioration and a call for help; early CPR; early defibrillation; then high-quality post-resuscitation care.
Undoubtedly, the last could have played a significant role in Mr Muamba’s survival. However, high-quality early CPR and early defibrillation must not be underestimated. It is more than likely these parts of the chain ensured the return of spontaneous circulation after prolonged resuscitation.
Healthcare professionals delivered this CPR and defibrillation, but not everyone who has an out-of-hospital cardiac arrest will have a clinician on the scene. None the less, the outcome could be just as inspiring.
Bystander CPR - that performed by lay people - has been shown to extend the period for successful resuscitation and at least doubles the chance of survival following a shockable cardiac arrest, where a defibrillator is employed. Despite this, in most European countries, bystander CPR is carried out in only approximately 30% of cases. Is there a need to provide training in CPR to all and improve the provision of automatic external defibrillators?
The recent high-profile cases are likely to make the public realise that simple skills can have a big impact. This, hopefully, will encourage people to “have a go”. In the days after the Fabrice Muamba incident, the CPR instruction page on the British Heart Foundation’s website received many hits. This is an ideal opportunity to promote the need for training.
CPR training for the public is usually accessed through first aid courses or the ambulance services. The potential for a favourable outcome begs the question: should a more formal strategy be adopted?
There have been recent moves to incorporate emergency life support skills into the national curriculum for schools. Despite the clear advantages offered by such an approach, the vast majority of schools do not include it. A petition to include the emergency life support skills in the national curriculum can be found at tinyurl.com/schools-CPR. Perhaps it is time to raise this issue to encourage national debate? There has probably never been a better time to do so. NT
- Dan Higgins is senior charge nurse critical care, University Hospitals Birmingham Foundation Trust and freelance clinical educator
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