Most witnessed, unexpected, adult collapses are from cardiac arrest. Over a decade ago an observation was made by a distraught woman whose husband had collapsed and she was attempting CPR. “Why is it that every time I press on his chest he opens his eyes, and every time I stop to breathe for him he goes back to sleep?” She summarized in layman’s terms the fact that cerebral perfusion is critical to neurological function. The Sarver Heart Saver Group in Tucson Arizona has pioneered a better model of resuscitation based on that principal.
A person’s vital organs can be maintained for long periods of time if adequate and continuous chest compressions are performed. It takes one minute of proper chest compressions to generate blood flow to the brain. If compressions are stopped that blood flow drops after 5 seconds. Compressions interrupted for 10 seconds or more ceases all blood flow to the brain and another minute of compressions are required to reestablish that blood supply. Blood flow to the brain and heart are dependent on several factors:
Cardiac arrest patients often have muscle twitching and agonal respirations (gasping). This gasping will provide self-ventilation with proper compressions. However, most lay responders interpret this twitching and gasping incorrectly and fail to compress chest. Our assessment mnemonic for witnessed cardiac arrest should be circulation (chest compressions), breathing, then airway (CBA); Not airway, breathing, circulation (ABC). At the time of arrest most adults have a normal oxygen level in their blood stream. A person only uses 25% of the oxygen in their blood stream at any given time. During the initial phase of cardiac arrest, the pulmonary veins, heart, and entire arterial system is filled with oxygenated blood. Circulating that oxygen filled blood is our priority.