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The Dose Transcript for March 7, 2024

Host: Brian Goldman

BRIAN GOLDMAN: Hi, I'm Dr. Brian Goldman. Welcome to The Dose. Every day, paramedics bring patients to the hospital in cardiac arrest, which means their hearts have stopped. The key to their survival is less about what we do and more about what you can do at the scene. So this week on The Dose, we're asking, what do I need to know about cardiac arrest? Hi, Roopi. Welcome to The Dose.

ROOPINDER SANDHU: Hi, Brian. It's great to be here.

BRIAN GOLDMAN: And it's great to be talking to you. I want to ask you a question. Have you ever witnessed a cardiac arrest? Not in hospital, but in public. You know, like in a stadium or in, you know, in a gym or something like that.

ROOPINDER SANDHU: Yeah, I've definitely witnessed a cardiac arrest in the public. And it is, you know, for someone who is in the medical profession, probably something you jumped right into, you know, coming closer to seeing, assessing the situation. But I can see why it might not be as much of a knee jerk reflex for someone who doesn't have that kind of background.

BRIAN GOLDMAN: Yeah, exactly. Like you and I are trained to do it. We drop tools and we run to the scene. You know, we have something called Code Blue. Well, they don't have a Code Blue in the field. What they have to do is actually activate the Code Blue, and you're the best person to tell us about what that's all about. So before we begin our conversation, can you give us a hi, my name is? Tell us what you do and where you do it.

ROOPINDER SANDHU: Absolutely. Hi, my name is Roopinder Sandhu. I'm a cardiologist that specializes in heart rhythm disorders, and I am the director of the Women's Cardiovascular Health Initiative and the Martha Brauer Chair in Women's Cardiovascular Health Research at the Libin Cardiovascular Institute at the University of Calgary.

BRIAN GOLDMAN: Okay, here we go. Explain what heart and stroke means when they talk about something called the chain of survival.

ROOPINDER SANDHU: So when we're thinking about the chain of survival, we really want to see what needs to be done right away when someone is having a cardiac arrest. So that means that you’re calling, or if there's somebody around, asking for 911, you're going to shout out for an AED, again, if someone's around, and you're going to start CPR right away so that the patient can be transported to the hospital where they will undergo any other advanced life support management. And then it's the care after the patient has that cardiac arrest.

BRIAN GOLDMAN: So it's a very specific order of things that are done in a row. What's the sense behind doing that?

ROOPINDER SANDHU: The sense is that each of these things are really instrumental in trying to improve a patient's chance of surviving to the hospital and then discharged from the hospital.

BRIAN GOLDMAN: Explain to me the importance of laypeople trained in basic life support and why they are important to initiating the chain of survival.

ROOPINDER SANDHU: Well, they're the first very critical step in trying to reach survival. So being able to perform CPR and having an AED can actually double your chance of survival.

BRIAN GOLDMAN: What are some of the signs that someone is going into cardiac arrest that you would want people to recognize out in the field, laypeople?

ROOPINDER SANDHU: So we want people to remember that when someone's having a cardiac arrest, this means that their heart has stopped beating. And it's often sudden and unexpected, so they're going to collapse. They're going to be unresponsive and not breathing. And if they are breathing, they'll have gasping sounds that you might hear. So that is your first sign that somebody could be having a cardiac arrest.

BRIAN GOLDMAN: And this is a bugbear of mine, but please explain for laypeople, the difference between a heart attack and a cardiac arrest, because often in the lay press, they are used interchangeably.

ROOPINDER SANDHU: Yeah, and it's a really important distinction. So a cardiac arrest is an electrical problem. So think about it as if a breaker is turned off. There is no blood that is being pumped from the heart to the brain or the rest of the vital organs. And that is why the patient will or the person will collapse or be unresponsive. And that's different than a heart attack. A heart attack is when you have a partial or complete block in one of the heart vessels. And that means that there is impaired blood supply to part of the heart muscle, but the heart can still pump. Patients are able to experience symptoms, and then they can get help.

BRIAN GOLDMAN: As a cardiologist, you see lots of people with heart disease. And I know they are among the most likely to have a cardiac arrest, but let people listening to us know who are the kinds of people that are most likely to have a cardiac arrest. How old are they? What kinds of diseases do they have?

ROOPINDER SANDHU: So you're absolutely right. When somebody has a cardiac arrest, the most common reason when we are looking at identifiable causes is a history of having heart disease. So that can be previous blockages, heart attacks, it can be weakness of the heart muscle. And we know that there is a distinction between men and women where as women have a lower likelihood of having a previous history of heart disease, most cases, the sudden cardiac arrest is their first manifestation of having any heart disease. Other causes can be congenital. They can be a primary electrical problem. But there can be causes that are unrelated to the heart. So anything that causes a respiratory distress or, for example, drug use. In the most recent statistics, we have learned that cardiac arrest, at least half of them occur in patients that are less than 65 years of age. And we think that that could be related to an increase in the opioid crisis and also because of the COVID pandemic.

BRIAN GOLDMAN: You subspecialize in heart rhythm disturbances, so I have a particular question for you on that subject. There are people who are more prone to have a cardiac arrest in the course of doing strenuous exercise. Can you talk about that?

ROOPINDER SANDHU: Yeah. I mean, so the cardiac arrest when it is because of an electrical problem is due to a really chaotic, irregular rhythm from the bottom chamber of the heart, called ventricular fibrillation. So it's a short circuit that happens. And sometimes, we do see that people can have this when they're exercising and maybe related sometimes to an underlying primarily electrical problem that they have. But it could also be from somebody who has a history of heart disease, and the exertion may cause almost like a supply demand mismatch that causes them to go into one of these lethal life threatening rhythms.

BRIAN GOLDMAN: To what extent can you prevent cardiac arrest by addressing risk factors for heart disease?

ROOPINDER SANDHU: This is one of the keys, is to be able to identify risk factors for heart disease, and particularly be aggressive in modifying those ones that can be. So for example, high blood pressure, diabetes, obesity and smoking.

BRIAN GOLDMAN: What about an implanted defibrillator? How important are they for people who are at risk of going into ventricular fibrillation on a recurrent basis?

ROOPINDER SANDHU: So we know that there are certain people that are at high risk for having one of these lethal fast rhythms from the bottom chamber of the heart. Those are people that we know have a history of weak heart muscle, who are on the proper heart medications, and their heart muscle just doesn't recover. These people we want to put in defibrillators before they have a cardiac arrest. And then, of course, there are people that do have a cardiac arrest, and we want to protect them from having a second cardiac arrest if there isn't something that is reversible. So there isn't a clear cause for why they had that cardiac arrest.

BRIAN GOLDMAN: You know, Roopi, of course, you know, I'm an emergency physician. You're a subspecialist in cardiology. And we like to think that we're the ones that save lives when patients go into cardiac arrest. But when they have a witnessed arrest in the field, it's really important that laypeople know what they're doing and know how to begin the process of getting patients to the hospital where we can do the magic things that we do. Isn't that right?

ROOPINDER SANDHU: Absolutely. The layperson is really the key to survival. So for them to be able to recognize and activate the emergency response system, perform early CPR and rapid defibrillation with an AED, is really the key steps to survival for someone who suffers a cardiac arrest.

BRIAN GOLDMAN: And those key things include, first of all, I guess establishing from the things that you described off the top, that they are unresponsive, and then checking breathing and initiating breathing and then starting CPR. And how are they supposed to juggle when to get help, when to activate the emergency response when they're by themselves?

ROOPINDER SANDHU: Well, when they're by themselves, I would call 911 right away and start CPR immediately following. If there is somebody around, then you do want to shout out to them and say call 911, shout out for an AED while you are starting CPR.

BRIAN GOLDMAN: And they're going to be doing CPR. How important is good quality CPR in maintaining that chain of survival and keeping people going until they can be defibrillated?

ROOPINDER SANDHU: It really is critical to be able to perform good CPR. And what that means is you're placing the heel of your hand in the centre of the chest, you're interlocking your fingers of your other hand on top, and you're pushing hard and fast. And you want to make sure that your elbows stay locked, and that's about 100 and 120 times per minute. And a lot of people say if you're just thinking about different tunes and specifically staying alive, to think about how fast and hard that you should be performing CPR. It's a good trick.

BRIAN GOLDMAN: Yeah. And for you, Stayin Alive by the Bee Gees would be an archival bit of music. That would be to me, you know, listening to The Whiffenpoofs song from the 1920s, or a great Cole Porter song. But yes, Stayin Alive by the Bee Gees, that's the song. That's the tempo and the rhythm of good quality CPR, isn't it?

ROOPINDER SANDHU: Absolutely.

BRIAN GOLDMAN: Automatic external defibrillators or AEDs are one of the most important tools that help resuscitate people who have had cardiac arrest. How do they work?

ROOPINDER SANDHU: So the AED is really an easy to use device, and I want to make sure that people know it's a safe device to use. And what an AED does, it can analyze the heart rhythm. And if necessary, it can deliver an electrical shock to help the heart establish an effective rhythm.

BRIAN GOLDMAN: Have you ever recommended that somebody purchased an AED for personal use?

ROOPINDER SANDHU: I've not recommended that anybody purchase an AED for personal use. We do want to make sure that AEDs are located where people normally have a cardiac arrest. So in public, high traffic areas, like for example, in schools and in gyms. Having said that, we know that women are more likely to have a cardiac arrest at home. We just haven't got to the point yet, and we need more data to suggest whether it's beneficial for everyone to have something like an AED at home.

BRIAN GOLDMAN: Under what circumstances, generally speaking, do much younger people, say people in their late teens and early 20s, have a cardiac arrest?

ROOPINDER SANDHU: So for really younger people, they can have a cardiac arrest that are, for example, sports related. And we see that a lot in the media. Those cases are really something that garners a lot of attention. And they may be unrelated to an underlying heart condition, but sometimes, they are a manifestation of having a primary electrical issue or abnormality in the heart muscle that hasn't been previously detected. And then, of course, the increase in the opioid crisis is another reason we're seeing a younger part of the population having a cardiac arrest, along with COVID.

BRIAN GOLDMAN: Let's take those, you know, one at a time. You know, I'm thinking about that Buffalo Bills football player who was struck in the chest and had a cardiac arrest right there on the field and, of course, was successfully resuscitated. What was going on there?

ROOPINDER SANDHU: So that was referred to as commotio cordis. It's when there is a blow to the chest, over the heart, when the heart is going through a critical part of the electrical resetting. A blow at that vulnerable period can initiate ventricular rhythm or that very fast, chaotic, short circuit from the bottom chamber of the heart that leads to cardiac arrest.

BRIAN GOLDMAN: You mentioned younger people and opioids. And of course, you know, we're still in the midst of the opioid crisis, and we're dealing with fentanyl on the streets in many parts of Canada and elsewhere. What role does Naloxone or Narcan, the opioid antagonist, play in the resuscitation of people in the field?

ROOPINDER SANDHU: So Narcan reverses the effects of opiates, including respiratory depression and hypertension, that can lead to a cardiac arrest. So it should be given if there is a high suspicion of opioid overdose after an active airway is managed. But it won't treat cardiac arrest. So that still requires early CPR and defibrillation.

BRIAN GOLDMAN: And finally, how hard is it to learn basic life support?

ROOPINDER SANDHU: Learning basic life support is pretty easy to do. There are a tremendous amount of resources available through a lot of our organizations, such as the Heart and Stroke Foundation. But, you know, anybody can just go online and see a YouTube video of how to perform CPR. And I would encourage everybody to really take the 10 minutes to look to see what resources are available and learn CPR.

BRIAN GOLDMAN: Well, Roopi, thank you so much for coming on to The Dose to talk about this important subject. And, you know, I hope people who don't know CPR, don't know basic life support, are motivated to go out and get some training, because it can make a big difference.

ROOPINDER SANDHU: You're so welcome. Thank you.

BRIAN GOLDMAN: Doctor Roopinder Sandhu is a heart rhythm specialist, professor in cardiac sciences and director of the Women's Cardiovascular Health Initiative at the Libin Cardiovascular Institute at the University of Calgary. Here's your dose of smart advice. Heart stoppage or cardiac arrest is common. Nearly 90% of cardiac arrests in a public place are witnessed. That means laypeople who are trained in basic life support can save lives. Organizations like the Heart and Stroke Foundation introduced something called the Chain of Survival. It's the order of steps that need to happen from the moment of a witnessed cardiac arrest. The chance of survival goes up a lot when four key steps are followed quickly and effectively. Here are the four steps. The first is to recognize that someone is in cardiac arrest. That means the person is unresponsive, isn't breathing and doesn't have a pulse. At that point, either you or a partner call 911 or call out for help and grab the automatic external defibrillator or AED. The second step is to begin good quality CPR. The third step is to attach the AED, follow its voice prompts, and push a button to defibrillate the patient if the voice prompt tells you to do so. The fourth step is advanced cardiac life support, the stuff paramedics and people like me do. Although cardiac arrest is more likely in older patients, it can happen to younger people too. Given the opioid crisis and the wide availability of illegal fentanyl on the street, the prompt use of Naloxone or Narcan has been incorporated into the first response by laypeople. The chain of survival works when trained bystanders recognize and respond to cardiac arrest. You have an important role to play in saving lives. If you have topics you'd like discussed or questions answered, our email address is thedose@cbc.ca. If you liked this episode, please give us a rating and review wherever you listen. This edition of The Dose was produced by Sameer Chhabra and Isabelle Gallant. Our senior producer is Colleen Ross. The Dose wants you to be better informed about your health. If you are looking for medical advice, see your health care provider. I'm Dr. Brian Goldman. Until your next dose.

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What do I need to know about cardiac arrest? - Transcript

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