If you witness a cardiac arrest, here's what to do | Hacker News Reader

If you witness a cardiac arrest, here's what to do

cbc.ca

56 pointscolinprince59 comments

Always good to do. Medicos I talk to say two things: you have to press a LOT harder than people think, and when they do it, cracked ribs are normal. And, its really sad, but it just doesnt work sometimes. A lot of times.

Do it, but don't be surprised if it doesn't work. But do it.

Helen Clark, ex PM of NZ tried to save her mountain guide friend up a hill, kept going for an hour or more. When I measure up prime ministers, this is the standard I look for.

Another thing said by medics that's stuck with me is "you can’t screw up CPR because the person is already dead"

Effective CPR is a team effort because it is physically demanding and requires a number of individuals to work other elements of the problem set (airway, medication and access, AED, relief for CPR practitioner, communication with emergency department, police etc...). There is an awful lot to do in these situations and the scenario balloons in players from the first rescuer to the receiving emergency department. The goal should really be continuous motion to a higher level of care vs. getting frozen in place.

I will also note that it is pretty emotionally demanding, particularly given that it's likely to fail, and be coincident with someone else in distress (family member, friend etc...). This is an event you're going to want to put into a box and give yourself some time to work with.

Well dang, I guess in hospital success rates for CPR are <20% survival to discharge. Outside of hospital they are < 10% and quickly drop. Sort of terrifying, even though I've done CPR training many times for work I was of the impression that success rates were much higher.

It's low with CPR alone, but getting an AED involved (which should be accessible in most urban places these days) raises the chances to 50-70%.

Look more carefully at that 50 to 70% figure. It is exaggerated (or at least misleading to directly compare) because the usually cited studies are assuming an arrest with a shockable rhythm (and timely, and correct AED application), but only 30 to 40% of out of hospital cardiac arrests have a shockable rhythm, so the overall survivability is not over 50%. Practically speaking even with an AED present its more like 20-30% and that is just survivability, not taking into account long term deficits.

They're cheap enough now for normal people to own one.

I carry one in my car as well as a bleed kit, and some other bits and pieces I'm qualified to use (oropharyngeal airways and a bag valve mask respirator).

They're $600 refurbished for anyone wondering.

Depends on the country, but as low as $599 AUD ($378 USD) brand new.

https://cellaed.io/au/products

Where can I find those numbers?

You're a lot better off, if it's just a Heimlich. They don't say it, but probably much better, if you have access to an AED (most of that remaining 10%).

Survival rates when CPR is applied outsite a hospital is below 10%. About 1/3 of those 10% that survive will have permanent neurological disability and about 50% whish they died instead of having CPR.

https://www.npr.org/sections/health-shots/2023/05/29/1177914...

That still leaves a small percentage of those to survive and continue their lives, I’d say it’s worth it. My father was probably killed by CPR as we found out at autopsy that he had aortic aneurism, an aortic fissure that ruptured badly during CPR. And yet ER tried their best and was his only chance of survival.

Here is the non-lite version of the article: https://www.cbc.ca/radio/whitecoat/the-dose-cardiac-arrest-1...

Useful illustrative graphic in that version of the article for remembering the compression rhythm with a Bee Gees' song mnemonic and required depth.

> remembering the compression rhythm with a Bee Gees' song mnemonic

i prefer the Queen song mnemonic :D

thank you!

From https://news.ycombinator.com/item?id=39850383#39863280 :

> Basic life support (BLS) https://en.wikipedia.org/wiki/Basic_life_support :

>> DRSABCD: Danger, Response, Send for help, Airway, Breathing, CPR, Defibrillation

> "Drs. ABCD"

From "Defibrillation devices save lives using 1k times less electricity" (2024) https://news.ycombinator.com/item?id=42061556 :

> "New defib placement increases chance of surviving heart attack by 264%" (2024) https://newatlas.com/medical/defibrillator-pads-anterior-pos... :

>> Placing defibrillator pads on the chest and back, rather than the usual method of putting two on the chest, increases the odds of surviving an out-of-hospital cardiac arrest by more than two-and-a-half times, according to a new study.

From SBA.gov blog > "Review Your Workplace Safety Policies" (2019) https://www.sba.gov/blog/review-your-workplace-safety-polici... :

> Also, consider offering training for CPR to employees. Be sure to have an automatic external defibrillator (AED) on site and have employees trained on how to use it. The American Red Cross and various other organizations offer free or low-cost training.

Also learn the Heimlich maneuver if you can. It’s easy to learn and you don’t need to be certified. Never thought I’d need it but I saved my brother’s life many years ago. An outlier for sure given about 6,000 people in the US die from choking each year, but still.

https://my.clevelandclinic.org/health/treatments/21675-heiml...

Heimlich maneuver is good, but it must be done right, and customized for the person. Doing it wrong can cause injury that can kill a person.

https://pmc.ncbi.nlm.nih.gov/articles/PMC9108913/

https://pubmed.ncbi.nlm.nih.gov/37695097/

A few years back while recertifying, I got interested in what the world record was for the longest successful CPR recovery. Found this incident that lasted 4 hours, involving someone who'd gone into hypothermia some hours before:

http://www.cbc.ca/news/canada/british-columbia/christine-tin...

In this case, her lowered body temperature contributed to surviving long enough for rescue.

CPR doesn't have the highest success rate, but it's worth knowing how to do as it can make a life or death difference.

"They aren't dead until they're warm and dead."

This article fails to mention that if their lungs aren't breathing, you could also do two rescue breaths for every thirty compressions. This will also give you a break from doing all those compressions. Obviously call emergency services before you do anything at all.

whats the liability if you dont?

In the US, you don't have to do anything. If they are not responsive without a pulse you can legally administer CPR with the "good Samaritan" laws. However it's extremely unlikely to actually work in the best of conditions. We were taught as EMTs that it's really for the bystanders to have something to do. Unless there's an AED, it almost never works, but hey you may as well try.

If it works 10% of the time, that's unquestionably worth it. What's the cost, sore arms?

I am a volunteer EMT, so it's worth it for me. But I also understand it's very likely that even if you return the patient to spontaneous circulation, they might still not live or might have serious issues like brain damage. Cardiac arrest is often caused by something else.

Also it's not just sore arms, CPR on an elderly patient will often crack ribs which is pretty upsetting. A 9/10 chance you'll feel like you killed a person by crushing their chest is pretty high.

Mouth to mouth is really gross and I wouldn't do it to someone with vomit all over them. Without a suction device it's not effective anyway.

I do think everyone should have to take CPR+AED in high school and college, it's a great skill to have and shares the burden of basic life support around the community. But I totally understand why someone wouldn't want to perform it.

> CPR on an elderly patient ...

A nurse advised me, regarding advanced directives for an elderly person, of the same. It sounds awful.

For me, the cost was a lot of emotional trauma at my own failure, and exposure to the victim's vomit.

That's a high enough cost to let someone die?

No, but it's a lot higher cost than some sore arms.

Have you performed a CPR since you judge others?

My concern would be the risk of going into cardiac arrest while performing chest compressions, because the universe has a sick sense of humor.

You probably have a liability to call 911 if you are able to. You're never liable for providing untrained medial assistance but if you're a medical professional that might change.

Legally or morally?

legally, in Australia

I don't know of anywhere in the world where common law requires you to save someone in peril as a civilian

If a toddler falls in to a fountain, you can just walk away?

If it's not your toddler and not your fountain, sure.

It might even be the smart move. depending on the good Samaritan protections in your jurisdiction, you might be open to liability if you try to help.

Maybe true for common law, but definitely not everywhere. For example in Polish penal code: "Art. 162. §1. Anyone who does not provide assistance to a person in a situation threatening a direct danger of loss of life or serious damage to health, when he could provide it without exposing himself or another person to the danger of loss of life or serious damage to health, shall be subject to a penalty of imprisonment for up to 3 years."

It's obvious that this isn't universally true from a legal perspective, and certainly not universal from a personal perspective.

Now, you, personally - if you were watching a toddler obviously drown in a fountain, would you walk away?

I would help, but I am generally sensitive to the legal penalties around these things.

California has decent good Samaritan laws to protect people trying to help from civil liability, and some narrow situational protections from criminal liability.

This is actually known as the Drowning Child problem, and its most important implication is that any billionaire is "extremely evil."

The parent comment would still be correct though, and billionaires are just filling a power vacuum, nothing wrong about that. I genuinely believe U.S. is also just filling the power vacuum & mostly has done nothing wrong, similar to other superpowers. There's nothing inherently wrong about letting the child drown unless you are the child & can protest about your own drowning, and there's nothing wrong with filling the power vacuum, because the universe has determined that someone ought to do it sooner or later. And we cannot do anything about this.

I define problem/issue/similar words in the following way: a thing that, if deemed existent by me, is also my own fault & realistically fixable by my self.

You are talking about peter singers drowning problem, which is a pretty separate set of concerns.

I was highlighting systemic disincentives that punish potential help.

For example, About 15 years ago restaurants stopped feeding the hungry and poor because they could be sued, and locking up their dumpsters due to liability.

That's monster-ish.

Agreed, but not criminal in most US states, nor bearing civil liability.

>In Buch v. Amory Manufacturing Co., the defendant had no obligation to save a child from crushing his hand in a manufacturing machine. The court suggested an analogy in which a baby was on the train tracks – did a person standing idly by have the obligation to save him? Legally, no. He was a “ruthless savage and a moral monster,” but legally he did not have to save that baby.

https://www.enjuris.com/blog/questions/good-samaritan/

i know for a fact you cannot legally drive away if you witness a car accident (in some european countries)

But is that about requiring you to give medical assistance, or just a statement to the police?

There is no common law duty to rescue. If you do nothing, you'll be fine legally but I don't know how you'll sleep at night.

In NSW, the Civil Liability Act 2002 provides protections for good samaritans assisting in good faith. Other states and territories have similar legislation.

https://www5.austlii.edu.au/au/legis/nsw/consol_act/cla20021...

Like Seinfeld?

Thankfully the episode's interpretation of a Good Samaritan Law is completely wrong, at least in many (most?) US states. They protect citizens acting in good faith to help somebody, not like it was interpreted in the episode to require somebody to help.

Not completely wrong. There are duty to rescue or duty to report laws, and they too are very commonly referred to as Good Samaritan laws even if that more commonly refers to a different concept of liability.

https://www2.law.ucla.edu/Volokh/rescue.htm

Duty to report are on the books, including in Massachusetts (ch 268 §40), requiring bystanders to report crimes, but not necessarily render aid. Duty to report laws are rarely enforced, which is what makes the Seinfeld setup more ironic. Although MA has one of the broadest duty to report laws (covering armed robbery and manslaughter in addition to sexual assault), the max penalty is a $2500 fine, but other states have jail time penalties. Duty to rescue is most always only for special relationships, such as parent/guardian/child, spouse, employer/employee, passenger, not random bystanders.

https://www.findlaw.com/legalblogs/law-and-life/in-which-sta...

It's been drilled into my head as an American that I should never help anyone. Too much risk.

That's why there are good Samaritan laws.

   No person who in good faith, and not for compensation, renders emergency 
   medical or nonmedical care at the scene of an emergency shall be liable for 
   any civil damages resulting from any act or omission.

https://recreation-law.com/2014/05/28/good-samaritan-laws-by...

Is it really? If I help someone am I really risking being sued?

No: You are protected by a good samaritan law of some kind in all 50 states:

https://en.wikipedia.org/wiki/Good_Samaritan_law#United_Stat...

Certainly we, all of us, may be sued at any time for anything but there is specific protection codified into law for this particular scenario.

If somebody needs help you should help them.

Good to know. I'd hate to get in trouble for merely helping out. I don't know how to do CPR but I'd definitely attempt to pull someone out from a burning car for example. If I were training for CPR this part would likely be covered in the training.

Here's the rub tho, you can still end up getting sued if for example you acted with gross negligence. An example I'd use here is you move somebody from a car wreck and injure them even further rather than waiting a few minutes for emergency response.

This is entirely going to depend on the victim and their lawyer, but they can absolutely make your life a living pain especially if they find out you have money and might just settle to make it go away.

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