Lack of confidence, apathy may be reasons many bystanders do not attempt procedure

ABOUT only one in five people who suffers cardiac arrest here receives cardiopulmonary resuscitation (CPR), doctors said at a seminar where they released new guidelines on the proper way to perform this life-saving routine.

The help rate is low compared to places such as Seattle in the United States, where more than half the victims receive CPR.

The procedure is performed on patients who suffer cardiac arrest, a condition where the heart stops functioning suddenly.

Such an attack occurs when heart abnormalities, such as a blocked artery, hinder blood flow and starve the brain of oxygen. It can kill in five to 10 minutes.

CPR involves pressing a victim's chest repeatedly to restart blood circulation. It also involves offering mouth-to-mouth resuscitation, to help the patient breathe. It can be performed by trained personnel only so it is imperative for more people to undergo training, said cardiologist Teo Wee Siong, a senior consultant at the National Heart Centre.

About 30,000 people, mainly health-care professionals and emergency workers, receive CPR training here every year. But this number could include repeat attendees as health professionals in public hospitals are expected to renew their training every two years.

'One of the big problems is that in about four in five cases, bystanders do not even attempt resuscitation,' Dr Teo said yesterday.

He suspects that in some cases even those who have undergone training may not attempt to revive a patient as they are not confident enough. 'That must change.'

Senior Minister of State for Health Balaji Sadasivan also backed the call for more CPR training while speaking at the seminar yesterday.

'The public mindset must change, from apathy and the belief that learning CPR is someone else's duty, to one of shouldering the responsibility, not only for oneself, but also for the community.'

In Singapore, only about 5 per cent of people who suffer cardiac arrest outside hospitals survive, said Dr Lim Swee Han, head of emergency medicine at Singapore General Hospital, who did a study of survival rates of 1,000 such patients.

However, survival chances double if patients are given prompt CPR. Timely use of machines known as automated external defibrillators, or AEDs, that can shock the heart back into action, also boosts a victim's chances.

Aside from training emergency personnel and lay people, some countries have targeted CPR programmes, said Dr Lim.

In some places, high school students, for instance, are trained. In others, employees at places where people have been known to suffer cardiac arrests - such as casinos, airports and sports stadiums - are given special training.

Such targeted training has proved effective in the US, said Dr Michael Sayre, an associate professor of emergency medicine at Ohio State University.

If there are no trained personnel around to offer CPR, bystanders should call an ambulance immediately, said Dr Teo. 'Too often people wait too long and it's too late.'

Nurse manager Ismail Sheriff, 53, who has undergone CPR training, could not agree more.

A few years ago, he received a frantic phone call that his 72-year-old neighbour had collapsed with chest pains. He rushed over and tried to revive the unconscious woman. But it was all in vain - she was dead.

'It was only later that I realised that they had called me more than 20 minutes after she had collapsed,' he said. 'It was much too late.'

radhab@sph.com.sg

New guidelines

DURING CPR, rescuers need to frequently press hard against a victim's chest and offer occasional mouth-to- mouth resuscitation.

New CPR guidelines released here yesterday say rescuers need to perform at least 30 chest compressions followed by two rounds of mouth-to-mouth resuscitation. Earlier guidelines said only 15 chest compressions were required. Studies have shown that a victim's blood pressure may fall if chest compressions are done only 15 times in a cycle.

Chest compression jump-starts blood circulation. Mouth-to-mouth helps the victim breathe. CPR should begin within four minutes of a person collapsing.

Rescuers should also:

Push hard and fast, pressing the chest at the rate of about 100 compressions per minute.

There should be no interruptions in the 'pump and breathe' routine. CPR should continue till paramedics arrive.