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View Full Version : Surviving A Heart Attack: The Myth of Cough CPR



Reasonable Rascal
03-03-02, 19:23
Claim: It's recommended one attempt to rhythmically cough during a heart attack to increase the chance of surviving it.

Status: False.

Example: [Collected on the Internet, 1999]


*This one is serious . . . Let's say it's 4:17 p.m. and you're driving home,(alone of course) after an unusually hard day on the job. Not only was the work load extraordinarily heavy, you also had a disagreement with your boss, and no matter how hard you tried he just wouldn't see your side of the situation. You're really upset and the more you think about it the more up tight you become.

All of a sudden you start experiencing severe pain in your chest that starts to radiate out into your arm and up into your jaw. You are only about five miles from the hospital nearest your home, unfortunately you don't know if you'll be able to make it that far.

What can you do? You've been trained in CPR but the guy that taught the course neglected to tell you how to perform it on yourself.

HOW TO SURVIVE A HEART ATTACK WHEN ALONE

Since many people are alone when they suffer a heart attack, this article seemed in order. Without help the person whose heart stops beating properly and who begins to feel Faint, has only about 10 seconds left before losing consciousness. However, these victims can help themselves by coughing repeatedly and very vigorously. A deep breath should be taken before each cough, and the cough must be deep and prolonged, as when producing sputum from deep inside the chest. A breath and a cough must be repeated about every two seconds without let up until help arrives, or until the heart is felt to be beating normally again. Deep breaths get oxygen into the lungs and coughing movements squeeze the heart and keep the blood circulating.

The squeezing pressure on the heart also helps it regain normal rhythm. In this way, heart attack victims can get to a phone and, between breaths, call for help.

Tell as many other people as possible about this, it could save their lives!

From Health Cares, Rochester General Hospital via Chapter 240's newsletter. AND THE BEAT GOES ON... (reprint from The Mended Hearts, Inc. publication, Heart Response) *


Origins: This helpful e-mail began its life on the Internet in June 1999. Those kindhearted souls who started it on its way likely had no inkling the advice they were forwarding could potentially be harmful to someone undergoing a heart attack, but that is indeed the case. Those in the know have come down strongly on the side of cough CPR being a dangerous procedure for the uninitiated to attempt.

If you were a doctor and knew exactly what you were doing, it might help save your life. If, however, you are not a physician and you misjudge the kind of cardiac event you're experiencing, cough CPR could kill. This "helpful" e-mail could help you right into a grave.

The e-mailed advice about coughing during a heart attack leaves the impression that "cough CPR" technique is endorsed by Rochester General Hospital and Mended Hearts. Rochester General had nothing to do with any of this -- how its name came to be attached to this message is a mystery. See their web page which denies their having endorsed this e-mail

Mended Hearts (a support group for heart disease patients and their families) is not nearly so blameless.
Although the text of the e-mailed advice was published in a Mended Hearts newsletter, the organization has since disavowed it and for a time had a page on its web site asking readers not to take the e-mail seriously because they didn't stand behind it. The piece on "cough CPR" found its way into that publication through a blend of too much enthusiasm and a dearth of fact checking. From there, other chapters picked it up, spreading the notion to an even wider audience. Attempts now to distance the organization from it don't begin to undo the damage done by the piece having been picked up from there.

Darla Bonham, Mended Heart's executive director, has since issued a statement about cough CPR:

"I've received email from people all across the country wanting to know if it is a valid medically approved procedure. I contacted a scientist on staff with the American Heart Association Emergency Cardiac Care division, and he was able to track a possible source of the information. The information comes from a professional textbook on emergency cardiac care. This procedure is also known as "cough CPR" and is used in emergency situations by professional staff. The American Heart Association does not recommend that the public use this method in a situation where there is no medical supervision. "

Dr. Richard O. Cummins, Seattle's director of emergency cardiac care, explains that cough CPR raises the pressure in the chest just enough to maintain some circulation of oxygen-containing blood and help enough get to the brain to maintain consciousness for a prolonged period. But cough CPR should be used only by a person about to lose consciousness, an indication of cardiac arrest, he cautions. It can be dangerous for someone having a heart attack that does not result in cardiac arrest. Such a person should call for help and then sit quietly until help arrives, he says.

In other words, the procedure might be the right thing to attempt or it might be the very thing that would kill the afflicted depending on which sort of cardiac crisis is being experienced. Without a doctor there to judge the situation and, if cough CPR is indicated, to supervise the rhythmic coughing, the procedure is just far too risky for a layman to attempt.

Forget about coughing -- key to surviving a heart attack is obtaining proper medical assistance within a very limited window of opportunity. Once an acute myocardial infarction (AMI) has been diagnosed, speedy injection of thrombolytic agents to dissolve clots is of the utmost importance -- the more quickly those drugs are delivered, the better the chances of survival are. It's a race against the clock.

Most patients who present with minor chest pains usually look healthy and show no signs of a heart attack. Electrocardiogram (ECG) results tell the story though, so be sure to insist upon one being performed if you've any doubts at all. Often mild heart attacks are left untreated and undetected because hospital staff
mistake a heart attack for something more benign because the presenting symptoms are minor.

Rather than risk killing yourself with cough CPR, those experiencing a heart attack should heed the advice of physicians the world over -- down a couple of Aspirin as an emergency remedy. Doctors believe that during the early stages of a heart attack, Aspirin -- which is known to prevent blood platelets from sticking
together -- can prevent a clot from getting bigger. In 1991 Dr. Michael Vance, president of the American Board of Emergency Medicine, recommended that people who think they are having a heart attack should "Call 911, then take an Aspirin."

Oh, and it probably makes a great deal of sense to chew the Aspirin before swallowing. The sooner it is dispersed by the stomach, the sooner it gets to where it is needed. During a heart attack, waiting for the enteric coating surrounding the pill to break down naturally could be a mistake.

In 1993 The American Heart Association began recommending a 325mg Aspirin at the onset of chest pain or other symptoms of a severe heart attack. That bit of advice is going unheeded though -- a follow-up report published in 1997 shows as many as 10,000 American lives a year could be saved if more people who think they're having a heart attack took an aspirin at the start of chest pains.

Okay, so in terms of the drama of it, swallowing an Aspirin seems quite a come-down from bravely trying to induce a perfectly timed coughing fit. Less flamboyant is better, though; Aspirin saves lives, whereas coughing might well cost them.

http://www.snopes2.com/toxins/coughcpr.htm#add

Reasonable Rascal
03-03-02, 19:32
Stories about "Cough CPR" or "How to Survive a Heart Attack When Alone" have been circulating on the Internet. What is the American Red Cross' position on this issue?

The American Red Cross does not endorse the "How to Survive A Heart Attack When Alone" coughing technique that is being publicized on the Internet. The American Red Cross develops materials from the consensus of medical opinion such as the National Academy of Sciences, the American Heart Association's
Emergency Cardiac Care Committee, the American Academy of Pediatrics, and the American College of Emergency Physicians.

The 1992 Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiac Care and the Guidelines 2000 for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care - International Consensus on Science briefly discuss the technique called Cough CPR ¹. Cough CPR is a self-administered form of cardiopulmonary resuscitation described by CM Criley in 1976 ². According to Criley, self-initiated CPR is possible; however, its use is limited to clinical situations in which the patient has a cardiac monitor, the arrest is recognized before loss of consciousness, and the patient can cough forcefully. To date, there is insufficient scientific research concerning the efficacy of Cough CPR. Therefore, American Red Cross cannot advocate teaching the technique until it has been thoroughly tested in national studies and found to be effective.

As a training organization, the American Red Cross encourages the public to recognize the signals of a heart attack:

- Persistent chest pain or discomfort (which can range from discomfort to an unbearable crushing sensation in the chest) that lasts longer than 3 to 5 minutes or is not relieved by resting, changing position, oral medication, or goes away and then comes back.
- Discomfort, pain or pressure in either arm; discomfort, pain or pressure that spreads to the shoulder,
arm, neck or jaw.
- Breathing difficulty, which may cause dizziness.
- Nausea.
- Skin appearance, which may be pale or bluish in color. The face may be moist or may sweat profusely.
- Unconsciousness.

To care for a heart attack victim:

- Recognize the signals of a heart attack.
- Call 9-1-1 or the local emergency number for help.
- Convince and help the victim to stop activity and rest comfortably.
- Try to obtain additional information about the victim's condition.
- Assist with medication, if prescribed.
- Monitor the victim's condition.
- Be prepared to give CPR and use an AED if the victim's heart stops beating.

Often a heart attack victim experiences chest pain that does not go away; the pain may spread to the shoulder, arm, neck, jaw or back. It is usually not relieved by resting, changing position or taking medicine. If the pain is severe or does not go away in 3-5 minutes, call 9-1-1 or your local emergency number at once. A heart attack victim may deny that any signal is serious. If it appears as though the victim is having a heart attack, stay calm, reassure the victim, and call 9-1-1 or your local emergency number!

1.American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiac Care. JAMA. 1992; 268(16): 2135-2302.

2.Criley JM, Blaufuss AH, Kissel GL. Cough-induced cardiac compression. JAMA, 1976; 236:1246-1250.

3.Guidelines 2000 for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care - International Consensus on Science

Reasonable Rascal
03-03-02, 19:36
Heart Attack Symptoms & Warning Signs

IF YOU THINK YOU'RE HAVING A HEART ATTACK, CALL 9-1-1 OR YOUR EMERGENCY MEDICAL SYSTEM IMMEDIATELY.

The American Heart Association says your body likely will have one or more of these symptoms:

Most common or "classic" warning signals of a heart attack

* Uncomfortable pressure, fullness, squeezing or pain in the center of the chest that lasts more than a few minutes, or goes away and comes back
* Pain that spreads to the shoulders, neck or arms
* Chest discomfort with lightheadedness, fainting, sweating, nausea or shortness of breath

Less common warning signs of heart attack

* Atypical chest pain, stomach or abdominal pain
* Nausea or dizziness (without chest pain)
* Shortness of breath and difficulty breathing (without chest pain)
* Unexplained anxiety, weakness or fatigue
* Palpitations, cold sweat or paleness

All of these signs don't occur in every attack. Sometimes they go away and return. If some occur, get help fast. IF YOU NOTICE ONE OR MORE OF THESE SIGNS IN SOMEONE ELSE, DON'T WAIT. CALL 9-1-1 OR YOUR EMERGENCY MEDICAL SERVICES SO THE PERSON CAN GET TO A HOSPITAL