I’m dead. Not figuratively, actually. I’ve had this gnawing dull ache in my chest since I started walking back home from town, and felt a bit sick and sweaty, but I couldn’t be bothered to wait on the bus and didn’t want to upset the wife. So we kept walking up the hill, and now this. The ache became a pain, like a vice round my chest, and next thing I knew I was looking down on myself collapsed on the pavement by the Commie Pool.
The wife went berserk – can’t blame her really, I’m only 53 but a “committed” smoker – and ran into the pool where they got a lifeguard or someone, who sprinted out and started pumping on my chest. It looks really painful but I don’t seem to notice. An ambulance arrives in a flash, and the paramedic gets back-up soon after. There are 3 paramedics there, attaching some equipment to me. The machine looks like it’s reading my heart tracing, and they place some sticky pads on my chest. The tracing is all over the place, big zig-zag waves. Someone shouts for everyone to “stand clear!” The lifeguard jumps off and they press a button on the machine and I suddenly convulse with the electricity that has just been sent through me.
“Re-start chest compressions!” one of the paramedics shouts. They are all looking at the machine whilst the lifeguard (who looks like he might need the machine in a minute) leaps back into action. A minute or so later they stop him to look at the heart tracing again. Even I can tell it looks better. One of the paramedics puts a tube in my windpipe and starts to inflate my lungs for me, whilst one of the others puts a small drip in a vein in my arm to start some intravenous treatment. I still seem to be completely out of it, but they can feel a good pulse and load me into the ambulance and whisk me down the road to the Royal Infirmary with the sirens blaring.
I can hear the driver pre-alert the team in the Emergency Department whilst driving along, and when we arrive there are 2 doctors and 2 nurses waiting for me in one of their resuscitation rooms. They quickly check my breathing tube, my pulse and the heart tracing, and then hear the story from the paramedics. The timings of all the events are meticulously recorded, and some more tests are organised.
“We have good ROSC (return of spontaneous circulation) but no breathing yet”, one of the docs says to someone down the ‘phone. “Do you want us to cool?” The reply seems to indicate the affirmative. One of the nurses gets some drugs in syringes ready and the other gets some big pads that look like ice cube holders out of a freezer. They give me some medicines into the drip, whilst one of the docs puts a probe down my gullet to measure my core body temperature. My breathing is now smooth and steady, regulated by (another) machine behind my head, and they start to stick the ice cube pads on my legs, back and front. They are cooling me down to protect my brain, I hear one of the docs explain to a medical student.
Two days later, I surprise myself to wake up surrounded by countless machines and a lovely nurse on the intensive care unit. I am re-united with my body, and it seems, with a bit more care of my heart and myself, I might just make it after all.
The high-stakes relay race
Cardiac arrest happens for many different reasons, but is often due to a sudden problem with the function of the heart. Surviving cardiac arrest depends on treatment starting immediately, right from when someone collapses. Like a relay race, the baton of treatment must then pass quickly and seamlessly between each team that looks after the patient, from the point of collapse to the intensive care unit.
First of all, it is imperative for a bystander to phone 999, and ask for an ambulance. In the 5-10 minutes it takes for help to arrive, bystanders have a crucially important job to do. The thing which probably makes the biggest single difference to the casualty’s chance of surviving is good bystander chest compressions. The relay race has begun!
Many bystanders get anxious about having to give “the kiss of life” or start mouth-to-mouth breathing. This is no longer recommended - just get your hands onto the centre of the chest and compress it by about a third of its depth - hard and fast (about 100 times a minute). You may break a rib or two, but you may also save a life. You cannot make things any worse.
In Edinburgh, the important parts of this relay race have been studied by our research team based in the Emergency Departments (EMeRGE group).Working together closely with the Scottish Ambulance Service to optimise all of the stages in the relay, we have been able to double the number of people in Lothian whose hearts have been successfully restarted after cardiac arrest compared to 6 years ago. In addition, your chances of surviving to go home after a cardiac arrest in Lothian have improved tenfold.