The sudden collapse of a person is a high-stress emergency that demands immediate and organized action. Cardiac arrest occurs when the heart’s electrical system malfunctions, causing the heart to stop beating effectively, unlike a heart attack, which is typically a circulation problem caused by a blocked artery. Without immediate intervention, brain death begins within minutes. The goal of a bystander is to bridge the time until professional medical help arrives by maintaining blood flow to the brain and heart through cardiopulmonary resuscitation (CPR) and rapid defibrillation.
Activating Professional Help and Securing the Scene
The immediate priority following the recognition of cardiac arrest is the activation of the emergency medical services (EMS) system. If two rescuers are present, one should begin chest compressions immediately while the second calls the local emergency number, such as 911. During this call, state the precise location, the victim’s approximate age, and that CPR is actively in progress.
The caller must remain on the line to answer all questions, confirming the man is unresponsive and not breathing normally. The caller should also retrieve an Automated External Defibrillator (AED) from a known nearby location, as defibrillation is the definitive treatment for many cardiac arrests.
Securing the environment for resuscitation helps prevent injury to the victim or the rescuers. The man should be on a firm, flat surface to ensure that chest compressions are effective. Any unnecessary furniture or objects should be quickly moved out of the way to allow EMS personnel clear access when they arrive.
Optimizing Chest Compressions and Ventilation
Once CPR has begun, maintaining the quality of chest compressions is the primary factor in maintaining blood flow to the vital organs. Compressions must be delivered at a rate of 100 to 120 beats per minute. The recommended depth for an average adult chest is at least 2 inches, but should not exceed 2.4 inches.
Allow the chest to fully recoil between each compression, which permits the heart to refill with blood. Minimizing the interruptions between compression cycles is critical, as even short pauses can cause the coronary perfusion pressure to drop significantly. The goal is to maintain the chest compression fraction—the proportion of time spent compressing the chest—as high as possible, ideally 60% or more.
When two rescuers are present, the compression-to-ventilation ratio for adults is 30 compressions followed by two rescue breaths. To prevent rescuer fatigue, the rescuers should plan to switch roles approximately every two minutes, or after five cycles of 30:2. The rescuer providing compressions should receive encouraging feedback to help maintain the correct rate and depth until the switch occurs.
Safe and Effective AED Deployment
The arrival of the AED marks the next phase of the resuscitation effort, as rapid defibrillation is crucial. The rescuer should immediately power on the device and follow the verbal and visual prompts provided by the machine. While the AED is being prepared, compressions must continue without a break.
The adult AED pads must be applied directly to the bare skin of the man’s chest. One pad is placed on the upper right side of the chest, and the other is placed on the lower left side of the chest. The chest should be quickly wiped dry if wet, and any medicated patches or metal jewelry should be removed from the pad area.
Once the pads are connected to the AED, the device will prompt everyone to stand clear while it analyzes the man’s heart rhythm. If a shock is advised, the machine will charge and issue a final “Clear!” warning. The rescuer must confirm no one is touching the victim before pressing the shock button. Immediately after the shock is delivered, or if the AED determines a shock is not needed, CPR must be instantly resumed, beginning with compressions, without waiting to recheck a pulse.
Handoff Procedures and Post-Resuscitation Care
When the professional EMS personnel arrive on the scene, the priority is a smooth transfer of information and care. The initial rescuers should provide a concise briefing, detailing the timeline of the event, the man’s initial status, and all interventions performed, including the number of shocks delivered by the AED. Continue high-quality CPR until the EMS team is physically ready to take over.
The EMS team will integrate advanced life support measures, but the continued high-quality basic life support from the initial rescuers is a seamless bridge to this advanced care. Once the man has been transferred to the care of the paramedics, rescuers should understand that witnessing or participating in a cardiac arrest event is stressful. Seeking emotional support afterward is a healthy and necessary step.