Distressingly, the world has watched as a man suffered cardiac arrest live on television. Christian Eriksen was playing for the Danish national football team during the UEFA Euro 20 tournament when he dropped suddenly to the floor – his team mates stricken and the fans and commentators shocked. Thankfully he is well and recovering in hospital – but how much of his good outcome was due to having the world’s best medics on hand? Perhaps not quite as much as you’d think says Dr Christopher Smith, an Emergency Medicine doctor and researcher in out-of-hospital cardiac arrest at Warwick Medical School.

“Christian Eriksen’s collapse was because his heart had stopped. He was saved by the quick action of his team mate and the referee who recognised the signs and summoned help almost immediately. The medical team started CPR and attached an Automated External Defibrillator (AED) very quickly. Yes, he was lucky to have a highly-skilled medical team immediately by his side, but primarily he was lucky to have someone start CPR and use the AED as soon as possible. Any other bystander, alert to the situation, could have done the same within those precious first minutes after Erikson collapsed, even with little or no prior training,” says Dr Smith.

This is an important message arising from Eriksen’s awful situation. Cardiac arrest does not have great outcomes. Figures show there is about a one in ten survival rate – slightly higher in public places. But if you can start CPR straight away and access an AED, you double the chances for the patient.

Get stuck in

“CPR and using the AED are not difficult to do, but there is a barrier because people worry about doing it properly, says Dr Smith. "If you can recognise the signs and get your head round it, starting CPR and applying the AED as early as possible makes a massive difference to survival.

“Once the heart has stopped it stops delivering blood and oxygen to a patient’s vital organs. The quicker this situation is reversed the better chance of a good recovery. The heart is a mechanical pump coordinated by an electrical system. The CPR pumps blood and oxygen around when the heart has stopped and, if the reason the heart has stopped is primarily because of a problem with the electrical system, the electric shock of the AED can reset or restart the electrical system so that the pump starts up again. This electricity or ‘defibrillation’ is needed as early as possible, to minimise damage to the pump and other organs during cardiac arrest.”

Knowing the signs

“When people collapse with cardiac arrest they can sometimes take irregular, gasping breaths. They sometimes look like they are having a seizure. But these are both signs that the heart has stopped. The key is – if they are unconscious and not breathing properly they are in cardiac arrest and need to receive CPR immediately,” says Dr Smith.

What to do if someone collapses

Dial 999

“Always ring 999 and get medical help on its way. The call room staff have a pre-prepared script which will help you perform CPR. They can also advise where the nearest AED is located. If the AED is kept in a locked cabinet, which some unfortunately are, they should also be able to give you the code to unlock it” says Dr Smith.

Start CPR

"Don’t wait for the ambulance to arrive. CPR is something you can do and starting straight improves the chances of survival from cardiac arrest. To prepare yourself for this eventuality you could go to face to face training run by organisations like St John Ambulance. With current COVID measures in place, you may prefer to familiarise yourself with scenarios online by getting the LifeSaver App produced by the Resuscitation Council UK. It includes videos and instructions on realistic scenarios including cardiac arrest and choking events,” explains Dr Smith.

Send someone to get the nearest AED – AND USE IT

“Do not be afraid to use the AED. As you open the box, a recorded voice gives you instruction on how to use the machine. The machine itself decides whether or not to shock the patient, so there is no decision making involved,” says Dr Smith.

“AEDs are dotted around our villages, towns and cities at places like train stations, shopping centres and village halls and it’s worth knowing where your nearest one is located” he adds. “Medically, it is the most serious thing that can happen to a person. Even if you do everything perfectly, sadly the majority of people don’t survive. But know that if you start CPR and get a defibrillator on a person quickly, you can increase their chances and you did everything you could.”

Dr Christopher Smith is an Emergency Medicine doctor at University Hospitals Coventry and Warwickshire and a researcher in the Clinical Trials Unit at Warwick Medical School. His research looks at ways of improving public access to AEDs. His new project is studying the potential to use drones to deliver AEDs to very rural areas. This summer he will be running cardiac arrest simulations where an AED is delivered from a drone to a bystander performing CPR.

Published:

18 June 2021

About:

Dr Christopher Smith is an Emergency Medicine doctor at University Hospitals Coventry and Warwickshire and a researcher in the Clinical Trials Unit at Warwick Medical School. His research looks at ways of improving public access to AEDs. His new project is studying the potential to use drones to deliver AEDs to very rural areas. This summer he will be running cardiac arrest simulations where an AED is delivered from a drone to a bystander performing CPR.

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