CPR in cardiac arrest: Lessons from South Korea

The world has witnessed one of this year's most devastating tragedies recently. On October 29, while celebrating Halloween, more than one hundred thousand revellers mobbed into a narrow alleyway off the high road in Itaewood, South Korea.

Subsequently, one hundred fifty-six revellers were crushed to death, and more than a hundred were severely injured. 

Videos went viral on social media, where we glimpsed clusters of laypeople performing CPR (cardiopulmonary resuscitation) on those who collapsed in that stampede due to cardiac arrest.

Apart from these mishaps like stampedes where a person falls short of oxygen, cardiac arrest may happen due to other reasons like heart attack, coronary artery diseases, major blood loss, and the like. Each year, globally, over 3,50,000 cardiac arrests occur outside hospital settings. With such a high number, cardiac arrest has become one of the world's major concerns today.

Research shows that about nine in 10 people who fall victim to cardiac arrest outside the hospital die. Unfortunately, most people who experience cardiac arrests at home or outside the hospital don't get the help they need from family members or bystanders before the arrival of professional medical services. 

During cardiac arrest, the heart cannot pump blood to the rest of the body, including the brain and lungs. Without medical care, death can occur within minutes. Cardiopulmonary resuscitation (CPR) can lessen the harm and save lives. By applying chest compression, CPR simulates the heart's pumping action and thus supports the body's natural blood flow. 

A person's chance of survival can be doubled or tripled if CPR is administered correctly within the first few minutes of cardiac arrest. However, the need for CPR training is still not well understood in our country, in contrast to the developed countries where it is profoundly emphasised. And, except for a few non-governmental organisations, such as Healthy Heart Happy Life, the government has taken no significant steps hitherto.

Let's look at two empirical events regarding cardiopulmonary resuscitation. In a 2020 European Football Championship match, Danish footballer Christian Eriksson suddenly fainted on the field due to cardiac arrest. But as his teammates managed to administer CPR to him in time, he survived. On the other hand, in our country, as many of you may remember, in August 2019, a female banker suddenly died of cardiac arrest while working in her office in Dhaka. The tragic death scene was caught on the bank's CC camera. Sadly, had her colleagues known how to perform CPR, she could have survived.

The prevalence of CPR training among general populations in China is 38%, and 49% in Japan. Although there's no study on the prevalence of CPR training in our country, it's not hard to assume that the number is meagre. In the case of South Korea, it is almost 50%. This is a noticeable number. However, previously, this number was much lower. 

The establishment of a national public CPR programme, public awareness campaigns, the passage of the Good Samaritan Law, and legislation requiring CPR instruction in schools were all significant changes in South Korean national practices that contributed to an increase in the prevalence of CPR training.

Given what South Korea has accomplished, it is time for us to implement some drastic measures for CPR training. To spread awareness and knowledge about cardiac arrest and the importance of CPR training throughout the country, the government should come forward with some immediate and necessary steps, for example, incorporating CPR into the curricula of primary and secondary schools, providing hands-on CPR training to the mass population covering major divisional areas, and using social media to advocate the importance of CPR training among youngsters.  

For every minute without CPR, the survival chance of a person experiencing cardiac arrest decreases by 10%. Therefore, many more people who fall victim to cardiac arrest would survive long enough to obtain the expert treatment required if they were trained in CPR techniques. 

The good thing about CPR is that it's a simple process that even non-health professionals can master without much effort. Therefore, every responsible citizen should invest in acquiring this much-needed education to ensure the safety of the people around us, especially those we care about the most.

Dr Shiblee Shahed is a public health specialist, researcher, essayist, and translator. He also serves as senior research executive at IPDI Foundation.