I have taught CPR for three years, and thought I was well-prepared in case of an emergency, but I learned a lot from actually having to perform CPR in a crisis situation.
Recently, a gentleman collapsed outside my massage clinic location. Staff immediately called 911 and went to try to help. The gentleman was rapidly turning blue, and I felt his heartbeat stop underneath my hand.
We lowered him to the floor from his wheelchair and we began CPR. We continued for 12 minutes until the paramedics arrived. The gentleman was unresponsive for at least 30 minutes, despite CPR. He was loaded onto a gurney and wheeled off to an ambulance while the paramedics continued to work on him, with no response at all.
CPR is a lifesaving skill taught to most massage therapists in school. We all know the basics: Check for a pulse, call 911, begin CPR and wait for the automated external defibrillator (AED) to arrive. We have seen CPR performed on many TV shows and we know how it works—or do we?
I want to share some things with you that may save someone’s life, based on my experience. (This article is not a substitute for training in CPR.)
1. Agonal Breaths
As the man was struggling, he was drawing long, gasping breaths called agonal breaths. I knew these were not real breaths and not a sign of recovery. And yet, I couldn’t help but wonder with each of these four breaths he drew, whether he was actually dying. Don’t let these breaths trick you into not beginning CPR. The American Heart Association (AHA) has changed its guidelines to emphasize checking for heart rate, not breaths, because too many people were delaying CPR. You should begin CPR immediately and not wait for agonal breaths to stop.
2. The Chest Cavity
CPR is very rough on the body, since you need each compression to get deep enough to squeeze the heart and move blood along. You must break the chest cavity and then go deeply with each stroke. With the very first compression, you will feel and hear either the ribs break or the cartilage between the sternum and the ribs separate. If you do not hear this, you are not compressing deeply enough. (Two inches is standard for an adult.) Only having done CPR on a torso manikin before, I was surprised at how completely the man’s whole body moved with each compression. His feet actually rose and then hit the floor with each compression.
3. Hands Only
Uninterrupted CPR is now the method of choice for most organizations. This means no rescue breaths. I know this, but did the breaths anyway because that was how I reacted. The EMTs all reminded me that this is no longer necessary and research is backing them up. AHA and Red Cross are now both recommending hands-only CPR in many cases. (Children and infants are the exception to this rule.) Rescue breaths do not seem to improve the chances of CPR success for adults.
4. The AED
An AED only shocks when it senses some rhythm, like ventricular fibrillation or ventricular tachycardia. If there is no beat at all, it will not shock the client. We didn’t realize this; so when the AED advised, “No shock required, continue CPR,” we lost precious time staring at the machine trying to determine what had gone wrong. Don’t expect the AED to fix everything. It may not shock your client at all.
5. Passersby
Everyone wants to help in an emergency. Some help is useful, like the woman who stepped in to help as we tired, or the woman who helped us count and stay organized. Some “help” is not—such as the person who offered a bottle of aspirin and the person who offered a pen in case we needed to perform an emergency tracheotomy. All of these gestures come from a good place in people’s hearts, but they get in the way. Focus on what you need to do and try to ignore the chaos around you.
Success Rate
This is something I stress in my classes, but I want to make sure it is well-understood: If someone needs CPR, he or she is already dead, and the chances for survival with CPR are about 7 percent. His chance for survival, even with an AED, are less than 25 percent, according to research published in the Journal of the American College of Cardiology.
Between my team at the massage clinic and the emergency medical technicians, we did more than 30 minutes of CPR with no result. We kept the man’s blood pumping and gave him a chance, but none of us felt we had succeeded. However, we did what was necessary and gave him a chance at life he would not have otherwise had.
One of the most difficult things for my staff was that one hour later, everyone else was back to normal. We were not. I watched people walking over the spot where a man had just collapsed, and felt chills.
If you have to perform CPR, understand that it is difficult and scary and traumatic. Don’t be afraid to seek counseling afterward if you need it.
Neither we nor the ambulance team will ever know whether this man lived after reaching the hospital, or not. All we know is that we did our best. That will have to be enough.
Perhaps this information will help you, should you ever be faced with this type of situation. Do the best you can, and take comfort in the fact that every time you try, you improve someone’s chances.
Note: This article is not a substitute for CPR training. To find training or a refresher course near you, contact the American Red Cross or the American Heart Association.
About the Author
Kathy Sankey has practiced as a massage therapist for 12 years. She has taught CPR for three years.