surviving cardiac arrest: heart and stroke study highlights alarming stats for canadians
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the heart & stroke foundation, in partnership with governments, has placed over 15,000 aeds in communities across the country, while other organizations and businesses are installing even more.
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if an annual facebook memory didn’t remind lisa hutcheson of what happened to her on a cold january morning 15 years ago, the slight bulge of an implantable cardioverter-defibrillator (icd) under her skin will never let her forget.
she had always been active, but like so many people come the new year, she wanted to step it up a bit. so she enlisted a personal trainer and was working out at her markham, ont. gym. “we had a pretty normal session,” she says, before everything went awry. “i was on the treadmill and told him, ‘i don’t feel very — ‘ and didn’t get to finish the sentence.”
hutcheson didn’t feel very well, and was about to fall to the concrete floor when her trainer caught her. fortunately, two retired police officers happened to be in the gym at the time. the three of them took turns performing chest compressions (cpr) on her while an ambulance raced to the scene.
“at the hospital, i was in a medically induced coma for two days while they were trying to figure out what had happened,” says hutcheson, who was 41 at the time.
what happened is that she had suffered a sudden cardiac arrest.
“i want people to know i had a cardiac arrest, i did not have a heart attack,” she says. “people inter-mix them; they don’t understand the difference.”
in its new report, “every second counts”, the heart & stroke foundation of canada wants people to know the difference, too, because that knowledge can be life-saving.
what’s the difference between cardiac arrest and a heart attack?
a heart attack is referred to as a plumbing problem. it occurs when blood flow to the heart muscle is slowed or blocked, but the heart keeps pumping blood to the rest of the body. a person experiencing a heart attack is often still conscious, but in some discomfort, often with sweating and chest pain, so it’s vital to call 9-1-1 immediately.
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cardiac arrest is known as an electrical problem. it happens when the heart’s electrical system suddenly stops working and stops pumping blood to the brain and other vital organs. the person may not be breathing normally or breathing at all. call 9-1-1 immediately, shout for an automated external defibrillator (aed) and start cpr immediately.
what canadians don’t know about cardiac arrest and heart attacks
the recent report from heart & stroke revealed some alarming statistics around cardiac arrest:
- one in three canadians don’t realize cardiac arrest and heart attack are different
- one in three don’t understand the severity of cardiac arrest — 90 per cent of people who experience cardiac arrest outside of hospital don’t survive
- previous estimates of annual out-of-hospital cardiac arrests numbered about 35,000. the new report shows it’s much higher — at 60,000. that’s one in every nine minutes.
- nearly half of cardiac arrests happen to those under 65 — even to professional athletes
- only four per cent of canadians can name cardiac arrest as a possible cause of unexpected collapse
- cpr rates vary across the country from between 42 per cent to 72 per cent
- bystander use of aeds in some public places is only about 13 per cent
- brain injury can begin within five minutes and survival drops significantly for every minute without cpr and an aed
lesley james, director, health policy & systems, heart and stroke, says there are a number of potential explanations for the higher number of 60,000 cardiac arrests.
“the canadian population is growing and aging — and age is a risk factor for heart disease,” she says. “there’s also been an increased prevalence in health conditions like high blood pressure and diabetes, and environmental risk factors like air pollution.”
james says covid-19 and the opioid crisis have also had a detrimental effect on many people’s health outcomes, and experts are still trying to understand the extent of their impact on cardiac arrest rates.
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how to save a life after cardiac arrest
given that every second counts when someone is experiencing a cardiac arrest, it makes sense that more people understand the condition and how to react quickly. immediate cpr keeps the blood pumping to keep the brain and other vital organs alive. an aed will shock the heart to help it restart.
unfortunately, too few people take action into their own hands. one reason is the fear of breaking a rib while doing cpr.
“there is a risk of breaking a rib but that risk is much lower than the risk of someone dying if cpr is not done,” says dr. sheldon cheskes, professor at university of toronto, canadian resuscitation outcomes consortium co-principal investigator, medical director for regions of halton and peel, and resuscitation scientist. “if cpr is performed properly, the likelihood of breaking a rib is very low.”
and coupling compressions with mouth-to-mouth resuscitation is not necessary — a good thing since many people fear contracting a contagious disease, especially since covid.
“if you simplify the process and allow people to do chest compressions only, you’re likely going to have many more people performing cpr,” says cheskes.
but, he says, there is still stigma around giving cpr to women, which is why they are less likely to be resuscitated — 61 per cent of women received cpr from a bystander compared to 68 per cent of men, according to a recent study from the montreal heart institute. many people are uncomfortable removing clothing and placing their hands between the breasts of a stranger.
cheskes says in scandinavian countries like sweden and denmark, bystander cpr rates are around 80 per cent. “part of this is the societal impetus to act at the time of need. in north america there is a willingness to act but i think there’s also the fear of harming an individual. but it’s hard to harm somebody who is already dead.”
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as for using an aed, he says many people are afraid of using it incorrectly. “the manufacturers have developed smaller, easier to use defibrillators and provide excellent instructions as you’re using them,” says cheskes.
“i’d love to see the use of an aed at 50 per cent, and it would be excellent to reach the rates of the scandinavian countries.”
he says in some parts of europe drivers can’t renew their licences without taking a cpr course. and they’re often taught in school. “there are many jurisdictions here that do teach cpr in schools but the next step is making it mandatory in grade schools to teach cpr and aed across the country.”
in fact, children as young as 10 can provide effective cpr, and a 2022 heart & stroke survey found 93 per cent of canadians support making cpr and aed education mandatory in elementary, middle and high schools.
“it’s important to note that teachers don’t always have the resources or capacity to teach these skills,” says james. “that’s why heart & stroke will be working with educators in schools across canada to provide programmatic solutions to better support the teaching of resuscitation skills.”
equipping the unequipped: the need for more defibrillators
as for increasing the use of aeds, even if there were enough people who were willing to use them, are there enough available?
james says the heart & stroke foundation, in partnership with governments, has placed over 15,000 aeds in communities across the country, while other organizations and businesses are installing even more.
she says new brunswick, nova scotia, newfoundland and labrador, pei and quebec have all committed to installing aeds in schools, and quebec has made the same commitment to indigenous communities. some provinces, like ontario, also include cpr and aed training in their curriculum.
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“but there’s still a lot more work to be done,” she says. “aed availability is uneven across the country and even in locations where they do exist, they can be inaccessible — in a locked office or a venue that’s closed, for example. aeds are also not always properly maintained, and they are often not registered in an ems database, meaning 9-1-1 services cannot direct lay responders to find the nearest one.”
cheskes says having lots of aeds in public places is ideal, but the reality, he says, is that 80 per cent of cardiac arrests happen at home. he predicts that, in the near future, every home will be equipped with a personal aed.
lisa hutcheson’s gym did not have an aed at the time of her cardiac arrest, but it got one right after. and since then, she has learned how to do cpr and use an aed. but she’s still confounded as to why this happened to her.
“it was such a shock, and it still is a shock,” she says. “in my mind i was young, in seemingly good health, no pre-existing conditions, no family history, no indications at all. on reflection, i had a lot of stress in my life and i was getting less sleep. i wasn’t taking as good care of myself as i normally would have and my body was just saying, i’m tired.
“but i think it’s important for people to be aware that it can happen to anyone, and the importance of heart health. i’ve always been quite health conscious, and i would say more so now. i’m much more mindful, much more aware, more forgiving of myself when i’m tired, and i listen to my body when i need a break.”
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