CPR for AFib and VFib

June 23, 2023 12:15 PM

Are lay people qualified to provide first aid for fibrillation?

I know that atrial fibrillation and ventricular fibrillation are both types of irregular heartbeats, and that AFib affects the two upper chambers of your heart and VFib affects the two lower chambers of your heart.

I am a certified lifeguard. I was trained that you do CPR (heart compressions plus mouth to mouth breathing) when there is no pulse and the victim is not breathing, and that you do mouth to mouth resuscitation (breathing) without heart compressions when you feel a pulse but the victim is not breathing.

Today, someone said they read somewhere that CPR should be done on people who are experiencing AFib or VFib.

Mayo Clinic's website says:
"Ventricular fibrillation requires emergency medical treatment to prevent sudden cardiac death. The goal of emergency treatment is to restore blood flow as quickly as possible to prevent organ and brain damage. Emergency treatment for ventricular fibrillation includes: Cardiopulmonary resuscitation (CPR)."

A lifeguard wouldn't be expected to provide emergency treatment for fibrillation, would they? A lifeguard would just need to call 911, correct? It seems to me that a medical professional would be the one to provide CPR in cases of fibrillation.

posted by SageTrail to Health & Fitness (16 answers total)

How would a lifeguard know what the diagnosis is?
posted by chesty_a_arthur at 12:20 PM on June 23, 2023 [3 favorites]

The facility you lifeguard at may have a public AED (automated external defibrillator) which can be generally be used by a layperson. The public AED I was trained on during AED/CPR training had full voice prompts for hooking it up to the individual, and it was able to assess and deliver shocks (or not) to address arrhythmia or full cardiac arrest on its own. I would check in with your facility as to whether they have an AED on hand and expectations regarding accessing/using it. (You or a companion should absolutely still call 911 if there is a life threatening emergency, even if an AED is available.)

The FDA has information on public AEDs.
posted by eschatfische at 12:34 PM on June 23, 2023 [14 favorites]

Best answer: I think you’re overthinking this. Your job is to give CPR if the person doesn’t have a pulse, that’s it. It’s not part of your job to speculate on a diagnosis and withhold CPR based on that speculation. If they’re unconscious without a pulse, they need CPR. Someone in AFib will have a pulse. It affects the upper chambers of the heart—the lower chambers, which pump blood to your body, are still working. In vfib the heart basically quivers but the lower chambers don’t beat. This causes unconsciousness and cardiac arrest. They won’t have a pulse and will need CPR. Any CPR is better than none which is why bystander CPR can save a life. Your only job is to check for a pulse and proceed accordingly.
posted by Amy93 at 12:56 PM on June 23, 2023 [14 favorites]

When was the last time you refreshed CPR training? I ask because rescue breathing has not been recommended for non-medical professionals for a number of years. And I believe the latest guidance is to not even look for a pulse. If someone has collapsed and is unconscious start CPR immediately after calling 911 or directing a bystander to do it.

Source: my Red Cross CPR training from 2020 and this website which talks about the latest updates.
posted by muddgirl at 12:57 PM on June 23, 2023 [4 favorites]

Yup, keep it simple:

If you think they don't have a pulse, do chest compressions , call for an AED, call for someone to call 911. Chest compressions should be fast, deep, distinct from each other. Rescue breaths are optional.

If you have an AED, it will tell you whether to press the button for shockable heart rhythms. Besides that, heart rhythms are not your problem.

Keep going till EMS arrives.

That's it.
posted by latkes at 1:04 PM on June 23, 2023 [6 favorites]

latkes has it right! But the order of operations: get the 911 call happening first, then proceed with CPR.

Do not doubt: this can work. Do it. A relative collapsed in my house, and the ~5min that we spent doing chest compressions & breaths before the EMT's arrived saved her life. Along, of course, with the astounding efforts of her ER & ICU care team. It turned out to have been AFib.
posted by hovey at 1:10 PM on June 23, 2023 [8 favorites]

Or consider the case of Damar Hamlin who experienced a rare arrhythmia that became a cardiac arrest, and whose life was saved by immediate CPR. Doubtful that condition was diagnosed on the field.
posted by credulous at 1:18 PM on June 23, 2023

I last did CPR training in something like 2018. No rescue breaths (you would need a mask to prevent disease transmission). Yes to AED.

I don't know the source, but there's a quote saying that the only bad CPR is no CPR!!! Take a class and feel empowered.
posted by 8603 at 1:36 PM on June 23, 2023 [1 favorite]

I just took the class two weeks ago and the current advice is that giving CPR is ALWAYS better than no CPR and laypeople that have just basic training can definitely save lives. The numbers are something like the chances of surviving a cardiac arrest go down by 10% for each minute CPR is delayed...so it can really make a huge difference.

Here are the steps from the American Heart Association Heartsaver Reminder Card. The stuff is parentheses are details I remember from the class...not from the card.

For Adults
1. Tap and shout to see if they are responsive (CPR shouldn't be given if they can respond to you and/or are breathing normally)
2. Shout for help. Phone or send someone to phone 9-1-1 and get an AED
3. Look for no breathing or only gasping (if they aren't breathing or are only gasping, they need CPR)
4. Push hard and fast on the center of the chest. Give 30 compressions (to rhythm of Bee Gees Stayin' Alive & make sure that the chest returns to the normal position between compressions).
5. Open the airway (by tilting chin gently back) and give 2 breaths. (Pause for breaths for no longer than 10 seconds then restart compressions. Many first aid kits come with pocket masks to use when giving breaths)
6. Repeat sets of 30 compressions and 2 breaths
7. When AED arrives, use it immediately. Turn it on and follow the prompts. (It won't instruct you to press the shock button unless it determines it is necessary. Restart CPR immediately after the shock and continue to follow the AED prompts until trained help arrives.)

Highly recommend folks take the class if they can. Most public buildings (and probably private as well) have Automatic AED machines that will walk you thorough the process so it really helps to have some familiarity with them. Definitely know where the first aid kit, AED and Stop the Bleed kits are in your workplace/school/etc.
posted by victoriab at 2:34 PM on June 23, 2023 [7 favorites]

Just wanted to agree with latkes that according to my recent training, rescue breaths are optional and folks get a huge benefit from the compressions alone. Basically, you're building up pressure in the circulatory system so that vital oxygen and nutrients can make it to the brain and essential organs to prevent tissue death...so introducing more oxygen is nice but there is still oxygen remaining in the blood stream so keeping the blood pressure up and the blood moving is the most critical thing.
posted by victoriab at 2:40 PM on June 23, 2023 [1 favorite]

(I should add that guidelines on rescue breathing may be different for suspected drowning victims, I am not lifeguard trained. But my point was that bystanders providing aid are encouraged to start CPR right away and not worry about heart rhythms unless there is an AED giving I instructions).
posted by muddgirl at 2:59 PM on June 23, 2023

Response by poster: Would like to add that my lifeguard training says the if the person does have a pulse but is not breathing, do not do chest compressions but do give breaths, either using a pocket mask or a bag valve mask.
posted by SageTrail at 3:51 PM on June 23, 2023 [1 favorite]

So, cardiac arrest from drowning is different than cardiac arrest in a dry/land setting. A drowning can cause cardiac arrest, so focusing on establishing oxygen supply is of the utmost importance, then worry about airway and compressions. Regular old cardiac arrest ABC, right? Airway Breathing Circulation.

Just because a person has a hx of AFib or other shockable rhythm, that doesn’t mean that is the reason that they’re in cardiac arrest. There are so many variables. Basically, on land focus on compressions and get an AED on the patient after 5 cycles. The AED will determine if the rhythm is shockable. First responders should be on scene within a few minutes. A lot of LEO carry AEDs in their patrol cars, so don’t be surprised if law arrives first; sometimes they’re in the area. Fire will have an AED or a monitor depending on their level of EMS response. EMS will have a monitor.

In a land-based cardiac arrest, the human body has quite a few minutes of oxygen, that’s why quality 1.5”-2” compressions at a rate of 100 per minute are so important. I think I’ve mentioned this in a comment before, but if you’re the first person on the chest and you’re not breaking ribs, ya ain’t doin it right.

If you need more resources re: CPR response for drowning victims, feel free to memail me.
posted by sara is disenchanted at 5:35 PM on June 23, 2023 [1 favorite]

I'm hoping the poster already knows this, but just in case they or someone else reading this thread isn't aware: many people suffer from chronic uncontrolled atrial fibrillation that may persist for years. It has a number of undesirable effects, such as significant increased chances of stroke and a decrease in effective circulation, so it's definitely something people should seek treatment for, but in many cases it's not correctable or, if corrected, can return unpredictably.

In any case, for many who are affected by atrial fibrillation it's a "talk to your physician about treatment options" condition and not a "critical intervention should be initiated immediately as soon as it's detected" one.
posted by Nerd of the North at 6:19 PM on June 23, 2023 [2 favorites]

My dad experienced vfib two weeks ago, and presented with the exact symptoms you describe here:

I am a certified lifeguard. I was trained that you do CPR (heart compressions plus mouth to mouth breathing) when there is no pulse and the victim is not breathing, and that you do mouth to mouth resuscitation (breathing) without heart compressions when you feel a pulse but the victim is not breathing.

He had no pulse and was not breathing. My mom performed CPR and revived him. (She didn't mention checking for pulse, actually, but we know now it was vfib, so he had no pulse.)

So yeah, don't overthink the training here.
posted by billjings at 11:17 PM on June 23, 2023 [2 favorites]

There are many different agencies that offer CPR and rescue breathing training, for various circumstances. The Red Cross CPR program is the most rigorous I've taken, and over the years it has flip-flopped between recommending checking pulse and doing rescue breaths. The changes have been driven, as I understand it, by research about what first responders actually do in emergency situations. Rescue breathing is gross (though the absolute risk is quite low) and so for a while there was an emphasis on compressions only, because people were more willing to do compressions. There's what's ideal, and what people actually do. My most recent class was this month and it was back to recommending pulse checking and rescue breaths, for what that's worth.

CPR is all about making sure people don't die due to lack of oxygen in the few minutes before emergency services arrive, period. If you do it right, you are likely to break ribs, but the alternative is quick brain death. The life support available in ambulances has increased considerably in sophistication in the last few years (part of why it costs $2K for a 5 mile trip) so if you can keep the victim alive even a short time it has a real impact on long term survival.
posted by wnissen at 10:46 AM on June 26, 2023