Many news stories about the death of Carrie Fisher on an airplane flight from London to Los Angeles. As so many times the media used the term "heart attack" to describe her incident. As those in the world of resuscitation know this was not a heart attack but a cardiac arrest episode. It is crucial to get people (especially the media) aware that these two cardiac emergencies bear no relation to one another.
A Heart Attack is a "plumbing" problem with the heart resulting in a portion of the heart incurring damage which is permanent. Unlike other muscles in the human body the heart does not regenerate tissue. The heart attack victim, by definition, is breathing.
Cardiac Arrest is best described as an electrical problem with the heart which causes it to flutter (quiver) and no longer pump blood. This electrical problem most often is known as "ventricular fibrillation." When this occurs the person's blood supply in a blink of the eye goes to zero and the brain is cut off from receiving any blood or oxygen. The brain will be dead or irreparably damaged in between 3-6 minutes. High quality CPR helps deliver the oxygenated blood in a person's body to the brain extending the 3-6 minute window by perhaps doubling or maybe tripling that time. CPR cannot start the heart. It buys time. The only way to stop a heart that is in "fibrillation" is to "defibrillate." The electric shock from the debrillator (or AED) stuns the heart with the intent that it restarts or "reboots" back to its normal rhythm. When an AED finds Ventricular Fibrillation is has a between 70-80% chance of restarting the heart. When an AED is used within the first minute of a cardiac arrest recent studies have shown that we have a 90% chance of restarting the heart.
Much of the time the AED arrives and no shockable rhythm is found Most of those times it is because no CPR had been attempted before the AED arrived or it was started to late. It must start IMMEDIATELY. Here I give credit to PO Bryan Platz, of Minnesote, who coined the phrase, "Don't wait for the help. become the help." Anyone who owns a pair of hands should know how to do chest compressions to get the victims blood flowing. You cannot hurt the person, they are already at least clinically dead. If an injury occurs and you get them back to life medical science will fix that injury. Rememer CPR stands for Cardio Pulmonary Resuscitation and the word resuscitation means to bring back to life.
Now, back to the title of this blog, "The Plight (or Flight) of Carrie Fisher."
We now know from the autopsy report that Ms. Fisher died of Cardiac Arrest due to Sleep Apnea. The word Apnea is a Latin work meaning cessation of breathing. In sleep Apnea this is most often a temporary condition and can happen to someone who suffers from sleep apnea often as many as 300-400 times a night. When it happens we would hear the person struggle to breathe or gasp for air. This movement is what causes that person to wake up and the body resumes breathing. This gasping sound is often mistaken by people as snoring. It is not snoring. Snoring is breathing in and out and with sleep apnea nothing is drawn in so there is no exhale. Ergo the gasping.
Now I have a plausible scenario that I feel is very likely what could have occurred on that flight. I was not on the flight but my theory also helps to draw attention to the condition we refer to as Agonal Respirations. Agonal respirations are extremely common in the early stages of cardiac arrest. Agonal respirations sound like and resemble sleep apnea gasping.
So, how do you tell the difference? Try to wake the person. If they wake you simply helped them resume breathing and those sounds may have been produced by this person having sleep apnea. If they DO NOT WAKE they are in CARDIAC ARREST and CPR must begin immediately.
Once again, back to Ms. Fisher. Imagine someone sitting next to or near her and they are hearing those sounds. They likely would find it annoying and think she was snoring. Now some time passes and finally someone notices her in her seat not looking all that OK. They then investigate to see if she is alright. They got no response and begin CPR. She even was brought back with shocks from a defibrillator. She died on Tuesday after her Cardiac Arrest the previous Friday.
The question is how long Fisher could have been without breathing before CPR began? Was she in agonal respirations and no was aware? All of these things might have, and I repeat only might have, had a different result if this was the scenario and more people had been more aware.
This is what we all struggle with in the resuscitation community. People not having the proper information and knowledge of how to save someone's life. I cannot say that Carrie Fisher would be alive today if earlier CPR had been performed. I do know I suspect that earlier CPR was necessary and not diagnosed. Would that have made a difference? We cannot know that. When CPR is performed there are no guarantees because we do not know what is going on within that person's body. But the only guarantee that does exist is that the person who needs CPR and does not get it immediately will not respond favorably or at all to later attempts.
Get people to know how crucial it is to just manually pump the chest to effectively circulate blood in that adult or teenager that has collapsed. Further awareness that mouth to mouth is not only not required but not recommended for anyone to perform on a stranger. Take a CPR class and learn the elements that are necessary for effective resuscitation. If you cannot, do not want to for whatever reason do not take a class learn how to perform chest compressions. There is ZERO LIABILITY if you take action. Only perform techniques that you can perform without compromising your own safety. Becoming a lifesaver is not difficult. It just requires one to make a decision to try and help.
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