The Heart of the Matter: Understanding Sudden Cardiac Arrest

Sudden cardiac arrest is a critical emergency where the heart unexpectedly stops beating. According to the Sudden Cardiac Arrest Foundation, it strikes people of all ages who may seem to be healthy, even children and teenagers. Sudden cardiac arrest leads to death in minutes if the person doesn’t get help right away. Ron Banister, M.D., is vice chairman of anesthesiology and associate professor at TTUHSC. Dr. Banister talks to us about sudden cardiac arrest and explains what happens when sudden cardiac arrest occurs and the impact on the body and organs. He shares survival rates and helps puts the number of deaths into perspective and how accessible, low cost defibrillators can help save lives.

Transcript

Melissa Whitfield  00:09

Hello and welcome back to Texas Tech Health Check from Texas Tech University Health Sciences Center. I'm your host, Melissa Whitfield. We want you to get healthy and stay healthy with help from evidence based advice from our physicians, health care providers and researchers. Sudden cardiac arrest is a life threatening emergency when the heart suddenly stops beating. According to the sudden cardiac arrest foundation, it strikes people of all ages who may seem to be healthy, even children and teenagers. Sudden cardiac arrest leads to death in minutes if the person doesn't get help right away. Dr. Ron Banister is vice chairman of anesthesiology and associate professor here at TTUHSC. He talks to us about sudden cardiac arrest, explaining what happens and the impact on the body and organs, the survival rate, and helps put the high number of deaths into perspective, and basically gives us greater awareness about sudden cardiac arrest and how accessible and low cost defibrillators can help save lives.

Melissa Whitfield  01:28

Dr. Banister, welcome to our podcast. Can you tell us a little bit about yourself, your expertise and what you do here at the Health Sciences Center? 

Ron Banister, M.D.  01:34

So yes, I've been at the Health Sciences Center for 25 years. Started off my residency in anesthesiology here and became a faculty member. Since then I've been doing general anesthesia. Probably, although this dates me in a number of different ways, have taken care of between 70 and 75,000 patients over the last 25 years. And I will tell you one thing that that's done. It's made me very cautious. And so I'm vice chair of the department. Have been interested in developing medical devices and innovations for some period of time, which is what has led to my interest in sudden cardiac arrest and what we might do to make that a disease that begins to disappear.

Melissa Whitfield  02:17

Well, again, welcome to our podcast. So you mentioned your interest in sudden cardiac arrest. What is sudden cardiac arrest and how is that different from a heart attack or a general heart palpitations? 

Ron Banister, M.D.  02:30

So sudden cardiac arrest is exactly what it sounds like. I mean it literally, the heart stops suddenly. It does not beat and therefore, no beating, no flow of blood, you literally collapse. Actually, I had that happen to me once. I won't go into details but fortunately it was a very brief event. But it could happen from a huge variety of reasons. And I could give you a list of about 20 of them as a matter of fact and they're all over the place. They literally can be something that seems innocuous, and it is not the same thing as a palpitation or just a dropped beat. It's where there's literally no other flow through the heart. And so it can be due to heart disease. It can be due to other underlying arrhythmias that finally manifest themselves as a complete stop of blood flow. It can be coronary artery disease and any of the other types of things. It can be due to electrolytes. It can be due to the fact that someone hasn't been taking their medications, as far as that's concerned. But they all wind up with the same event where there's no forward flow. You lose consciousness and unless that flow is restored, then that person is going to die.

Melissa Whitfield  03:45

How often does it happen during surgery? Because some of us might be aware of sudden cardiac arrest and think that happens only during surgery, but how often does it happen during surgery versus other times?

Ron Banister, M.D.  03:55

So, probably, an event of that nature. And of course, we have other modalities. I would say it's probably incredibly rare. I probably had about 15 patients out of that 75,000 to 70,000 patients, that I mentioned to you, that have had sudden cardiac arrest in the OR. We run a lot of codes in the hospital. We get called to a code for intubation and the underlying issues that I was mentioning to earlier, the reasons why those things happen throughout the hospital. Obviously, a lot of these things can be age dependent as well, and the statistics that I've seen for hospital cardiac arrest on the order of another 60 to 120,000 dependent upon who does the counting and how they actually report those things as well.

Melissa Whitfield  04:44

Can you expand a little bit more on the causes of sudden cardiac arrest? Are more people at risk than others?

Ron Banister, M.D.  04:52

Yes, as obviously, age is a factor in that as well and certain underlying abnormalities can be an issue there. The actual little wiring of the heart. And so sometimes we're able to find those people quickly. Sometimes you can restore their circulation quickly. If there's someone there, they can do CPR or has actually the equipment to do the actual shocking. And then, quite frequently, they will wind up having a pacemaker put in, and sometimes a defibrillator, dependent upon the combinations of things. But that's always at some level, a day late and a dollar short, because if there's no one there to observe it, or no one there that can do something about that issue, then it's going to become a fatal event very quickly. So one of the things that I was trying to get at is is there are multiple causes of sudden cardiac arrest. And so if you have the ability to do something about it, then you have a chance of correcting the underlying issues and move along from there. But if you don't have those kinds of modalities where you can intervene or where it is witnessed, then the outcomes are very bad. Which is why I mentioned the incredible numbers. And of course, this is not just in the United States but if you look around the world, in all the industrialized countries, it's a parallel number of people that have these same kinds of issues and problems. The thing that a lot of people don't realize is they think that it's always an older patient. It doesn't necessarily have to be an older patient. In fact, there are statistics that show in the 25 to 65 year age group in the United States, there are 70 to 75,000 people that succumb to sudden cardiac arrest.

Melissa Whitfield  06:26

And the conversation that we had earlier, outside of this recording, you mentioned that women suffered from this in greater numbers?

Ron Banister, M.D.  06:34

It appears that is so but there might be a distortion of those numbers because a lot of males die much earlier than females. So I don't know that that actually is quite the same thing, but yes, there does appear to be that but I think the males have skewed that on their own, own process. 

Melissa Whitfield  06:51

So what is the survival rate and how does it impact the organs or body? 

Ron Banister, M.D.  06:55

So without blood flow, the brain is the one that cooks the fastest. You can sometimes restore, you know, we find someone that is down in any kind of a variety of situations, but of course, in the hospital environment I see more of them, and we can begin the process. But four minutes is about the limit of what the brain takes for most people. This is why early recognition and having the ability to intervene is so very important under these circumstances. So even in a hospital situation, depending upon the level of acuity of the or the care that they're getting in the particular unit that they're in, you know, on the floor versus walking down the hall. I've actually had people that I've had to take care of actually that succumbed to walking down the hall in the hospital because they did not realize that their arrhythmias were as bad as they were. And so this all depends upon where you're going with being able to take care of these patients and how you take care of them across the hospital. And then you can see at home, the issues are even larger, because the likelihood of being able to intervene there is even smaller.

Melissa Whitfield  08:06

What is the response then, or the treatment for sudden cardiac arrest?

Ron Banister, M.D.  08:11

So if you see it witnessed, you can, if you have the strength to do it actually just hit someone right in the middle of the chest. That is not part of the regular algorithm now, because so few people have the upper body strength of actually making an impact. But the first thing that you would do under those circumstances is actually begin chest compressions. But it should, in the very beginning, if you witness it, be a very vigorous chest compression, because you do have the chance of actually restarting the heart that way. Have done it myself, as a matter of fact. Don't recommend it if you don't have to, though.

Melissa Whitfield  08:47

So are there ways to prevent death from sudden cardiac arrest? And can you talk about low cost ways other than, you know, us all increasing our upper body strength?

Ron Banister, M.D.  09:01

Yeah, that's not a good way to go, and doesn't necessarily always produce the best outcomes. So actually, having low cost defibrillators available will make a huge difference. Let me give you an idea again, of the scale of the problem. Let's go back for a moment. So I mentioned earlier to you in our earlier discussions about the death rate from automobiles. And the reason I use this, there's more than one reason, is that, first off, a lot of people don't even realize how many people die in automobiles each year in the United States. It's between 33 and 35,000 people die of automobile accidents. The contrasting number, as I mentioned earlier, is 350, to potentially 400,000 people a year that die of sudden cardiac arrest. Less than 10% of those people survive at home. And I think the number actually is probably closer to 7 to 8% because it all depends on who's doing the statistics and how they look at that. But think about that.  That's a tremendous number. And I also ask you rhetorically, what's the difference between the automobile accident death rate and what's going on with sudden cardiac arrest? Well, there is in your car a device called an airbag. Everybody knows about them. And there are also seat belts. We have nothing like that for you in your home. It's not required. So there are over 250 million automobiles in the United States. Each air bag installed in a car cost anywhere, depending on who you're asking to quote the figures, between 500 and 700 dollars per air bag and 150 to 200 dollars per seat belt. So, most cars you're spending probably on the order of 2 to 4,000 dollars to provide a seat belt and an air bag for automobile accidents. We have nothing in our houses like that. Literally, we have nothing in most businesses like that. If we had all of those. Oh, by the way, so here's another contrast. So there's minimally 125 million homes and apartments in the United States, but again, there are no requirements here. And I think the major reason for that is that no one knows about it. It is a hidden statistic and that's one of the reasons that I wanted to do this podcast so that we could start talking about a way of publishing this information that people can see it. Right now, it's an invisible issue. I don't think it should be invisible anymore.

Melissa Whitfield  11:33

Is there anything else that you would like to add?

Ron Banister, M.D.  11:36

Yes, because I think if we can find a way, with a local EMS and with all the other reporting agencies that we have just in our location here in Lubbock. If we started a process where we could report this data and information then all the other steps will begin to happen. Awareness fuels that kind of change in behavior and change in reporting. We can change behavior and change reporting then we also can put pressure on a number of different agencies so that they will begin to address this. I think it is actually, it's, it's horrible that we don't have a way to take care of this many people who are dying in the United States and give them the opportunity to do that. Like I said, we do it for cars. We're not doing it for our homes, for our apartments. And a requirement like this could come if we put enough pressure onto our governments, local as well as national, and then do the same thing with the insurance companies. Looks like they have plenty of money that they can do something like this.

Melissa Whitfield  12:39

Well, Dr. Banister, thank you again for coming on our podcast and sharing all this information with us. It definitely is an eye opener.

Ron Banister, M.D.  12:46

Thank you very much. I appreciate the opportunity.

Melissa Whitfield  12:48

Thank you for listening to Texas Tech Health Check. Make sure to subscribe or follow wherever you listen to podcasts. This information is not intended to be a substitute for professional medical advice. Always seek immediate medical advice from your physician or your health care provider for questions regarding your health or medical condition. Texas Tech Health Check is brought to you by Texas Tech University Health Sciences Center and produced by TR Castillo, Suzanna Cisneros, Mark Hendricks, Kay Williams and me, Melissa Whitfield.