FAMILY MEDICINE® COLUMN

By John C. Wolf, D.O.Associate Professor of Family Medicine Ohio University College of Osteopathic Medicine

"COUGH CPR" HAS SOME MERIT, BUT NO SUBSTITUTE FOR CPR TRAINING

Question: I've gotten e-mails from several different friends about how to survive a heart attack by coughing. The gist of the story is that coughing every ten seconds will keep enough blood flowing through the damaged heart to sustain you long enough to call for help. One of the e-mails even said that this is now part of basic CPR training. This sounds far-fetched to me. Is it legit?

Answer: Heart disease is the number one killer in our country today. One slightly twisted way of looking at this fact is that it shows how much progress we have made on dealing with infectious disease and trauma -- once the leading causes of death. The bad part of heart disease statistics, of course, is that about 1.1 million people will have a heart attack this year, and about 60 percent of those will die before they can reach the hospital.

The best treatment for heart disease is prevention. I've written before about the importance of frequent exercise, eating a balanced diet, lowering cholesterol, controlling diabetes and blood pressure. These behaviors reduce the risk of heart attack for each individual as well as collectively for our population. These practices won't, however, do anything beneficial for the person who is in the process of having a heart attack right now.
The best chance for surviving a heart attack is to have CPR started immediately after the person collapses. The first six minutes are particularly important because the brain is likely to suffer permanent damage if it goes without oxygen for a period longer than this.

It is important for everyone from high school students through old age to learn basic CPR because you never know when you may need to resuscitate a loved one. I know, because I've done it, and I sure was glad that I had the necessary training to save the life of my father-in-law. Basic CPR classes are presented in essentially every community. The American Heart Association accredits these courses and can help you find one nearby. Your local chapter's number should be in the phone book, or they can be located from the national organization's Web site at http://www.americanheart.org

Cough CPR isn't a myth, but it isn't quite the way your e-mail presented it, either. It works this way: Coughing momentarily increases the pressure inside the chest. This pressure forcefully pushes air out of the lungs and simultaneously it also pushes some blood from the heart. In this regard it is like chest compressions done in CPR. Unfortunately, it isn't as effective as chest compressions, so the amount of blood reaching the brain and the rest of the body is less than ideal. That said, it could sustain consciousness for a brief period.

Cough CPR is most helpful when the heart suddenly develops an irregular beating that prevents it from pumping properly. This can happen during the process of a cardiac catheterization or at other times when the heart is being monitored in the hospital. Beginning cough CPR at the time the irregular beat begins can sustain circulation until more sophisticated treatments can be started. In the case of irregular beats as a consequence of a cardiac catheterization, the cough CPR may restore a regular beat, making the use of other treatments unnecessary.

An individual suffering a heart attack usually has pain, weakness and sweating as symptoms, or some simply collapse. In these situations, coughing -- while theoretically beneficial -- is of no practical benefit because the person is already unable to cough, or it expends more energy and only makes matters worse.

Instead of pondering the merits of cough CPR, I'd suggest that you and your e-mail friend sign up for a CPR course to get the necessary information and skills to save a life.

"Family Medicine" is a weekly column.

To submit questions, write to John C. Wolf, D.O., at Post Office Box 110, Athens, Ohio 45701.

Past columns are available online at http://www.FamilyMedicineNews.org.