In the wake of the recent incident when Congolese musician Papa Wemba slumped and died on stage during a performance in Ivory Coast, the media has been awash with condolence messages from fans as well criticisms of the way the emergency was handled. A disturbing footage shows the musician surrounded by fellow performers trying to fan him minutes after his collapse but this first aid did not help matters. To the dismay of others, when the 66-year old was taken to a nearby clinic, he could not be resuscitated. While controversy still surrounds his death, some argue that absence of qualified medical staff and slothfulness in action probably led to his death.
This is not the first time someone is collapsing on stage over what many call the sudden death syndrome. In 2003, former Manchester City and West Ham footballer Marc-Vivien Foe died while playing for his country in an international match. At age 28, the Cameroon midfielder collapsed in the second half of a game in Lyon. It was a heart attack but nothing could be done to save his life.
Only one athlete, Fabrice Muamba, survived a similar tragedy when playing for his former club Bolton Wanderers. As the stadium fell silent, medical staff huddled around him. Muamba’s heart stopped beating for 78 minutes, but cardiopulmonary resuscitation CPR provided by qualified personnel saved his life. The reasons why many people in a similar situation die may not be well known but cardiologists believe risk factors always manifest.
Dr Nathan Ruhamya, a cardiologist at King Faisal Hospital, Kigali, is of the view that cardiac attacks can be avoided because causes are well-known but limited attention is often given to the signs that manifest earlier.
“The causes are many and well-known. However, the problem is that people neglect these symptoms that would be important in preventing the condition from aggravating,” explains Dr Ruhamya.
The cardiologist further suggests that knowledge of simple practices such as basic life support (BLS) is important but requires constant training.
“At least every three months, hospitals should carry out such exercise to equip staff with knowledge of handling heart attacks,” he says.
On the other hand, the advanced stage of BLS, known as cardiopulmonary resuscitation (CPR,) may be too complicated to do at home, but Dr Joseph Mucumbitsi, a cardiologist at King Faisal Hospital, Kigali, explains that people who have the skills increase chances of survival for victims who collapse suddenly whether at home or in the workplace.
“It may even be on the street when someone is walking and falls suddenly. BLS can be helpful. Similarly, when a colleague at work collapses, before thinking about taking them to the hospital, this should serve as first aid,” says Dr Mucumbitsi.
The cardiologist further points out that in more developed countries, equipment designated for this purpose is placed in public places and can be accessed by first aid providers in case an emergency arises.
“It is done in the US at the train and bus stations, where some devices are placed in easy-to-access places so that anyone can be able to handle incidents of emergency promptly,” he says.
Burden of sudden attacks
According to the World Health Organisation, about 7.4 million people died from coronary heart disease in 2012, whereas 6.7 million died because of stroke. Out of the 16 million deaths under the age of 70 due to non-communicable diseases, 82 per cent live in low and middle-income countries and cardiovascular diseases cause 37 per cent of these.
Dr Harold Golberg, a cardiologist at Spokane, USA, explains that the most common cause of sudden death or sudden cardiac arrest under the age of 35 in more developed countries is hypertrophic cardiomyopathy – a situation of thick heart muscle while the other is congenital coronary artery anomalies.
“Under congenital anomalies, the coronary arteries originate in unusual ways, for example, the left coronary artery originates (takes off) from the right coronary artery cusp and is compressed in between the aorta and the pulmonary artery, other causes are unusual weakness of the right ventricle – right ventricular dysplasia with fat in the wall of the right ventricle,” explains Dr Golberg.
The situation worsens in athletes or people engaged in heightened activities, but generally, above the age of 35 most problems arise from interrupted blood flow.
“During strenuous activity when the chest gets hit with an object at high velocity, this may cause the heart to go into a sudden rapid rhythm. The most common cause that relates to heart attacks is the low blood flow from blockages in coronary arteries,” he adds.
Response using BLS in such situations is very important, experts say.
Recent statistics of world rankings among the 50 causes of death position stroke in Rwanda and hypertension at 42 and 70 respectively.
In a UK study, of the approximately 60,000 cases of suspected cardiac arrest cases that received response, resuscitation was attempted by ambulance services in less than half of these cases. The main reasons are that either the victim had been dead for several hours or has not received bystander CPR so by the time the emergency services arrive the person has died.
The study, however, concluded that strengthening the community response to cardiac arrest by training and empowering more bystanders to perform CPR and by increasing the use of automated external defibrillators (AEDs) at least doubles the chances of survival and could save thousands of lives each year
How to conduct BLS
The first thing that should be checked during BLS is the responsiveness of the victim and if there is no feedback then an emergency alarm should be activated. An automated external defibrillator is used with the pulse continuously checked. In the absence of pulse, high-quality cardiopulmonary resuscitation (CPR) at a compressions-to-breaths ratio of 30:2 is started. Nevertheless check up on the pulse should continue throughout the process.
To improve chances for the victim’s survival changing rescuers every two minutes is recommended.
With the head tilted, chin lifted and Jaw thrust, ventilation is observed together with visible chest rise.
However Dr Mucumbitsi suggests that advanced stages of the BLS may require hospital-based CPR.
“In case simple steps do not yield results, then the rest should be done by trained medical professionals, otherwise, the situation may compromise the health of the victim,” he adds.
Dr Nathan Ruhamya, adds that the quality of BSL depends on established standards since each country has a different procedure.
“There are different standards, some are issued the USA, others from South Africa but they are not too sophisticated to be understood by ordinary people, “says Dr Ruhamya.
While people neglect training in simple life skills, Dr Achile Manirakiza, a training oncologist in Mubimbili, Tanzania, explains that even in situations of injury there is a big chance of survival with knowledge of basic life support.
“The reason we need to all learn basic life support principles is to be able to use them in case of a serious and life-threatening event happening when we are around, before the victim could reach hospital. With a serious injury, we stand at least a 5-golden minute rule of general assessment before waiting for proper management from hospitals,” he says.
How to tell if someone is having a heart attack
- If the person is unconscious and breathing: Look at the patient’s chest to see if it is rising and falling. If they are breathing, place them in the recovery position, and then call for help from the emergency services.
- If the person is unconscious and not breathing: If they’re not breathing, they are in respiratory arrest and the current advice states that in this situation, they are also likely to be in cardiac arrest (cardiac arrest is a condition where the heart has stopped beating effectively).
It’s best to treat them as if they are in cardiac arrest, rather than waste valuable time looking for a pulse. The latest guidelines suggest that lay persons should not try to find a pulse. Instead, CPR should begin immediately on anyone who is unresponsive and not breathing normally since even a delay of just a minute or two spend looking for a pulse can have a very substantial detrimental effect on the outcome.
- If there is no breathing, the patient is in cardiac arrest. What help is needed? Immediately place the palm of your hand flat on the patient’s chest just over the lower part of the sternum (breast bone) and press your hand in a pumping motion once or twice by using the other hand. This may make the heart beat again.
The procedure to perform chest compressions
- kneel by the side of the victim
- place the heel of one hand in the centre of the victim’s chest (the lower half of the sternum, or breastbone)
- now place the heel of your other hand on top of the first. Interlock your fingers together
- keep your elbows straight and bring your bodyweight over your hands to make it easier to press down vertically
- press down firmly and quickly to achieve a downwards movement of 4 to 5cm, then relax and repeat the compression. After each compression, release all the pressure on the chest without losing contact between the hands and the sternum
- aim for a rate of compression of about 100 per minute. You can help your timing and counting by saying out loud ‘one and two and three and four...’ etc
- do this 30 times, then give artificial respiration twice, and continue this 30:2 procedure until help arrives.
How to give artificial respiration
- Tilt the head back and lift up the chin.
- Pinch the nostrils shut with two fingers to prevent leakage of air.
- Take a deep breath and seal your own mouth over the person’s mouth.
- Breathe slowly into the person’s mouth – it should take about two seconds to adequately inflate the chest.
- Do this twice.
- Check to see if the chest rises as you breathe into the patient.
- If it does, enough air is being blown in.
- If there is resistance, try to hold the head back further and lift the chin again.
- Repeat this procedure until help arrives or the person starts breathing again.