Heart massage, the playlist that can help keep the right “rhythm” during life-saving maneuvers – breaking latest news

«Stayin’ Alive» («Stay alive»), the historic song by the Bee Gees, is the ideal song to perform a heart massage. But it’s not the only one: so are Lady Gaga’s “Just Dance”, Adele’s “Rumor Has it” or Justin Bieber’s “Sorry”, Madonna’s “Who’s that girl”, Abba’s “Dancing Queen”. Their pace is ideal to dictate the time to those who, especially non-experts, find themselves having to perform life-saving chest compressions in an emergency
after someone’s heart stops beating. On the most famous music platform there are even ad hoc playlists, like the one published by New York-Presbyterian Hospital dal titolo Songs to do CPR (Songs to do cardiopulmonary resuscitation). The playlist has obviously not been created to be listened to while performing compressions, but only to raise awareness of the fact that you can save a life using only your hands.

A life saving maneuver

“Cardiopulmonary resuscitation is an emergency technique whose recommendations apply both to witnesses who are not healthcare workers and to rescuers of the emergency-urgency system”, he begins Robert Pedretti, director of the cardiovascular department at IRCSS MultiMedica. “It is based on the association of chest compressions and ventilation techniques, the simplest of which is mouth-to-mouth resuscitation. The goal is to support circulatory function in order to maintain an acceptable perfusion of the brain until the restoration of spontaneous cardiac and respiratory activity».

«The peculiarity of Stayin’ Alive is to have a rhythm of 103 Beats per minute (Bpm). For this reason, in the United States it has been proposed as a “mental metronome” for guide rescuers to perform compressions at the right frequency which, in fact, must be 100-120 Bpm. Furthermore, contrary to popular belief, cardiopulmonary resuscitation can also be performed without using mouth-to-mouth resuscitation. Guidelines recommend performing external CPR only whenever the rescuer is not trained in ventilation techniques or ventilation is otherwise not possible for other reasons. Indeed, at least in the first 10 minutes after the onset of cardiac arrest, there is still a sufficient amount of oxygen in the blood. If the circulation can distribute it, there is no survival disadvantage with chest compressions alone for basic life support,” he adds.

The importance of rhythm

But why is it so important to keep the correct rhythm of chest compressions? «The goal of external cardiac massage is to support cerebral circulation until the restoration of spontaneous cardiac activity», continues the cardiologist. «This is obtained by “squeezing” the heart from the outside, precisely through the massage, so that the blood still flows to the other organs and especially the brain. In order to support cerebral circulation, it is necessary to guarantee an adequate frequency and depth of compressions. Studies have shown that a compression rate of 100-120 bpm and a depth of 5-6 cm should be guaranteed to obtain the best possible result.. Different rhythms or compressions that are too superficial can lead to suboptimal results».

Some scholars are skeptical of the benefits of music

Given the combined importance of correct depth and frequency, some researchers are skeptical about the possible benefits of music because they have found that the compressions do not necessarily reach the correct depth. «The “mental metronome” technique, based on the rhythm of a song, can help the rescuer maintain the correct rhythm», the expert points out.

«Emotional involvement is necessarily high, therefore clear and simple paths that guide actions can be very useful. It may not be natural to perform external cardiac massage at the correct frequency, especially for those who are not called upon to intervene in such circumstances on a regular basis. In the past years some scientific studies have been performed on dummies to verify the reproducibility over time of the ability to massage at the right frequency, observing a certain advantage in those who used the “musical mental metronome” compared to the control groups”.

«If music can help us solve the question of the rhythm of the massage, it is however important to compress adequately. With the rhythm issue under control, you can focus on the effectiveness of the compression. It has been known for many years now that early initiation of CPR by bystanders, pending the arrival of help, is an important determinant of subsequent survival with good neurological function. In fact, this helps to preserve brain function and also increases the probability that, as soon as a defibrillator is available, the heart rhythm can be regularized. The guidelines of the American Heart Association they report that fewer than 40% of adults with cardiac arrest receive cardiopulmonary resuscitation
and less than 12% use an automatic defibrillator before rescuers arrive».

What to do in an emergency

Here are the directions ofEuropean Resuscitation Council published in the latest 2021 guidelines and summarized by the cardiologist Pedretti. “The rescuer, in the event of a person collapsing, must first verify that both the victim and bystanders are in a safe scenario. Immediately afterwards the rescuer must shake the patient by the shoulders and ask him: “Sir, is everything okay?”. In case of no reply place the victim supine on his back and place one hand on the forehead and the fingers of the other hand under the chin, tilting the victim’s head backwards: this maneuver guarantees the opening of the airways.

“At that point, for no more than 10 seconds, it is necessary to “look, listen and feel” if the patient breathes: during this operation it is important to bear in mind that an unconscious person who breathes with difficulty or who shows infrequent and deep gasps has abnormal breathing. In case the victim is not breathing or breathing abnormally it is necessary to call or have called for help (call 112/118), remaining close to the victim; it matters at that point use the hands-free function of the phone in order to have your hands free and to be able to talk to the emergency center while cardiopulmonary resuscitation is being carried out».

«If available, it is good to send someone to retrieve an AED – Automatic External Defibrillator and start resuscitation without delay. The automatic external defibrillator is a device that delivers, through the chest, an electric shock (defibrillation) which, reaching the heart, can interrupt cardiac arrest in the presence of a serious arrhythmia, ventricular fibrillation, often the cause of the arrest itself . Ventricular fibrillation is a disorganized electrical activity that makes the heart “inert” from a contractile point of view, therefore unable to pump blood around our body.

“If ventricular fibrillation is treated quickly with defibrillation, the chances of saving the life of the person in cardiac arrest increase dramatically.
. For this reason, the AED was created, which can also be used by non-medical personnel. In fact, the AED is always equipped with easy-to-understand text and graphic instructions and, now almost always, also with voice instructions.

«Non-medical personnel should not be afraid to use it. Firstly, because the AED guides us “step by step”, talking to us and telling us what to do. Secondly, the AED works with sophisticated electrocardiogram analysis algorithms
which are accurate in recognizing arrhythmia in almost 100% of cases. The DAE, therefore, will deliver the electric shock only in case of proven need, when not necessary, he will invite us to continue cardiopulmonary resuscitation”. Without forgetting that a recent law introduced immunity for anyone using a defibrillator.

How to perform the «massage»

«To perform cardiopulmonary resuscitation», concludes the expert, «it is necessary stand next to the victim, kneeling; must place the palm of one hand (usually the right, for right-handed people) on the center of the patient’s chestat the level of the lower half of the sternum, then place the other hand on the first and interlace the fingers. You must have your arms straight and perpendicular to the patient’s chest and start compressing the chest with a depth of 5-6 cm».

“At the end of each squeeze, it matters release the pressure on the chest without losing contact between the hands and the chest wall. The compression rate should be 100-120/min. The guidelines indicate, after 30 compressions, if you are trained in the technique to start ventilation with 2 mouth-to-mouth breaths and continue with compressions and insufflations at a ratio of 30:2. If you are not trained or if ventilation is not practicable, according to the guidelines, continue with chest compressions only, always at 100-120 beats per minute”. Maybe humming Stayin’ Alive in your head: no song could have a better title.