September - Cough-CPR / A Simple Test for Stroke

Cough-CPR / A Simple Test for Stroke

September 2006

If you think that you might be experiencing a heart attack or coronary failure, many articles have been circulating on the Web for the past year or so relating to a method of facilitating your health. I spoke with representatives of manufacturers of a popular AED (Automatic Electronic Defibrillator). While looking at the features of their machine, I asked the question concerning the validity of “cough-CPR.” He was familiar with the same documents that I have on file, so he referred me to the American Heart Association.

The American Heart Association does not endorse “cough-CPR,” a coughing procedure widely publicized on the Internet. As noted in the American Heart Association’s textbook Basic Life Support for Healthcare Providers, the American Heart Association DOES NOT TEACH THIS AS PART OF THE CIRRICULUM IN ANY COURSE.

During a sudden arrhythmia (abnormal heart rhythm), it may be possible for a conscious, responsive person to cough forcefully and maintain enough blood flow to the brain to remain conscious for a few seconds until the arrhythmia disappears or is treated. Blood flow is maintained by increased pressure in the chest that occurs during the forceful coughs. This has been mislabeled “cough-CPR,” although it’s not a form of traditional resuscitation.

“Cough-CPR” should not be routinely taught in lay-rescuer courses, because it would only complicate the teaching of traditional CPR. It would add information that’s not generally useful in a pre-hospital setting. In virtually all lay-rescuer CPR courses, the finding that signals an emergency is the victim’s unresponsiveness. This signals the rescuer to begin the “A,B,C,’s of CPR. Unresponsive victims will not be able to perform “cough-CPR.”

This coughing technique to maintain blood flow during brief arrhythmias has been useful in the hospital, particularly during cardiac catheterization. In such cases, the patient’s ECG is monitored continuously, and a physician is present. During cardiac catheterization, patients may develop sudden arrhythmias. If a life-threatening arrhythmia is detected within the first 10 to 15 seconds and before the patient loses consciousness, a physician or nurse may tell the patient to cough. Repeated, forceful coughing can help the person stay conscious until the arrhythmia disappears or is treated.

Therefore, the usefulness of “cough-CPR” is generally limited to monitored patients with a witnessed arrest in the hospital setting.

AMERICAN HEART ASSOCIATION

The best strategy is to be aware of the early warning signs for heart attack and cardiac arrest and respond to them by calling 9-1-1.

If you’re driving alone and you start having severe chest pain or discomfort that starts to spread into your arm and up into your jaw (the scenario presented in the Internet article, pull over and flag down another motorist for help or phone 9-1-1 on your cellular phone.

Since we have discussed the “cough-CPR,” I feel that it is probably timely to clear up the article also circulated on the net for the last year or two concerning the “SMILE TEST” or “A SIMPLE TEST FOR STROKE.” The American Stroke Association does not endorse the “Smile Test.”

The facts: A scientific poster presented at the 2003 International Stroke Conference titled “Untrained Adults Can Identify “symptoms of Stroke by Directed Use of Cincinnati Prehospital Stroke Scale” suggested that asking three questions could help bystanders identify a stroke.

1. Ask the individual to smile
2. Ask him or her to raise both arms
3. Ask the person to speak a simple sentence coherently

This presentation by researchers of the University of North Carolina-Chapel Hill School of Medicine was one of 450 presentations made at the conference hosted by the American Stroke Association. The poster showed positive results, but was a very small study. The research was funded by a grant from the American Stroke Association. However, the American Stroke Association has not taken a position on this topic nor endorsed this test.

Stroke Warning Signs are:

• Sudden numbness or weakness of the face, arm or leg, especially on one side of the body.
• Sudden confusion, trouble speaking or understanding
• Sudden seeing in one or both eyes
• Sudden trouble walking, dizziness, loss of balance or coordination
• Sudden, severe headache with no known cause.

If you should recognize one or more of these signs or experience one of these symptoms, CALL 9-1-1 IMMEDIATELY! TIME LOST IS BRAIN LOST!

BE SAFE TODAY & ALIVE TOMORROW!
DON’T KICK THE SAFETY HABIT!

Ted Gordon is the Risk Management/Loss Control Manager for the Mississippi State University Extension Service and the Mississippi Agricultural and Forestry Experiment Station. His office is located in the North Mississippi Research and Extension Center, in Verona, MS. His telephone number is 662-566-2201.