KUALA LUMPUR, Oct 8 — Individuals trained in cardiopulmonary resuscitation (CPR) should not hesitate to act if they encounter someone in cardiac arrest, experts say.
Dr Ahmad Suhailan Mohamed, an emergency physician at the National Heart Institute (IJN), reassured the public that no legal action has ever been taken against individuals who performed CPR in such situations.
“We consulted medicolegal and medical experts, and they agreed that if you can do CPR, go ahead. Performing CPR increases the chances of survival by three to five times,” Dr Ahmad Suhailan told reporters at IJN’s CPR Faculty last September 19 after a basic CPR and AED training for the media.
“There is no precedent for being sued. So their advice is, if you know how to perform CPR, don’t be afraid – just do it.”
CPR is an emergency procedure performed when someone’s breathing or heartbeat has stopped. It combines chest compressions and rescue breaths to maintain blood flow to vital organs until medical help arrives.
Accompanying CPR, an AED (automated external defibrillator) is a portable device that treats sudden cardiac arrest. It analyses the heart’s rhythm and can deliver an electric shock to restore a normal heartbeat, with user-friendly prompts to guide bystanders. Together, CPR and AED use can significantly increase the chances of survival.
Despite its potential to save lives, CPR and AED remain underutilised in Malaysia. Fewer than one per cent of the population is trained in CPR, and less than five per cent of out-of-hospital cardiac arrest (OHCA) victims receive CPR from bystanders.
While global survival rates for OHCA remain low, with only 10 per cent surviving to hospital discharge, the rate at IJN is 50 per cent because all staff – from clerks to attendants – are trained in CPR.
“If we look within a smaller setting, at IJN, for example, everyone knows CPR. Anyone who collapses will receive basic life support within five minutes. With bystander CPR and support from the code blue team, that’s why the survival rate at IJN is high (five times higher).
“If we apply this outside, if everyone knows CPR, along with effective ambulance services, the survival rate will increase,” Dr Ahmad Suhailan said.
IJN handles an average of 300 cardiac arrest cases per year, all of which require critical CPR. This amounts to nearly one case every day.
Who Should Get CPR Training
According to the American Heart Association (AHA), over 350,000 cardiac arrests occur outside of hospitals each year. Most out-of-hospital cardiac arrest (OHCA) cases happen at home (73.4 percent), followed by public settings (16.3 percent) and nursing homes (10.3 percent).
In Malaysia, a database to monitor the prevalence and outcomes of OHCA cases has yet to be established.
However, findings from the Pan Asian Resuscitation Outcomes Study (Paros), involving the Ministry of Health (MOH) and cited by former Health Minister Zaliha Mustafa, revealed that only 8 per cent of 389 OHCA cases recorded from January 2009 to December 2012 received hospital treatment.
Less than a quarter (22.6 per cent) received CPR from bystanders, while 2.6 per cent received defibrillation, and 12.7 per cent were given adrenaline by prehospital teams.
Dr Ahmad Suhailan said ideally, everyone should learn CPR, particularly those in households at high risk of cardiac arrest.
Reflecting on Euro 2020, when Danish midfielder Christian Eriksen collapsed on the pitch due to cardiac arrest, he suggested that sporting events should require players and officials to be trained in CPR.
“What we can learn from that incident is applicable to sports here, like futsal and badminton. Not only should these venues have AEDs, but the facility staff should also be trained in CPR.
“We also host many sports events like cycling and running. In these events, organisers need to ensure that not only the medical team knows CPR, but also that officials and volunteers are trained in it,” Dr Ahmad Suhailan said.
Better Awareness, Better Preparedness
“Nowadays, I feel there is greater awareness about CPR. For example, at the KL Standard Chartered Marathon in 2022, someone collapsed in front of my friend. My friend performed CPR, and then the medical standby team arrived and used an AED to deliver two shocks.
“They took the patient to Kuala Lumpur Hospital (HKL), then transferred the patient to IJN for an angioplasty – it was indeed a heart attack. The patient was eventually discharged in good health.
“This was possible because of bystander CPR, the AED, and an ambulance onsite to transport the patient to IJN. For high-risk activities like marathons, proper coverage is essential,” Dr Ahmad Suhailan said.
“This year, 42 doctors and paramedics will be involved in the KL Standard Chartered Marathon, and they will be running with an AED. They are essentially medical personnel on standby who will cover the event by sections.
“There is now an awareness that these kinds of activities are high-risk, and it’s great that organisers are improving their coverage,” he added.
Learn CPR To Save A Life
Sudden cardiac arrest can happen to anyone, and starting CPR early can triple the chances of survival. The CPR Faculty at IJN offers courses that adhere to the latest AHA guidelines.
Course offerings include a half-day Basic Life Support (BLS) programme for RM450, providing six CPD points; a two-day Advanced Cardiac Life Support (ACLS) programme for RM1,500, with 20 CPD points; a two-day Paediatric Advanced Life Support (PALS) course for RM1,500, also with 20 CPD points; a half-day Heartsaver CPR AED programme for RM200; and a one-day Heartsaver CPR AED and First Aid programme for RM350.
The general rule for CPR is to remember DR CAB:
D: Danger — Ensure the safety of the rescuer, bystanders, and the victim.
R: Response — Tap the victim’s shoulders and say, “Hello, are you OK?” If there’s no response, call for help.
C: Circulation — Check for breathing. If absent, start chest compressions. Push hard and fast: perform 30 compressions at a rate of 100 to 120 per minute, with a depth of at least 2 inches (5 cm) for adults.
A: Airway — Open the airway using the head-tilt-chin lift method.
B: Breathing — Administer two effective breaths until you see the chest rise. Continue chest compressions and breaths (30:2) for two minutes, then reassess.
