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Cough CPR…truth or myth?

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Cough CPR

I have recently come across a forum where cough CPR was discussed. It was debated if coughing could be beneficial when suffering a heart attack!

I cannot imagine a conversation with the emergency operator about this being effective.

Patient: “cough, cough, hello… I need and ambulance, cough… coughs”

Operator:  “could you please tell what are the symptoms?”

Patient: “cough, cough…chest pain…cough, cough”

Operator: “I can see you are having some cough too, probably a little flu, please go to your GP in the morning”

It just doesn’t work.

What actually confuses me is the CPR bit. As I understand it, when someone needs CPR it is because there isn’t any breathing or circulation therefore the patient is in cardiac arrest. This is different from a heart attack where the coronary arteries are block and the heart muscle is deprived of oxygen. The patient has circulation at this point but if not treated cardiac arrest might present quickly.

So the term CPR has probably misused in this occasion, it would be like having an appendectomy on your toe, or a craniotomy on your belly. It is just the wrong term.

But does cough have a place during heart attacks?

Some could argue that vigorous coughing, and I mean really vigorous, could generate enough intra-thoracic pressure to stimulate the vagal nerve, treating certain arrhythmias i.e. supra ventricular tachycardia. However some heart attacks can develop  heart blocks that slows down your heart, a vagal stimulus is probably not a good idea as slowing even more the heart could trigger asystole, and you might find yourself in the floor sooner than necessary.

Now, a statement from the resuscitation council (RCUK 2005) on this topic agrees that coughing could maintain momentaneously some sort of perfusion on your body due to the same intra-thoracic pressure created. However, this has only been replicated in controlled conditions on the cardiac cathlabs, where patient are induced a lethal arrhythmia (VF) to check that the internal defibrillator is working.

The BLS/AED Subcommittee knows of no evidence that, even if a lone patient knew that cardiac arrest had occurred, he or she would be able to maintain sufficient circulation to allow activity, let alone driving to the hospital”

RCUK 2005

So can you create some circulation by coughing? The answer seems to be yes. Can you feel that you are about to die and start coughing hard enough to get dress, find the keys of your car, drive to the hospital….Oh come on!!

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About the Author:

Resuscitation Officer, with a Nursing background and experience in emergency services.

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