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Cough CPR

Claim:   Doctors generally recommend that one attempt to rhythmically cough during a heart attack to increase the chance of surviving it.

FALSE

Examples:   [Collected via e-mail, 1999]

This one is serious . . . Let's say it's 4:17 p.m. and you're driving home, (alone of course) after an unusually hard day on the job. Not only was the work load extraordinarily heavy, you also had a disagreement with your boss, and no matter how hard you tried he just wouldn't see your side of the situation. You're really upset and the more you think about it the more up tight you become.

All of a sudden you start experiencing severe pain in your chest that starts to radiate out into your arm and up into your jaw. You are only about five miles from the hospital nearest your home, unfortunately you don't know if you'll be able to make it that far.

What can you do? You've been trained in CPR but the guy that taught the course neglected to tell you how to perform it on yourself.

HOW TO SURVIVE A HEART ATTACK WHEN ALONE

Since many people are alone when they suffer a heart attack, this article seemed in order. Without help the person whose heart stops beating properly and who begins to feel Faint, has only about 10 seconds left before losing consciousness. However, these victims can help themselves by coughing repeatedly and very vigorously. A deep breath should be taken before each cough, and the cough must be deep and prolonged, as when producing sputum from deep inside the chest. A breath and a cough must be repeated about every two seconds without let up until help arrives, or until the heart is felt to be beating normally again. Deep breaths get oxygen into the lungs and coughing movements squeeze the heart and keep the blood circulating.

The squeezing pressure on the heart also helps it regain normal rhythm. In this way, heart attack victims can get to a phone and, between breaths, call for help.

Tell as many other people as possible about this, it could save their lives!

From Health Cares, Rochester General Hospital via Chapter 240's newsletter. AND THE BEAT GOES ON... (reprint from The Mended Hearts, Inc. publication, Heart Response)
 

Origins:   This helpful e-mail began its life on the Internet in June 1999, and in the spring of 2004 a Powerpoint presentation of it began circulating online. Those kindhearted souls who started it on its way likely had no inkling the advice they were forwarding could potentially be harmful to someone undergoing a heart attack, but that is indeed the
case.

If you knew exactly what you were doing, this procedure might help save your life. If, however, you were to attempt cough CPR at the wrong time (because you misjudged the kind of cardiac event being experienced) or went about it in the wrong way, it could make matters worse.

Cough CPR is not a new procedure — it has been around for years and has been used successfully in isolated emergency cases where victims realized they were on the verge of fainting and about to go into full cardiac arrest (their hearts were about to stop) and knew exactly how to cough so as to keep enough oxygen-enriched blood circulating to prevent them from losing consciousness until help could be sought, or they were under the direct care of physicians who recognized the crises as they were taking place and were on hand to instruct patients step by step through the coughing. Even were the afflicted to correctly recognize they were experiencing the sort of cardiac event where cough CPR could help, without specific training to hit the right rhythms their coughing could turn mild heart attacks into fatal ones.

This is not to say cough CPR couldn't be effectively taught to patients deemed at risk of further heart attacks. According to a widely circulated news report surfacing in September 2003, a doctor in Poland has been attempting exactly that. Dr. Tadeusz Petelenz of the Silesian Medical Academy in Katowice Province claims to have successfully instructed a number of his patients in the procedure, but it should be noted his results have not been independently confirmed. While a September 2003 Reuters report detailed the Polish doctor's championing of cough CPR, a similar Associated Press report on the same subject noted that "Experts said while the concept is provocative, it needs more study" and that "Dr. Marten Rosenquist, professor of cardiology at the Karolinska Institute in Stockholm, Sweden, and an expert in heart beat abnormalities, said the concept is interesting but that Petelenz showed no evidence his patients actually had arrhythmias."

It is unclear from the news reports whether the Polish heart patients who supposedly experienced success with cough CPR were doing so under strict medical supervision in a hospital or were going about their private lives at the time of the cardiac events that prompted them to attempt the procedure. It is one thing for success to be achieved in a hospital setting where patients know intervention will swiftly follow if problems are encountered, and quite another when patients are in unscripted settings (at home, at work, or while driving in a car). Would such instruction hold up in field conditions, where those about to go into full cardiac arrest know there's no net under the tightrope?

Yet even if cough CPR can be effectively taught by physicians, it's not going to be learned from an e-mail, at least not well enough to be safe. Even if Dr. Petelenz's findings prove out, there's a wide (and dangerous) gap between in-person one-on-one training by a professional on hand to quickly correct a patient's mistakes before they become habit and generic printed instruction wholly lacking in direct feedback and guidance. Thinking one is a valid substitute for the other would be akin to believing studying a typed set of instructions is all it takes to learn how to drive a car well enough to take it down the freeway and back.

The e-mailed advice about coughing during a heart attack leaves the impression the "cough CPR" technique is endorsed by Rochester General Hospital and Mended Hearts. Rochester General had nothing to do with any of this — how its name came to be attached to this message is a mystery. See its denial of having endorsed this e-mail.

Although the text of the e-mailed advice was published in a newsletter put out by Mended Hearts (a support group for heart disease patients and their families), that organization has since disavowed it and has a page on its web site asking readers not to heed the advisory. The piece on cough CPR found its way into that publication through a blend of too much enthusiasm and a dearth of fact checking. From there, other chapters picked it up, spreading the notion to an even wider audience. Attempts now to distance the organization from it don't begin to undo the damage done by the piece having been picked up from there.

Darla Bonham, Mended Heart's executive director, has since issued a statement about cough CPR:
I've received email from people all across the country wanting to know if it is a valid medically approved procedure. I contacted a scientist on staff with the American Heart Association Emergency Cardiac Care division, and he was able to track a possible source of the information. The information comes from a professional textbook on emergency cardiac care. This procedure is also known as "cough CPR" and is used in emergency situations by professional staff. The American Heart Association does not recommend that the public use this method in a situation where there is no medical supervision.
Dr. Richard O. Cummins, Seattle's director of emergency cardiac care, explains that cough CPR raises the pressure in the chest just enough to maintain some circulation of oxygen-containing blood and help enough get to the brain to maintain consciousness for a prolonged period. But cough CPR should be used only by a person about to lose consciousness, an indication of cardiac arrest, he cautions. It can be dangerous for someone having a heart attack that does not result in cardiac arrest. Such a person should call for help and then sit quietly until help arrives, he says.

In other words, the procedure might be the right thing to attempt or it might be the very thing that would kill the afflicted depending on which sort of cardiac crisis is being experienced. Without a doctor there to judge the situation and, if cough CPR is indicated, to supervise the rhythmic coughing, the procedure is just far too risky for a layman to attempt.

Forget about coughing — key to surviving a heart attack is obtaining proper medical assistance within a very limited window of opportunity. Once an acute myocardial infarction (AMI) has been diagnosed, speedy injection of thrombolytic agents to dissolve clots is of the utmost importance — the more quickly those drugs are delivered, the better the chances of survival are. It's a race against the clock.

Most patients who present with minor chest pains usually look healthy and show no signs of a heart attack. Electrocardiogram (ECG) results tell the story though, so be sure to insist upon one being performed if you've any doubts at all. Often mild heart attacks are left untreated and undetected because hospital staff mistake a heart attack for something more benign because the presenting symptoms are minor.

Rather than risk killing yourself with cough CPR, those experiencing a heart attack should heed the advice of physicians the world over — down a couple of Aspirin as an emergency remedy. Doctors believe that during the early stages of a heart attack, Aspirin — which is known to prevent blood platelets from sticking together — can prevent a clot from getting bigger. In 1991 Dr. Michael Vance, president of the American Board of Emergency Medicine, recommended that people who think they are having a heart attack should "Call 911, then take an Aspirin."

Oh, and it probably makes a great deal of sense to chew the Aspirin before swallowing. The sooner it is dispersed by the stomach, the sooner it gets to where it is needed. During a heart attack, waiting for the enteric coating surrounding the pill to break down naturally could be a mistake.

In 1993 The American Heart Association began recommending a 325 mg Aspirin at the onset of chest pain or other symptoms of a severe heart attack. That bit of advice is going unheeded, though; a follow-up report published in 1997 shows as many as 10,000 American lives a year could be saved if more people who think they're having a heart attack took an aspirin at the start of chest pains.

In terms of the drama of it, swallowing an Aspirin seems quite a come-down from bravely trying to induce a perfectly timed coughing fit. Less flamboyant is better, though; Aspirin saves lives, whereas coughing might well cost them.

Barbara "from coughing to coffin?" Mikkelson

Additional information:
  Health and Safety FAQs   Health and Safety FAQs
  (American Red Cross)
  Cough CPR   Cough CPR
  (American Heart Association)
  Symptoms & Diagnosis of Heart Attack   Symptoms & Diagnosis of Heart Attack
  (American Heart Association)
  Warning Signs of a Heart Attack   Warning Signs of a Heart Attack
  (American Heart Association)
Last updated:   10 January 2014

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Sources:

    Brody, Jane.   "Personal Health: Saving a Life with CPR Can Be As Easy As ABC."
    The New York Times.   30 March 1994   (p. C13).

    Graedon, Joe and Teresa Graedon.   "FDA OKs Aspirin Against Heart Attack."
    The Houston Chronicle.   6 July 1996   (p. E8).

    Linn, Virginia.   "Coughing Is Not the Way to Stop a Heart Attack."
    [Pittsburgh] Post-Gazette.com.   27 July 1999.

    Ross, Emma.   "Coughing — One Way to Hold off a Heart Attack."
    Associated Press.   2 September 2003.

    Siegel-Itzkovich, Judy.   "Cough to Survive a Heart Attack."
    The Jerusalem Post.   27 June 1999   (Health, p. 9).

    Associated Press.   "Many Fail to Take Aspirin During Heart Attacks, Experts Say."
    St. Louis Post-Dispatch.   22 October 1997   (p. A9).