Cough CPR

If you're like me, you've received multiple copies of the e-mail that sings the praises of coughing your way out of cardiac arrest. The method remains controversial and has earned itself a place on "urban legend" web-sites. A Polish cardiologist, however, continues to investigate the method and would like to pull it out of the mythic category into everyday practice.

Sudden cardiac death caused by rhythm abnormalities of the heart which cut off circulation to the heart and brain takes out 300,000 Americans each year. Dr. Tadeusz Petelenz notes that patients have a 20-30 second prodromal period prior to pitching marked by dizziness, shortness of breath, nausea, sweating, and weakness. If properly trained, a quick thinking cardiac patient can launch into cough CPR, maintaining consciousness long enough to call for help.

Animal studies support the physiology behind this maneuver. Forceful rhythmic coughing causes an upswing in pressure through the chest cavity. With each cough, blood is squeezed out of the lungs, back through the heart, and into blood vessels serving important organs such as the brain. With each deep inspiration between coughs, blood zips back through the right heart chamber and into the lungs and the coronary circulation.

Over 100 of Dr. Petelenz's at-risk patients were taught cough CPR and successfully hacked their way out of nearly 300 prodromal events. They required medical assistance through 73 events during which they were unable to cough up their blood pressure. Doubtful colleagues at the Annual Congress of the European Society of Cardiology objected that there was no coughless control group, but who would want to be assigned to that bunch of deadbeats now that Dr. P. has fair evidence that it works? If I were a patient at high risk for sudden cardiac death, I'd rather cough than wait to see if this prodrome was the big one.