The Trick to Staying Alive
Alson Inaba, M87, was doing a grand rounds presentation for physicians at the Kapi’olani Medical Center for Women and Children, in Honolulu, back in 2005 and decided to deviate from the normal curriculum.
“I don’t like boring presentations,” he explains, “so I created a skit in which one resident walked up onto the stage and suddenly collapsed. Then a group of pediatric residents, sporting dark glasses, gold chains and a boom-box blaring ‘Stayin’ Alive’ rushed up to the stage to perform CPR.”
It was more than sparkly fun and games. “My teaching point was, Let’s do everything we can to help this guy stay alive. That got me to thinking about the beat of ‘Stayin’ Alive,’ which has about 100 beats per minute—the same rate the American Heart Association recommends for CPR chest compressions,” says Inaba, an associate professor of pediatrics at the University of Hawaii John A. Burns School of Medicine and head of the Division of Pediatric Emergency Medicine at the Kapi’olani Medical Center.
Some personal, even intimate, history lay behind the concept. Back in 1977, when the movie Saturday Night Fever first came out, with its stirring tale of young John Travolta’s character fighting his way out of a dead-end job in Bay Ridge, Brooklyn, through glissando moves on the dance floor of a neighborhood disco, Inaba and his pals had loved cruising around Honolulu in his Cadillac Sedan DeVille, the eight-track cassette player going full tilt and that very tune cycling again and again through the speakers. Inaba had always loved the punchiness of the tune, but now, as a physician, he realized it could serve a larger purpose. It could help save lives.
Once the American Heart Association (AHA) caught wind of Inaba’s approach, they asked him to write it up for Currents, the organization’s newsletter for its CPR instructors. Popularizing a simpler approach to CPR had found its moment. Research conducted by the AHA had shown that survival rates among cardiac arrest victims at home, at work or in public were just as good with “hands-only” CPR as they were when the traditional mouth-to-mouth efforts were included. That being true, it made sense to promote the importance of compressions far and wide.
Approximately 400,000 Americans suffer cardiac arrest each year, and about 90 percent of them—some 1,000 people every day—die because they don’t get immediate CPR. Hands-only CPR, properly administered, can double or even triple the chances of survival, according to the AHA.
The new, updated message really couldn’t be much simpler. There are just two steps: First, dial 911 to summon help, and then push fast and hard in the middle of the victim’s chest to the beat of “Stayin’ Alive” until help arrives. Don’t worry about hurting the person in the process, experts say. If you did nothing, the individual would surely die.
A heart attack and a sudden cardiac arrest, though often confused, are distinct events. Heart attacks result from blockage in blood flow to the heart. Although impaired, the heart may continue beating even during or after a heart attack, like a kinked garden hose that still permits a trickle of water to flow. With SCAs, often triggered by a heart arrhythmia, the heart has stopped cold. Blood and oxygen can’t circulate. Death occurs within a matter of minutes.
News of the hands-only approach to CPR spread through the media. National Public Radio aired a story in April 2008, in which host Robert Siegel quizzed Gordon Ewy, a cardiologist from the University of Arizona and a longtime advocate of the hands-only technique, about the revision in AHA guidelines. “I gather the research now shows that there’s no better result for using the mouth-to-mouth in addition to chest compression,” Siegel suggested at the start.
“Yes, that’s correct,” Ewy said. “Because if you or I were to collapse right now, our blood would have plenty of oxygen in it. And when someone starts compressing the chest, the flow to the heart and the brain is so marginal, that if you stop for anything, including breathing, it decreases the chances of the patient surviving.”
A moment later, Ewy mentions the ideal cadence of 100 beats a minute for the tempo of compressions, and attempts to sing a measure or two of the disco hit to demonstrate: “Ta, da, da, da, da, staying a-LIVE.”
“Well, thank you very much for this guidance,” Siegel offers lightly at the end of the interview, “and also for helping us to never hear the Bee Gees singing ‘Stayin’ Alive’ in quite the same way ever again for the rest of our lives.”
Later that year, the Today show ran a segment in which cohost Matt Lauer did a demonstration for his viewers under the guidance of Dr. Nancy Snyderman, chief medical editor for NBC News. Lauer, clad in coat and tie, gamely knelt over a beige mannequin on the studio floor and began exerting compressions on its chest—at first too slowly, and then more quickly, at Snyderman’s prompting—to show the proper life-saving technique.
One summer day three years ago, Debra and Christopher Bader went out for a walk. The husband and wife, both in their 50s, entered some woods north of Boston accompanied by their three dogs. A jaunt like this was a regular routine for the couple. Everything was going fine until Chris, headed up a steep hill, suddenly turned and looked back with what Debra describes as “a bad look” on his face. “It was almost like he’d forgotten something,” she says now. Chris immediately keeled over backward and crashed to the ground. He had suffered cardiac arrest.
Debra flew into action. She fished Chris’s cell phone out of his pocket and dialed 911 to summon help. Then she jumped on her husband and began pushing hard and fast in the middle of his chest while frantically singing snatches of “Stayin’ Alive,” pumping her interlocked hands up and down and yelling instructions to the EMS crew over the open phone.
“I was talking and yelling and singing,” says Debra, who kept at it for 15 minutes until the EMTs arrived and shocked Chris with paddles to get his heart going again.
Her husband’s collapse was not entirely unexpected. Chris, a software developer, had survived a heart attack on a busy street near their home just five months earlier. On that occasion, Debra admits she felt “helpless and horrified.” Should she apply mouth-to-mouth, or push on his chest, or do them both or leave him alone until help arrived? “The old approach was kind of complicated,” she says in her defense.
This time, deep in the woods, Debra knew what to do because she had heard a story on the radio about doing CPR chest compressions to the “Stayin’ Alive” tune, and had gone online to watch a video on the topic. She had further schooled herself by visiting multiple websites. “I became obsessed with it,” says Debra, a lawyer. “But as far as obsession goes, it was the right thing to be obsessed about.”
Chris and Debra were not the only ones who have gained from being up to speed.
Tom Maimone was a retired guy in his 50s who lived in Delray Beach, Fla. In top physical shape, he was a runner who frequented the gym nearly every day and who watched his diet carefully. In fact, at a recent physical exam, his doctor had gone so far as to tell him, “Everything looks great—how do you stay so ripped?” On April 25, 2009, while out on a 10-mile run, he was within a half mile of home when he dropped like a stone directly in front of a car driven by Tom Elowsen.
Maimone had suffered sudden cardiac arrest from a near-total blockage in an artery leading to his heart.
Elowsen, who had jumped out of his car, began pumping Maimone’s chest fast and hard while singing “Stayin’ Alive” in his head. It was a stroke of luck that he knew what to do. Elowsen had gone to pick up his girlfriend recently, and while waiting for her to get ready, he had watched a Today show segment promoting the simpler approach to CPR.
Seeing Maimone crumple to the ground, Elowsen sprang into action. Assisted by several others at the scene, he kept pumping to the disco beat for nine or 10 minutes until the EMTs arrived and shocked Maimone with defibrillators to restart his heart.
Maimone and Elowsen since have become friends and fellow evangelists for the heart association’s “Stayin’ Alive” campaign. The two Toms have appeared at public events and gone on the Today show to tell their story, helping spread the word about how easy it can be to save a life.
Historically, as good as it was, the mouth-to-mouth version of CPR had people hesitating too much at the moment of truth. Statistics gathered by the AHA say that fully 70 percent of Americans feel helpless to act during a cardiac emergency, either because they don’t know how to administer CPR or because they’re afraid of hurting the victim.
Timing the compressions is critical. If the tempo is too slow, not enough blood (and oxygen) will flow to the heart and brain. If too fast, the heart will not have time to refill properly between compressions. Inaba says that in his experience, without any guidance, most people compress either “way too fast” or “way too slow.”
On the Road
Once the AHA had secured the rights to use the Bee Gees’ song, the Hands-Only CPR “Stayin’ Alive” campaign was officially up and running. Everything about it is a reflection of the original skit at Inaba’s grand rounds presentation, with the same rakish look and the same unexpected mix of gravity and fun as that first enactment. The campaign’s official icon is a white disco suit modeled on the one Travolta wore in the movie. And the campaign seems to be gaining steam.
In early June, as part of National CPR Awareness Week, the AHA recognized Inaba at an elaborate media event in New York City—featuring actress Jennifer Coolidge backed by a cadre of dancers in flashy white suits, as well as Debra and Chris Bader, Maimone and Elowsen—for the teaching innovation that launched it all.
Inaba was interviewed by NBC News, the New York Times and Men’s Health. The event marked the start of a national three-year, 24-city promotional tour, funded by a $4.5 million grant from the WellPoint Foundation, that features a custom-designed van and trailer, complete with a whirling mirror ball and a sound system perfect for promoting disco-based CPR to dozens of people at once.
Just how far the message has reached is hard to say. Inaba has gotten emails from an emergency room nurse in Alaska and a hospital CEO in Botswana, among others, who say they have adopted his approach and saved lives.
The British Heart Foundation came aboard in January of this year with a droll TV ad featuring former football star Vinnie Jones, who plays a Cockney-tongued thug who threatens to teach viewers “a lesson you’ll never forget” by demonstrating proper CPR. For a sample victim, he uses an unconscious bloke who comes sliding into the frame on his back, propelled by two gum-chewing associates.
Jones bends to his rescue task. “Don’t forget—push fast and hard to ‘Stayin’ Alive,’ ” he growls after he’s done. “It ain’t as hard as it looks.” The online version of the ad has drawn millions of hits.
What sense does any part of this story make? The elements in it are whimsical, crazy, far-fetched—improbable, at best. But seven years ago, out on a speck in the middle of the Pacific Ocean, one man had a bright idea. And because of it, some people, basically dead, have lived to see another day.
This article first appeared in the Fall 2012 Tufts Medicine magazine.
Bruce Morgan can be reached at firstname.lastname@example.org.