Maltese teens could mend a broken heart with CPR skills at school

One of Malta’s leading paediatricians is calling for the introduction of cardiopulmonary resuscitation skills in the national curriculum for all 14-year-olds, in a bid to save more lives.

Sam Attard Montalto made the call in the Medical School Gazette, saying Malta should join Belgium, Denmark, France, Italy and Portugal which have introduced CPR training in their national curricula.

Already the facts speak for themselves: between 2016 and 2017, bystanders witnessed 71% of cardiac arrests, but only 39% of these people performed CPR, and only in 9% of these cases was a defibrillator device (AED) used. This delay in intervention has meant that there is only a 6% survival rate for cardiac arrests occurring out of a hospital.

CPR is an emergency procedure that combines chest compression with artificial ventilation, in an effort to manually preserve brain function until emergency doctors can restore blood circulation and breathing. The AED is a computerised device that shocks the heart back into action when it stops beating or is beating too quickly to create a pulse.

Attard Montalto contends that at 14 children are strong enough to deliver CPR effectively and mature enough to understand its importance. “At this age children are also less likely to be unencumbered by major exams,” he said.

CPR and the use of an AED are considered to be relatively uncomplicated skills that can be mastered easily by non-medically trained laypersons.

According to Attard Montalto the importance of good, bystander CPR cannot be underestimated. “This requires laypersons to identify the signs of collapse, and be competent to initiate good CPR without delay and certainly before medical help arrives”.

In Malta the average time for an urgent ambulance to reach a victim varies but, even with optimal circumstances, this is likely to exceed 10 minutes. This is more often than not too late for most victims of cardiac arrest, Attard Montalto said. Cardiopulmonary resuscitation (CPR) associated with defibrillation, if delivered effectively and promptly within 1-2 minutes of cardiac arrest, may improve the chances of survival threefold.

To date the Malta Resuscitation Council alone has trained more than 2,000 medical personnel and 1,000 laypersons in CPR. It has also helped train and equip the Health and Safety Unit within the Education Division who, so far, have trained around 300 schoolchildren.

CPR-AED training is now mandatory for all medical students and General Practitioners and young hospital trainees are also required to complete more advanced resuscitation courses.

The Red Cross, St John Ambulance, Malta Heart Foundation, Order of St Lazarus and others also provide courses in CPR.

However, training needs also to be accompanied by greater availability of AEDs. This is because between 25% of 33% of cardiac arrest in adults involve fibrillation.

Presently almost 600 AEDs are found in Malta but most are located in private institutions and are not available to the public. Moreover, some of these AEDs are not operative, usually because the battery has lost charge or has expired.

Although the Malta International Airport, Air Malta planes, Gozo ferries, most schools, banks, some hotels, factories and social clubs, amongst others, do have at least one AED, Malta needs many more in key and accessible locations to be truly ‘covered’ according to Attard Montalto.

The Valletta local council alone is taking the lead by installing eight AEDs with 24/7 public accesses. A mobile phone AED locator application is also being developed.

“Malta should strive to install (and maintain) AEDs in most if not all key positions where significant numbers of individuals are likely to aggregate…

“Moreover, as happens in most major cities, the distinctive AED locating sign (a green square with a medical cross, heart and lightning bolt) should be widely distributed and clearly visible in numerous locations. Only this eventuality, combined with a sufficient body of trained bystanders who can initiate CPR and operate an AED, will significantly improve our survival figures for out-of-hospital cardiac arrest,” Attard Montalto said.