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'Cough CPR' is not a hoax


2002 11 19  I received the following message.  It requires to be shared.

Ken Moyer [e-mail address omitted]
Sent: Tue 2002-11-19 07:06
Subject: Bad Information on your web site.

I have noticed on your web site you have reprinted the Hoax email about surviving a Heart Attack.  Please consider removing that information because you could be doing a disservice to your readers.  Please check out the information I have included below and let me know what you think.

http://www.viahealth.org/rgh/heartattack.htm
http://www.nuketown.com/templates/hoaxes.php?hoax_id=29
http://urbanlegends.about.com/library/blcpr.htm
 
http://www.snopes.com/toxins/coughcpr.htm

I Hope you will reach the same conclusion I did that this is not legitimate medical information and should not be spread.


Respectfully,

Ken Moyer, Austin Texas

I looked at all of the information pointed out by Ken Moyer and composed a reply.   Unfortunately, when I sent the response to him, it bounced, and so did two attempts to re-send it.  Therefore I'll post my response to his message on this page, in the hope that Ken Moyer may find it and decide whether he'll let his concerns stand.

From: Walter H. Schneider [ ]
To: Ken Moyer
Sent: Tue 2002-11-19 13:51
Subject: RE: Bad Information on your web site.

Dear Ken,

This is a re-send.  I received a somewhat confusing message from my mail server and am not sure my response reached you.

Thank you for sending the information.  Your message was short, but it linked to a lot of commentaries and much very useful information.  Therefore allow me to respond at length, so as to put my views into the context of life in general, rather than to evaluate alternatives that obviously apply only under ideal clinical conditions.  In general, the circumstances of life are conditions that are far from ideal.

Your message provided access to a very good overview of pertinent concerns and a good collection of leads to available information.  However, I would at least replace the period at the end of your header line with a question mark, but I would prefer it if I could quote your whole message at my website.  Will you give me your permission to do that?

I'll install a link to the last URL in the list you provided (or use your whole message, pending your permission).  I'll do that in the context of the web page by means of an explanatory note (perhaps by means of what I state in my response to you) and by identifying that some doctors don't like the instructions for self-help 'Cough CPR'.  That is because simply stating that information is deemed questionable by some is not sufficient proof that the information one questions is actually wrong.

There has apparently been insufficient research, so far, providing support for the criticism, criticism that is somewhat overdone.  On the other hand, there has been some research proving support for the 'Cough CPR' method.  Consider:

The 1992 Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiac Care and the Guidelines 2000 for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care - International Consensus on Science briefly discuss the technique called Cough CPR . Cough CPR is a self-administered form of cardiopulmonary resuscitation described by CM Criley in 1976 . According to Criley, self-initiated CPR is possible; however, its use is limited to clinical situations in which the patient has a cardiac monitor, the arrest is recognized before loss of consciousness, and the patient can cough forcefully. To date, there is insufficient scientific research concerning the efficacy of Cough CPR. Therefore, American Red Cross cannot advocate teaching the technique until it has been thoroughly tested in national studies and found to be effective.
_______________

  1. American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiac Care. JAMA. 1992; 268(16): 2135-2302.

  2. Criley JM, Blaufuss AH, Kissel GL. Cough-induced cardiac compression. JAMA, 1976; 236:1246-1250.

Source: American Red Cross

Note the reason why the American Red Cross is not recommending the 'Cough CPR' procedure.  Note especially that the American Red Cross does not state that 'Cough CPR' is a hoax.  The information in the article of concern to you is therefore not bad information.  It is not even questionable but merely being questioned by some people and organizations.  Those are important gradations.  Moreover, if there were to exist any evidence at all that someone killed himself by doing 'Cough CPR' when better methods were available and should and could have been used, we would be sure to hear about it.

There is a considerable amount of empirical evidence showing that the recommended alternatives leave much to be desired.  That may not be true to the same extent in the U.S. as it is in Canada.  Nevertheless, from watching and reading coverage of American health-care news and debates pertaining to current trends and the looming collapse of our health-care systems, I gained the impression that we are in the same boat.  The willingness of the spirit of health-care workers is increasingly not matched by their abilities or by the extent of funding provided to materialize what they wish for.

The advice offered in the text in question, even if its source is vilified as being obscure (the American Red Cross nevertheless unequivocally identifies the source of the 'Cough CPR' method), is not a hoax, and I didn't see anyone of repute actually state that it is, other than that some people distanced themselves from it.  I had followed the advice when I needed it, and it worked.  Perhaps it would have worked even better if, in addition, I would have taken an aspirin as recommended at the last link you identified.  Common sense indicates so, and the next time around I'll certainly do that, too.

Consider that the 'Cough CPR' method is recommended for people who can't reach a phone or any help when a heart attack hits them, not as an alternative to readily available and readily accessible cardiac care.  

The area where I live and farm is so remote that not even a cell phone will work here.  It can take a half hour or more to drive the tractor off the field and to our home (if driving it is still possible) before I can reach a regular phone.  Then we must wait at the very least a half hour before an ambulance will get to us when we need it.  It will most likely be more than two hours before I am in intensive care in the hospital - long after the narrow window of opportunity has gone by.

I'm no longer involved in farming to the extent I was, largely because of those circumstances.  Let's face it, anyone living in an area or circumstances such as ours hasn't got a chance to receive the required treatment within the narrow window of opportunity when he is afflicted by a heart attack.  The method under discussion is the only reasonable method available for people in our circumstances.

If you were to have a heart attack under those conditions, would you just sit and wait?  If coughing as instructed would eliminate your pain, would you do that instead of merely waiting helplessly and hoping that death may be quick or that you pass out, if for no other reason than that you'll no longer feel the pain? 

The advice and comments offered at some of the URLs you identified concentrate on the source of the method in question and on that there are better alternatives under ideal conditions.  Moreover, it is stated there that the method offered in the message under discussion could be deadly to someone who is unconscious.  That doesn't make much sense.  How can someone who is unconscious still cough deliberately and thereby risk causing his own death?   How would he even be able to dial 911, let alone ask for help?  I would not, would you?  However, provided I am still conscious and able to do so, I would cough as long as I could, even if I would literally cough my heart out.  At least I would die trying to save myself.

Nevertheless, what valid alternatives are there for someone in circumstances such as those I mentioned or for someone who is hunting in the bush or hiking, perhaps tens or hundreds of miles away from the nearest phone?

Even in Canadian urban health-care regions there have been numerous cases of heart-attack victims dying in ambulances that were carrying them from one hospital to hospital after hospital, trying to find one that would admit the heart-attack victim for treatment.  As long as I can, I would rather die while trying to help myself than to expire in transit.

Don't accept everything doctors tell you without critically examining it.  I hope that by saying that I don't offend you if you should happen to be a medical doctor.  However, doctors don't know everything, and they make mistakes, often.

I had an eye doctor try to use a magnet to attempt to remove a sliver of brass stuck in the centre of the pupil of my eye, even though I told him that non-ferrous metals have no magnetic properties and that brass is a non-ferrous alloy.  He could not be deterred and said, "Well, it can't hurt to try.  It might work.  You never know."   There most certainly is an over-abundance of scientific evidence contradicting what that doctor was unsuccessfully trying to do.  That didn't hold him back from trying anyway.  We know that brass is not attracted by magnets and therefore anyone with only a reasonable level of education would not even try to prove otherwise.  However, we should at least try to use methods that are not completely proven as long as they are the only practical hope that is accessible for survival.

I have had a doctor prescribe anti-inflammatory medication for me that caused severe intestinal bleeding because the prescription had me take that medication at a level that was twice the allowable daily maximum.  Not even the pharmacist, who should have, noticed that I was being put into danger.  And the doctor who had made out the prescription for the wrong dosage merely prescribed something else to alleviate the painful and damaging symptoms caused by my being overdosed.  I had to find information about the medication I was taking to determine why it was apparently killing me.  Common sense tells me that I'm alive and kicking in spite of my doctor's error and mainly because I found something that worked much better for treating the cause of my problem than the doctor-prescribed treatment of a problem symptom.

I no longer need to take anti-inflammatory medication for the symptoms of my arthritis because I found an effective home remedy that helped me and many other people whom we told about it.  I've been pain-free since 1990 and even stopped taking the home remedy about ten years ago.  Besides, the home remedy (apple-cider vinegar and honey dissolved in water) is less dangerous, by far, than what the doctor prescribed for me, even if that were taken only at the recommended levels; and that medication is still a very popular one frequently prescribed to patients suffering from acute inflammatory pains while it will do absolutely nothing to treat the root causes of the symptoms it is intended to alleviate   What doctors try to do in that respect is little more than the equivalent of putting a new coat of paint on a rusty old car or using a teaspoon of finely-ground pepper to stop a radiator leak.

I could give you a long list of comparable experiences by friends and relatives.  Let's just consider that it is estimated that in Canada alone about 10,000 to 12,000 people annually meet their maker on account of medical misdiagnoses and maltreatment, surgical errors, wrong prescriptions, wrongly administered medications and wrongly-filled prescriptions.  Therefore a Royal Commission has been launched to examine that calamity and to determine what needs to be done to address it. 

Do you think that the performance record of American medical professionals is better than that of the Canadian ones?  The Canadian Royal Commission will take about two years to collect and examine data, and to announce its findings and recommendations.  I hope that I don't need the services of too many MDs before the commission finishes its work.  However, I'll keep as watchful an eye on anything and everything any doctor is trying to do to me as if I were watching any mechanic doing work on any of my machinery or vehicles.  "Keep the doctors away and you might live to eat an apple a day." :-)

By the way, the recovery rates and record of recovery for heart-attack victims in France are much better than in North America.  That is because intensive initial cardiac care in France is being administered by paramedics at the homes of patients and by then providing for home care, rather than merely trying to keep patients alive during transport to hospitals. 

The narrow window of opportunity that was mentioned by some of the commentators at the web pages you identified is apparently better taken advantage of by doing what the French do than by what the North American medical services promote as the best possible alternative for the treatment of heart attacks.  That is especially true considering the inadequate and decreasing levels of services available under Canada's deteriorating socialist health-care system, where nurses (often) and doctors (sometimes) go on strike or work to rule, and where more and more hospital beds, even whole hospital wings are being closed down permanently.

In Canada's rural areas it is not merely hospital beds but large numbers of hospitals that are being closed.  If you are in the market for small hospitals, let me know.  I know some, that were recently renovated at the cost of ten's of thousands of dollars, that now stand empty and unused, and that you can own – including the land they stand on – for prices as low as 10,000 Canadian dollars a piece.

All the best,

Walter

Subsequent to my attempts to send that response to Ken Moyer I did some more searching on the Internet and found the following:

Statement on Cough CPR

During a sudden arrhythmia, it may be possible for a conscious/responsive victim to cough forcefully and maintain sufficient blood flow to the brain to remain conscious for a few seconds until the arrhythmia disappears or is treated. Blood flow is maintained by an increase in intrathoracic pressure that occurs during forceful coughs.1-3 The phenomenon has been mislabeled "cough CPR" although it is not a form of traditional resuscitation.

"Cough CPR" should not be routinely taught as a part of lay rescuer CPR because it would complicate the teaching of traditional CPR by adding information that is not generally useful in the prehospital setting. In virtually all lay rescuer CPR courses, the assessment finding that signals the presence of an emergency is unresponsiveness on the part of the victim. This signals the rescuer to begin the "A,B,C's" of CPR. Unresponsive victims will not be able to perform "cough CPR".

Full story and additional references at the website of the
American Heart Association

One of the references quoted in the information provided by the American Heart Association is the original paper by Criley JM, Blaufuss JH, and Kissel GL.   Two additional references refer to reports that are dated 1998 and 1996, respectively.  From that it is quite obvious that the 'Cough CPR' method to restore an individual's heart rhythm is far from being a hoax.
   It boggles the mind, that if a laymen could with little effort find accreditation of the procedure in two articles by prestigious and well renowned organizations, why supposedly professional health-care providers would label the procedure as a hoax.

Still, it needs to be stressed that the procedure should be used by an individual only when he has absolutely no other recourse and only then, which is a no-brainer, if he is conscious.

___________________
Comments:

Walter,

You are absolutely right.......cough CPR is not a hoax.

Thanks for sharing your response to the message from Ken Moyer and the (in my opinion) questionable logic of some highly regarded professional organizations.

A few years back, I had the unfortunate opportunity to personally need to use the cough CPR procedure. I was driving home from work at the time when I felt a very erratic rhythm to my heartbeat. There was absolutely no pain but, almost immediately, I became very dizzy which was getting progressively worse very quickly.

I was not in a remote area and I did have my cell phone with me but, let me assure you, there is not enough time to even stop a vehicle safely, much less flag down a passing motorist or call 911 as suggested by the American Heart Association. Upon feeling dizzy, you have 10 to 15 seconds before passing out. You have much less time than that to do any rational thinking or to take any actions.

I won't go into any details how I knew about cough CPR (by the way, it wasn't from the email) but I immediately began coughing very aggressively. This did not make the dizziness go away completely but it helped and certainly kept it from getting worse. With each cough, I could feel the dizziness subside slightly but increase somewhat again between coughs. I didn't try to time the coughs but determined when I needed to cough by how dizzy I was. I would guess that it was one every 1 to 2 seconds.

You don't have any sense of time under these circumstances but I would guess that I kept this up for about 20 seconds when I suddenly felt my normal heartbeat return. The dizziness went away almost immediately. I don't know if the coughing had any effect on restoring normal heart rhythm, as claimed by some, but I am certain that it kept me from passing out.

It doesn't take a lot of "horse sense" or a "rocket scientist" to conclude that the logical thing to do is take whatever steps available to live. As I have just conveyed by email to the AHA, it just doesn't make sense to sit quietly and wait to die or for help that may come too late.

I salute you on your courage to publicly disagree with the norm.

G. S.

Another comment (2009 02 09) by Lisa L.


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__________________
Posted 2002 11 19
Updates:
2008 08 01 (added comment)
2009 02 10 (added link to comment by Lisa L.)