Cardiac arrest: how to recognize it and what to do

“In Italy, around 60,000 cardiac arrests occur each year. In Lombardy alone, 13 people experience cardiac arrest every day, including 8 in the Milan area.

Fewer than half receive CPR before emergency services arrive, and in less than 1 out of 10 cases a defibrillator is used. When a bystander intervenes immediately, however, survival rates can increase to 40–50%. Citizen action is therefore essential it buys precious time and can save lives before the ambulance arrives,” explains Dr. Scquizzato.

Cardiac arrest can occur suddenly, even in someone who appears healthy. The main signs are:

• sudden loss of consciousness;
• absence of normal breathing.

“Although sudden, cardiac arrest can sometimes be preceded by warning symptoms such as:

• chest pain;
• shortness of breath (dyspnea);
• palpitations or fainting.

More than half of patients experience these signs, but they are often underestimated. Recognizing and reporting them in time can increase survival chances up to sevenfold,” says the physician.

“Myocardial infarction (heart attack) is caused by the blockage of an artery that supplies blood to the heart. In this case:

• the patient is usually conscious;
• they often report chest pain, sweating, and shortness of breath.

Cardiac arrest, on the other hand, is a sudden cessation of cardiac activity. The person:

• loses consciousness;
• does not breathe.

A heart attack may sometimes lead to cardiac arrest, but the two events do not always coincide,” explains Dr. Scquizzato.

If a person suddenly loses consciousness, you must act immediately and follow these steps:

1. Call and shake the person

If it’s safe, approach, call their name, and gently shake their shoulders to see if they respond. Ask for help from anyone nearby.

2. Check for breathing

If there’s no response, check for normal breathing, look for chest movement and listen for breath sounds.

3. Call emergency services 

If the person doesn’t respond and isn’t breathing normally, call 112 or 118 right away. Activate the speakerphone and clearly describe the situation to the operator.

4. Start chest compressions

• Place one hand on top of the other in the center of the chest.
• Push hard and fast: 100–120 compressions per minute (about two per second), allowing full chest recoil after each push. Do not stop, the operator will guide you step by step.

5. Use a defibrillator (AED)

The emergency operator will tell you if there’s a defibrillator nearby send someone to retrieve it. As soon as it’s available, turn it on and follow the voice and visual instructions with the operator’s assistance.

6. Continue CPR

Do not stop unless:

• the AED instructs you to pause for rhythm analysis or to deliver a shock;
• emergency medical personnel arrive and take over;
• the person shows clear signs of life (movement, coughing, or breathing).

An Automated External Defibrillator (AED) is a device that analyzes the heart rhythm and, if necessary, delivers an electric shock to restore an effective heartbeat.

It is safe and easy to use, thanks to voice and visual prompts. Anyone can use it, even without medical training. If untrained, the 118 operator will explain the procedure over the phone.

“Learning how to recognize cardiac arrest and perform CPR is a civic responsibility, it can mean the difference between life and death. With just a few hours of training, anyone can become a vital link in the chain of survival.

CPR can even be taught to children: studies show that kids and adolescents are capable of learning and retaining these life-saving skills. International initiatives such as ‘Kids Save Lives’, endorsed by the World Health Organization, promote CPR education in schools to build a society where everyone knows how to act in an emergency,” continues Dr. Scquizzato.

“At the Cardio-Thoracic-Vascular Intensive Care and Resuscitation Unit of IRCCS Ospedale San Raffaele, we host the Cardiac Arrest Center, the first center in Italy entirely dedicated to care, research, and innovation in cardiac arrest management.

In the past year alone, emergency services transported over 100 patients with cardiac arrest to our hospital. As part of the emergency network of the Metropolitan Area of Milan, our hospital provides every day:

• at least two intensive care beds;
• a dedicated pathway guaranteeing direct access to a high-technology intensive care unit staffed by highly specialized professionals.

We have the largest national experience in the use of ECMO (Extracorporeal Membrane Oxygenation) for cardiac arrest, with over 400 cases treated, placing us among the leading reference centers in Europe,” states Dr. Scandroglio.

“In addition to providing state-of-the-art clinical care, our team integrates clinical practice with research, working to better understand the causes and mechanisms of cardiac arrest, develop innovative therapies, and refine resuscitation techniques. Our research and innovation activities focus on four main areas:

1. Prevention of cardiac arrest;
2. Early resuscitation and defibrillation;
3. Advancement of resuscitation science through clinical and translational studies;
4. Integration of artificial intelligence and personalized medicine,” adds Dr. Scquizzato.