Does Cough CPR Work? | The Survival Doctorby James Hubbard, MD, MPH

Last week I wrote about deciding what to do if you have chest pain far away from expert help. Several comments on that post and on Facebook suggested vigorous and repetitive coughing could be tried. Since that suggestion is found far and wide on the Internet, I decided to check out, as best I could, whether there was any truth behind it.

The Premise

As far as I can tell, the thinking behind so-called cough CPR is that taking a deep breath, then a deep cough can raise your blood pressure for a second or two, thus delivering more blood to the brain. Also, the claims go, if your heart is in an abnormal rhythm, a deep cough might revert it back to normal by doing the same thing as a Valsalva maneuver (a technique that changes the pressure in your chest to make your body think your heart should slow down).

The Problems With the Premise

1. There’s a better way to raise a lower blood pressure.

Why Does Low Blood Pressure Matter?

A heart attack can cause very low blood pressure. When that happens, your body has a hard time pumping a sufficient amount of blood up to your brain and to your other organs. You may lose consciousness, and organs may start to die. So one of the first things to do when you’re having a heart attack is lie down. This reduces the amount of pressure needed to circulate that life-sustaining blood.

One of the common cough CPR scenarios I find proposed on the Internet is you’re driving and start having chest pain, maybe feel faint. To me, any time you feel faint, you should lie down or at least bend over so your head is level with your heart. (That way, you don’t need as much blood pressure to get blood to your brain.)

But when you’re driving, you can’t lie down. What to do? Some say start coughing.

Here’s what I would do instead: Pull over immediately, and turn on my emergency lights. Lie down either in the car (unlocked) or on the ground if I deemed it safe, I was easy to see, and I was away from traffic. Next, I would call 911. If I couldn’t pull over, I’d stop right on the road, turn on the lights, etc.

>> Click here for what you can do if you can’t call 911.

Now, if you deemed that impossible or way too risky because of fast traffic, I suppose you could cough a few times, but the main thing is stop as soon as you can. Same thing if you’re on a trail or anywhere. If you’re getting dizzy and your heart is going haywire, unless you get your head level with or below your heart, you may faint. Coughing cannot be depended on to keep you from it, especially if your head is higher than your heart.

2. There’s no proof coughing can stop arrhythmias (abnormal heart rhythms).

Another reason cited for coughing is to stop or prevent dangerous heartbeats. And actually, dangerous rhythms are major causes of death during or after a heart attack. Ventricular tachycardia is one of those rhythms. With it, only part of your heart continues to pump, and your blood pressure usually drops signficantly. Ventricular fibrillation is another. There is no pulse or blood pressure with V-fib—no blood flow at all. It’s the major problem that kills people in the first hours of a heart attack. V-tach can lead to V-fib, or V-fib may just start on its own.

Some people on the Web surmise coughing can prevent these two rhythms, but there’s no proof of that at all. As I stated at the beginning, the cough may be a way to do a Valsalva maneuver, but that treats a different type of arrhythmia, supraventricular tachycardia (fast heart rate, but the blood pressure is usually not extremely low). There’s no proof that it helps or prevents V-tach or V-fib, which are the immediate killers.

3. Coughing is not CPR.

Some sites have coined the procedure of coughing during a heart attack “cough CPR.” But a cough could never substitute for CPR.

Think about it. CPR is used only on someone with no sign of life. How can you cough when you’re basically dead?

The American Heart Association’s Take

The American Heart Association has addressed the idea of cough CPR and find little to no merit in it. The best they can say is:

During a sudden arrhythmia (abnormal heart rhythm), it may be possible for a conscious, responsive person to cough forcefully and repetitively to maintain enough blood flow to the brain to remain conscious for a few seconds until the arrhythmia is treated. Blood flow is maintained by increased pressure in the chest that occurs during forceful coughs.

But, after the heart stops beating, there may be a second or three before you lose consciousness. So what if you start coughing while you’re still conscious? I guess you could try, but I see no way that’s going to keep the blood pumping to your brain enough to keep you conscious.

So What’s the Problem With Trying?

The problem I see is depending on “cough CPR” when you should be doing the basics: lie down if you feel faint, immediately call 911 if that’s an option, and take an aspirin if you have one. Also yell for help—someone who might be able to do chest compressions or find an AED if needed. Even if you’re walking for help (which you may or may not want to do; see this post), lie down if you feel faint.

Then, if you wish, try the coughing. But, if it were me, I would do it more intermittently, if at all. I have no proof of this, but I would surmise repetitive, hard coughing again and again is going to be exerting and uncomfortable enough that it puts more stress on the heart and could lead to more damage. Since there’s no proof of coughing really helping, I guess it’s one of those judgment calls you have to make depending of the situation.

Next up, cayenne pepper and heart attacks: hype vs. facts. Subscribe below to be notified when this is published.

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Photo: Flickr/Simon James, “Day 301 – Cough!” shared under CC BY-SA 2.0.

Editor’s note: The quote from the American Heart Association was originally included in the main text due to a layout mistake. This has been corrected. Also, a link to what to do if you can’t call 911 has been added.