The TV was on. It might've been hot out.

That's all she remembers from that morning in August 2014. But after telling the story many times at various heart-related events in Michigan, Karen Grams can see it frame by frame, as if someone recorded the entire thing. 

She lay, with no pulse, motionless on the floor of her living room. Grams' husband, Bobby, kneeled over her body performing CPR – a dispatcher coaching him through the process over the phone.

"I was in a coma at the hospital for several days," said Grams, 61 at the time, an Ypsilanti resident since the 1970s. "The doctors were still unsure why I went into cardiac arrest. I was perfectly healthy at the time with no underlying conditions. If I hadn't received CPR immediately, I wouldn't have lived to see another day."

SEE ALSO: Heart Attack vs. Cardiac Arrest: Do You Know the Difference?

CPR, short for cardiopulmonary resuscitation, is an emergency procedure performed when a person's heart stops beating or they are not breathing. Grams still feels indebted to the dispatcher at Huron Valley Ambulance whose coaching aided in her lifesaving resuscitation. But she knows others did not receive the same help – and died because of it.

"There is a lot of misinformation about CPR that needs to be overcome," she said. "People need to be aware and do hands-only CPR right away."

Grams is one of the survivors participating in the Out-of-Hospital Cardiac Arrest Learning Community with Michigan Medicine and first responders in Washtenaw and Livingston counties. They work to improve the area's survival rates for out-of-hospital cardiac arrest, an abrupt loss of heart function and breathing.

More than 350,000 cardiac arrests occur outside the hospital each year. In 2020, over 9,200 EMS-treated out-of-hospital cardiac arrests occurred in Michigan.  Only 5.8% of these patients survived with good brain function, which is below the national survival rate of 7.1%.

"We are trying to make improvements across the chain of survival, which starts with bystanders," said Emilee Coulter-Thompson, LMSW, lead project manager at M-RISE, Michigan Resuscitation Innovation and Science Enterprise, a research program that works closely with the OHCA Learning Community. "These may be family members or just people walking by when another person collapses, but most people may not know the signs of cardiac arrest or how to start CPR."

The OHCA Learning Community, established in 2018, began with the goal of increasing survival rates by reducing the time to treatment through self-study and data collection in the two metro Detroit counties. It's the simple idea of solving a community problem by talking to the community, Coulter-Thompson said.

SEE ALSO: Hands-Only CPR: The Michigan Way

"But in doing so, we realized that we didn't have any data on people's willingness to do CPR," she said. "And since the end result of cardiac arrest depends on what happens in the beginning, we needed that data."

The OHCA community is currently administering an online survey to adults living in Washtenaw and Livingston counties about hands-only CPR, for which health care providers advocated during the COVID-19 pandemic.

"With COVID, we're seeing that fewer people may call 9-1-1 as often because they are tentative about going to the hospital, and many people still believe you have to give mouth-to-mouth when doing CPR," said Michelle Williams, M.H.I., manager of the OHCA project. "This has resulted in even more at-home deaths, which we desperately hope to curb through our efforts."

While some may use the terms synonymously, cardiac arrest is different than a heart attack and presents different symptoms. When a person is having a heart attack, one of the organ's blood vessels is blocked, which may cause dizziness, chest or abdominal pain, and loss of consciousness. When someone's heart stops beating during cardiac arrest, they may suddenly collapse and appear blue in the face.

"Recognizing that someone has gone into cardiac arrest is difficult, even for people who are trained," said Robert Neumar, M.D., Ph.D., professor and chair of emergency medicine at Michigan Medicine and director of M-RISE. "Then, it's not just whether you do CPR or defibrillation, it's how soon you start. Every second counts, and the earlier a person starts, there is a higher chance of survival and neurologic recovery for the patient."

In addition to CPR education, the OHCA Learning Community works to increase awareness on the availability of public access automated external defibrillators, or AEDs, which are used to re-start the heart. Leaders of the learning community are hosting a Zoom dialogue June 22 to develop communication strategies.

Getting the concern out in the media and promoting CPR training is the best way to get people more comfortable with lifesaving action, said Adrian Dantzer, 40, an OHCA advocate who suffered a different heart-related emergency at an Ann Arbor department store in 2017.

"I was a healthy 36-year-old at the time – anyone can have a heart attack or cardiac arrest, and it can happen anywhere," Dantzer said. "We need to make sure people know the signs [because] a lot of people still don't. The more people that know CPR and are comfortable with it, the more chances we have to save lives."

For more information, or to join the discussion, contact [email protected].