Why 'cough CPR' is not the lifesaver it's made out to be
By Genaro C. Armas, American Heart Association News
Misinformation has circulated for years on social media about how coughing forcefully can treat a heart attack. Health experts are quick to debunk that myth and warn that "cough CPR" is ineffective.
"Anytime anyone is having chest pain or other symptoms of a heart attack, get to a hospital. Calling 911 is the safest way to get to a hospital for chest pain," said Dr. Bryn Elissa Mumma, a professor of emergency medicine at UC Davis Health in Sacramento, California.
The term itself is a misnomer because CPR is for someone in cardiac arrest, meaning the heart has stopped beating. At that point, coughing would not be possible, nor would it be considered CPR.
"It physiologically does not make sense," Mumma said. "(Coughing) just would not work to restart a heart that's not beating."
Heart attack and cardiac arrest are medical emergencies requiring immediate medical treatment, though it is important to note they are two different conditions. A heart attack is a circulation problem and occurs when blood flow to the heart is blocked. Cardiac arrest is an electrical problem and occurs when the heart suddenly stops beating. A heart attack is a common cause for cardiac arrest.
Someone who goes into cardiac arrest will become unresponsive and stop breathing or gasp for air. Cardiac arrest can lead to death if not treated within minutes.
Confusion about cough CPR might be traced to a temporary measure that may be used for a sudden arrhythmia, or abnormal heartbeat, in medical settings in which patients are constantly monitored, such as a cardiac catheterization lab, said Dr. Manesh Patel, distinguished professor of medicine and chief of the cardiology division at the Duke University School of Medicine in Durham, North Carolina.
During a sudden arrhythmia, a doctor or nurse may coach a patient to cough vigorously to maintain enough blood flow to the brain to remain conscious for a few seconds until the arrhythmia is treated. But this technique is not effective in all patients and should not delay definitive treatment, according to the American Heart Association.
The misconception about cough CPR and heart attack may be tied to an idea that coughing can change the pressure in the chest, and, in turn, affect the heart, Patel said.
"I think people believe that it is changing, somehow, the heart's squeeze. But (coughing) has not been shown to do that," he added. "If somebody has lost a pulse, we very much know that you have to do CPR."
Mumma, a co-author of the AHA's advanced life support guidelines update in 2023, said a literature review to prepare for that update did not yield any research about cough CPR.
"It's certainly not something that is recommended in those guidelines because there is no evidence to support it," Mumma said.
If you're around someone who has gone into cardiac arrest, call 911 and start hands-only CPR, Mumma said. This means placing the heel of one hand in the center of the chest at the nipple line. Place the other hand on top and interlock the fingers. Start pushing hard at a rate between 100 and 120 beats per minute.
Get an automated external defibrillator, or AED, if one is close by or send someone to find an AED, Mumma said. People should use an AED as soon as it's available. Even untrained people can use the device by following its voice instructions.
Because a heart attack can lead to a cardiac arrest, experts say it's critical to call 911 when symptoms start. These can include chest pain, jaw pain, shortness of breath, sweating and nausea.
Then sit and rest until the ambulance arrives, Mumma said. "Avoid exertion." An aspirin may help for those not allergic to it, she said.
She also said someone with a prescription for nitroglycerin for chest pain should take the medication.
But one thing people don't need to do, both experts said, is cough.