ian CognitoAt age 60, British comedian Ian Cognito collapsed and died from a heart attack while performing on stage at a crowded comedy club on April 11, 2019.  The audience thought that this was part of his act and did not realize that he was actually having a heart attack, when every minute counts for a rescue team to save his life.  He had felt sick before going on stage, but was in his usual good form once he started to tell jokes.  Early in his act, he specifically joked, "Imagine if I died in front of you from a stroke or a heart attack."  Ten minutes later, he sat down on a stool on the stage, started to breathe very rapidly, stopped talking, bent his head backwards, put both hands behind his back, and his shoulders started to twitch.  The audience thought this was part of his routine, so they sat there watching and laughing at him. After about five minutes of the audience laughing at this supposed joke of him pretending to have passed out, the stage manager walked on the stage and touched his arm, expecting him to respond with a snappy line.  Instead he fell onto the floor and it was then that everyone knew that this was not an act.  Several people rushed on the stage and started to press on his chest to try to circulate blood to his brain. Others called for an ambulance, but when the emergency crew arrived, they declared that Cognito was dead from an apparent heart attack. 
A Life in Comedy
He was born in London as Paul Barbieri in 1958, to an Italian father who sold fish and chips and an Irish mother who was a bookkeeper.  He originally sang and played the guitar in rock bands and supported himself by working as a construction laborer and for British Airways.  He went to the University of Bath where he majored in economics.  At age 27, he was playing in a band at a local night club and started to insult the audience between songs.  The audiences loved him and told him that he should try standup comedy instead of just playing in a band.  He started performing a comedy act in night clubs and adopted the stage name of "Ian Cognito."
His comedy routines were so outrageous that passing out could easily have been part of his act.   No subjects were off limits and he would insult audience members and public figures.  In 2008, he was voted “Most-Banned Comedian” because he was banned from many comedy clubs and his acts were so vulgar that he never appeared on television.  In spite of that, he was a much-loved comedian who won the Time Out Award for Stand-up Comedy in 1999, and fellow comedians respected him as an outstanding comic who performed with hilarious material.  He would often come on stage with noisy power tools and might start his act by using a hammer to drive a nail into the wall and then hang his hat on it. Then he would say, "This lets you know two things about me. Firstly, I really don't give a s*** and secondly, I've got a hammer."  
In interviews and in his autobiography, A Comedian's Tale, he admitted that he drank excessively and that his off-stage behavior was often as out-of-control as his comedy act.  He made newspaper headlines when he threw a television set out of a hotel window because their room service was too slow.  At the time of his death he was single and lived by himself on a houseboat.  

Heart Attack Victims Need Immediate Resuscitation
As soon as a person develops chest pain or passes out from a possible heart attack, The American Heart Association recommends that you call 911 immediately.  Then ask if there is a doctor or a person trained in CPR (Cardio Pulmonary Resuscitation) nearby.  If the person is not breathing or has no pulse, the most qualified person should provide chest compression to try to keep blood circulating through the person's body.  Once the heart stops circulating blood to the brain, the brain can live only up to six minutes before it starts to die from lack of oxygen.
A heart attack occurs when blood flow to the heart is blocked completely and a part of the heart muscle is deprived of oxygen.  This can cause the heart to beat irregularly or to stop beating completely so that no blood is circulated to the brain.  The brain can live undamaged without oxygen  for only three minutes and dies rapidly after six minutes (Critical Care Medicine, Oct, 1988. 16(10):923–941).  The signal for a person to take a breath starts in the brain, so lack of blood flow to the brain will cause the person to stop breathing. Then the brain dies and so does the victim. The five minutes or so that passed while Ian Cognito's audience thought he was faking meant that his brain was probably already dying.  Starting CPR immediately after he passed out might have saved his life. 
The heart muscle can live without oxygen for up to three hours.  After that, the oxygen-deprived part of the heart muscle dies and if the person survives the heart attack, the damaged heart muscle will be replaced by scar tissue.  Doctors have only up to three hours after the beginning of a heart attack to open the blocked artery to prevent heart damage.
Take an Accredited CPR Course
Everyone should take a course in CPR so that if you ever see a person suddenly pass out, you may be able to save a life.  First, call 911.  Then, if you are well-trained in CPR and confident in your ability, check to see if there is a pulse and breathing. If there is no breathing or a pulse within 10 seconds, begin chest compressions at a rate of 100 to 120 times a minute.  This advice applies to adults, children and infants over four weeks old. If you are not trained in CPR, you can still try to provide chest compressions with your hands, pushing down on the chest as fast as you can until paramedics arrive.  Rescue breathing, mouth-to-mouth, is no longer recommended and should not be attempted.
To learn CPR properly, take an accredited first-aid training course, including CPR and how to use an automated external defibrillator (AED). The American Heart Association recommends the following steps, preferably done by a person trained in CPR: First open the airway by putting a palm on the person's forehead, gently tilting the head back, and with the other hand, gently lifting the chin forward.  Compression is used to try to restore blood circulation.  Lay the person on their back on a firm surface, kneel next to their neck and shoulders, and place the heel of your hand over the center of the person's chest between the nipples. Place your other hand on top of your first hand. Keep your elbows straight and position your shoulders directly above your hands. Use your upper body weight (not just your arms) as you push straight down on the chest at least two inches but not greater than 2.4 inches.  Push hard at a rate of 100 to 120 compressions a minute.  As soon as an automated external defibrillator (AED) is available, trained personnel should apply and administer one shock, then resume chest compressions for two more minutes before administering a second shock.
Other Celebrities Who Died While Performing
Ian Cognito is now on Wikipedia's List of entertainers who died during a performance
Among many others, 
• Actor Zero Mostel died in 1977 from an aortic aneurysm during a performance of a new Broadway play adapted from The Merchant of Venice.
• Comedian Godfrey Cambridge died of a heart attack in 1976 while playing Idi Amin in a television movie, Victory at Entebbe.
• Longevity expert Jerome Rodale died of a heart attack while taping a 1971 episode of The Dick Cavett Show.  He had said, "I'm going to live to be 100, unless I'm run over by a sugar-crazed taxi driver." This episode of the show was never aired.
• Singer Tiny Tim suffered a fatal heart attack in 1996 during a benefit concert in Minneapolis.
• Singer and songwriter Miriam Makeba died of a heart attack in 2008 during a concert in Italy.
• Actor and comedian Dick Shawn died of a heart attack in 1987, while performing a routine at University of California San Diego.  As with Ian Cognito, the audience assumed that Shawn's collapse was just part of his act and waited several minutes before calling for help.  
November 21, 1958 – April 11, 2019