80% of cardiac arrests happen outside a hospital, claims Indian Resuscitation Council and by learning CPR, one can save a life at home, at work or elsewhere. According to IRC, about 4280 people per 1 lac population in India every year are subjected to Sudden Cardiac Arrests and in these circumstances, the council has framed unique guidelines and to discuss the same, Medically Speaking invited a panel of experts from the IRC that included: Dr SSC Chakra Rao, Chairman, IRC; Dr Mukul Kapoor, Scientific Director, IRC; Dr Rakesh Garg, Honorary Director, IRC; Aditya Kumar, Honorary Director, IRC.
Here are a few excerpts from the interview:
Why do we need to have a continued dialogue and discussion on CPR, why is it that so little is talked about such a significant topic?
Dr SSC Rao: As per the survey done in 2016, less than 2% of people in India know about CPR, and about 4280 people per 1 lakh population in India every year are subjected to sudden cardiac arrest, and 90% of those people die because of lack of knowledge and not being revived. So, in these circumstances, IRC has thought that we should have our own guidelines and start giving CPR drives pan India. We have written our own guidelines with people like Dr Rakesh Garg and Dr Mukul Kapoor, and our guidelines are unique because we have certain issues in India. We have a very vast population, and the majority are literate, but there are barriers like superstition, myths, unapproachable and water-logged areas, language barriers, vivid religions, etc.
Could you elaborate on the same sir? That what these guidelines are about and how are you reaching out to people?
Dr Mukul Kapoor: These guidelines are simplified ones. We have AHA guidelines which are generally followed across the country but are very complex. They were meant for the western world, but not for the Indian world. In India, we have literate and illiterate people. We are literate, supposedly, but we are not being taught the right things, so we needed simple guidelines that were understandable by the general public, so we made algorithms and explained every step in a very simplified manner, not only in English but in other languages as well.
How are you reaching out to people who are in remote areas?
Aditya Kumar: We just have 2% of the people in our country aware of basic CPR. We are doing our best through social media like Facebook Live, regional newspapers, local-virtual programs, electronic media, and time to time, paper advertisements also. Due to Covid times, we are not allowed to hold public meetings, but we are doing them through virtual mode.
What these guidelines entail and what are you telling people?
Dr Rakesh Garg: When we talk about the guidelines, these need to reach the people and users, and here we are targeting the layman. The guidelines should be simplified, which Dr Kapoor was mentioning and we have released them in very simple languages. Let me take a simple example: a person is jogging in the park and suddenly collapses and is no more all of a sudden. This is called a cardiac arrest. But when we say cardiac arrest, we just have a few golden minutes for that. We cannot wait for minutes or hours because the chances of survival decrease by 7 to 10% with each minute that passes. it means if a patient gets treatment after 15-20 minutes, they might have a brain injury or a dead brain. So this means we have to immediately become the layman, and that is what we want to say. Each person can become a life saver. So it is very simple. Check if the person is responding; if not, it means he has a cardiac arrest and then start CPR. When we say the heart has stopped functioning, how to start it? If you try to compress the heart externally, it will pump blood. We have to keep both our hands on our chest and compress at a certain speed, which is two compressions per second, and then this will help the pumping of blood, and this is called manual chest compression. That’s why this whole guideline is called “Compression Only Life Support”. We are in talks about activating emergency medical services.
Where can one get these courses for free or understand these guidelines perhaps virtually or online if they want to access, sitting at the comfort of their home from their laptop?
Dr SSC Chakra Rao: So we have our own YouTube channel and our own website called www.cprindia.in which they can visit. The most important thing is that we are accessible and we teach for free to all the school children, including laypeople. Our charges are very minimal, even for doctors. All surgeons at AP Medical University are required to complete this training or their MBBS certificate will be revoked. Prior to this, there was no curriculum in MBBS to teach CPR, but now NMC has introduced it as a foundation course for the same. For the compression, we have to keep both hands on the chest and pump the heart, and this will pump the blood to the brain. Actually, cardiac arrest does not mean the heart immediately stops, it might be contracting but at a very slow rate. Majorly, it means there is no blood supply to the brain. That’s why the person suddenly collapses.
What is the need for people to learn this technique of CPR?
Dr Mukul Kapoor: When a person has a cardiac arrest, the person needs resuscitation within minutes because it is the golden time. The brain cells die within five minutes of the cardiac arrest. If the blood flow is not resumed to the brain in that period, the person is not likely to survive, and even if the person survives, he will be brain dead. So whoever is with the patient should take immediate action and start the activity of chest compression only then. The patient is likely to survive. That is why it is important for each person to be aware of this and, most importantly, follow the correct algorithm.
Is there hesitancy among people due to Covid?
Dr Rakesh Garg: I believe this is a concern nowadays because covid can come up and that’s why if you see the guidelines for the layman, they are not providing mouth to mouth breathing because these are not a part of the layman resuscitation. These are only kept for healthcare workers and they have proper precautions for HCW’s with all the safety measures. Therefore, the layperson should not worry about getting covid-19 because as I mentioned, they just have to do chest compression. If the patients cover their faces with a mask, they will be absolutely safe. The other aspect which you raised is lack of awareness. If you do not know something and someone asks you to do it for the first time, you will be heightened to do it, and that’s why the significance of the day is that we observe October 16th as World Restart a Heart Day, just to create awareness and sensitization.
Why us there so much lack of awareness among people regarding the topic?
Aditya Kumar: Other countries, such as the United States, Japan, and Singapore, have long included basic CPR in their curricula, and in our country, thanks to the efforts of the Indian Resuscitation Council, CBSE has recently included it in the syllabus, and we are working to include it in local boards as well, so that more and more people are aware of its importance. More than 80% of cardiac arrest cases happen outside the hospital area. How can we help our own people if you don’t know basic CPR?
Do you think in India, it’s the carried the approach which could work or maybe we need to make it mandatory in every school in every college only then can we reach out large number of people and create awareness since voluntary awareness clearly doesn’t seem to be reaching the knowledge which is needed?
Dr SSC Chakra Rao: Training should be made mandatory. Not only that, in cinema halls, swimming pools, gyms, and many other places like railway stations, people trained in CPR must be hired. We must know when somebody is getting a cardiac arrest and when they will be taken to the hospital. But not only that, even in our houses, all our family members and neighbours should be trained. I want to ask all the municipal commissioners of the smart cities to make a law for this under which the CPR trained fellows should be kept as watchmen.
Latest studies suggest that if children go into cardiac arrest, mouth to mouth breathing. is that true it all? is the CPR technique different for adults and young children?
Dr Mukul Kapoor: Yes, it is very different for children and adults, but it’s just not respiration that helps in children, it is a combination of both. The techniques depend on the size of the case and whether it is a neonatal or a paediatric case. We have different guidelines for different age groups also. The one that requires more awareness and more dissemination is the one for adults.
What would be as closing comment, what would be your message on this World Restart a Heart Day?
Dr Rakesh Garg: I agree. I think it’s time to create awareness so that each citizen can be a life saver. Let’s have this sensitization programme on World Restart a Heart Day, and coincidentally, it’s also World Anesthesia Day today. So I will urge everybody to join together and save our citizens. It’s a doable technique, and each one of us can learn it. Let’s learn and save our citizens.
What would you say to the people today?
Aditya Kumar: Our two hands can save lives. Life donation is a very big donation. We must make the people realize that is common men will be involved, success will be achieved.
Why should we talk about it today when everyone is discussing Covid and third wave? What will you say to the naysayers?
Dr Mukul Kapoor: I would like to say that COVID is important, but we have had too much hype about it. People are dying, other than Covid, from incidences like cardiac arrest. So why not make people aware of that? And I would also like to add that the media can have a social responsibility. When you put ads in between programs, you can put some fillers on CPR.
How will you convince people to actually take the training sir?
Dr SSC Rao: This is really a make-in-India initiative, and our recommendations are saving us about Rs. 80 crores in foreign money since everyone is being drawn to the American Heart Association, and they are paying their own way. We’ve reduced the cost of training to only Rs 500, which includes a certificate. We are providing it for free to school pupils. We’re excited to teach people everywhere, and my idea is that we start with vaccine booths, but people are afraid. Nonetheless, I am certain that by the end of November, we will have trained one million life savers.