Cardiopulmonary Resuscitation (CPR) has proved to be one of the major life-saving interventions for those who collapse due to Sudden cardiac arrest. It is a major lifesaving technique, easy to learn, can be performed with our two hands and by anyone, anywhere;hence this skill should be acquired by one and all. It gives the best chance of survival to affected patients. However, there is no official figure of deaths that are preventable through CPR. Recently the issue was majorly highlighted on World Restart a Heart Day when doctors emphasised teaching CPR not only to healthcare workers but also to the common man.
In this context, Drug Today Medical Times (DTMT)’s Rohit Shishodia spoke to Professor and Consultant, Department of Anaesthesia & Intensive care, Vardhman Mahavir Medical College& Safdarjung Hospital , Dr. Nikki Sabharwal to seek more insight into CPR techniques. Dr. Sabharwal has vast experience of thirty years in Anaesthesia, Intensive care, emergency medicine, trauma, neuroanesthesia, and teaching and training of various life saving skills. She is a course director of The Advanced Trauma Life Support (ATLS) programme of The American College of Surgeons since 2009 and has been teaching care of trauma victim to doctors and nurses, all over India. She is also a founder member of The National Emergency Life Saving Skills programme of The Ministry of Health & Family Welfare, GOI,and Instructor of the Basic and advanced Cardiac Life Support programmes of both The American Heart Association and The Indian Resuscitation Council.Prof Sabharwal has been president of the Indian Society of Anaesthesiologists, Delhi branch 2020-2021.
DTMT: How crucial is CPR ?
Dr. Sabharwal: It is very important for any patient whose heart has stopped or whose breathing has stopped. For such patients, every minute counts. We have to immediately provide this CPR and give the patient the best chance of survival. But less than one per cent of people are trained in CPR. Even the layman can make a difference.
DTMT: How many people die due to lack of CPR in India?
Dr. Sabharwal: According to a study, a total of 4,280 patients per lakh population in India are dying due to lack of CPR. This is much more than in western countries. So, the mission of the Indian Council of Resuscitation is to train more people in CPR.
If the brain does not get oxygen for 3 to 4 minutes, it cannot function properly and becomes vegetative due to which the outcome is unfavourable. No medical help can come within three to four minutes. If everybody is trained around us and somebody collapses at home he can perform CPR on him while calling an ambulance.
DTMT: How can one identify the need for CPR?
Dr. Sabharwal: If anyone collapses, you need to tap on the victims shoulder from the front of the victim i.e. while facing him and ask loudly “ Are you alright?”. If the patient does not respond then you check if he is breathing or not by seeing his chest movement. If not then you check the pulse in his neck. If both are absent the patient is in a state of cardiac arrest, i.e. his heart has stopped beating and we need to start chest compressions immediately.Even if one doesn’t know how to check the pulse in the neck and sees that the patient is unresponsive and not breathing, immediate cardiopulmonary resuscitation should be started .
We have seen how our former President APJ Abdul Kalam died. He had a Sudden cardiac arrest. Had anyone been around him, trained in CPR ,his life could have been saved? This is the importance of this CPR. The government is doing well but more efforts are needed in terms of awareness of CPR.
DTMT: What is your advice and what can be done?
Dr. Sabharwal: Everybody needs to learn CPR because every life matters. IRC organises camps in locations where a large number of people gather. There should be trained volunteers and more ambulances.
DTMT: What are the challenges?
Dr. Sabharwal: Every person should have the attitude of saving people and should know how to use Automated External Defibrillators (AED), which are installed in different locations but only a few people have information about it. AED is part of CPR, which can be used by every person. This device should be installed everywhere.
First of all, you should see if the scene is safe to perform CPR or not. If it is safe then recognise whether the patient is in arrest or not. If yes, then you should call for help to get an ambulance and trained personnel and then start CPR.Chest compression has to be done 120 times a minute and at a depth of 5-6cm in an adult. This needs physical effort and one person alone cannot do it. You have to press the victims chest at adequate depth and rate till the ambulance comes. As soon as an AED is available, it should be used to determine if the victims cardiac arrest is due to a shockable rhythm or not. The AED is a machine which prompts the user and talks to the rescuer on what steps to take for helping the victim. Most adult cardiac arrests are due to an electrical disturbance that causes the heart to not be able to pump blood to the rest of the body including the brain.This rhythm disturbance called ventricular fibrillation, canbe treated by an electrical shock given by the AED. The AED, indicates whether it is a shockable rhythm or not and prompts the rescuer accordingly. It can make the difference between life and death.
DTMT: What made you choose the medical profession?
Dr. Sabharwal: I wanted to be a doctor to help heal people and decrease their suffering. I am very happy to have chosen Anaesthesiology and Intensive care as my specialization as the most critical conditions and lifethreatening situations are usually treated by the anaesthesiologists as resuscitation is our forte. i Today, there is so much commercialisation which I feel is wrong; but the social structure is responsible for this. The moral fibre of our society needs to be strengthened. Most of the doctors have a good attitude towards patients,but the patients too have a responsibility towards their healthcare provider.
DTMT: What is your mission now?
Dr. Sabharwal: My mission is to set up an emergency medicine department in Safdarjung Hospital. It has been made mandatory by the National Medical Commission.Secondly, recently the comprehensive resuscitation training centre of the Indian Resuscitation Council has been started at VMMC & Safdarjung hospital with the mission to train all healthcare providers and staff in Basic Life Support and Compression Only Life Support. The DGHS has also initiated a programme for making all three Central Govt. hospitals BLS Certified. I still have over one year of service and wish to work towards teaching and training of various Life saving skills including CPR, ATLS and NELS too.
DTMT: Issue of assault on doctors and miscommunication has been prevalent in hospitals for a long time. How can it be tackled?
Dr. Sabharwal: We need to be more communicable with patients. We should treat them with politeness and compassion. If we could manage our interaction with the patients and their relatives in a better way, then these assaults can be prevented. Patients and their relatives too too need to understand the limitations of medical treatment. Every patient cannot be cured and despite best efforts of the doctors and nurses, death is inevitable in certain conditions and situations. We have to accept that. Unrealistic expectations and nonacceptance of an unfavourable outcome leads to conflicts.