A Multi-Centre Study for Hands-only CPR Training Assessment Towards Building a “Nation of Lifesavers” in India

Failure to rescue a subject sustaining ‘Sudden Cardiac Arrest’ is a significant public health issue: A vast majority of these events occur outside the hospital setting, and are known as “Out of Hospital Cardiac Arrests (OHCA)”. Brain Death sets in within 4-6 minutes without blood circulation; restoring blood flow during the precious first few minutes before an ambulance arrives is a matter of life or death…Time is Brain!

With an estimated survival of less than 10%, OHCA remains one of India’s leading causes of death*. Raising community awareness and training lay public in rescuing a person sustaining OHCA is known as Bystander Cardiopulmonary Resuscitation (Bystander CPR). Since it is sufficient to perform CPR using hands only, without mouth-to-mouth breaths, on a teen or adult who suddenly collapses. This is also known as Hands -Only CPR (HOCPR).

A recent study (meta- analysis & systematic review- Critical Care, 2020;24:61) showed that the outcomes of OHCA have improved over the last 40 years; but the benefit is largely to those receiving bystander CPR. The bystander CPR rate in India is under 10%, far below the target of 62% set by AHA. The need gap is large and the opportunities for closing this gap are many in a large heterogeneous population of India to save lives.

A Collaborative between AHA and Several AIIMS is conceived to improve outcomes of OHCA

Under the leadership of Dr. T.S. Ravikumar, a collaborative of 5 AIIMS (Mangalagiri, Bhubaneswar, Raipur, Deoghar, and Bathinda) and AHA was launched in 2022 to serve as a platform to build A Nation of Lifesavers, India. One component of this unique initiative of ‘distributed leadership’ across a diverse topographic, linguistic, cultural & socioeconomic landscape is to train the trainers, followed by community outreach to increase awareness of OHCA & train communities to make them HOCPR ready.

The data presented at AHA Scientific Meeting on November 18th in Chicago related to the results of pre- and post- training survey of 113,828 trainees across 5 AIIMS, and the prior work done under Dr. Ravikumar’s directorship at SVIMS Tirupati to serve as a pilot study for validation. This is one of the largest training assessment projects done to date, to demonstrate the effectiveness in HOCPR training to quantify awareness, knowledge and skills development. One of the novel findings of this study is that, there are wide variations (heterogeneity) in both the pre-training as well as post-training characteristics of the trainees across the 5 regions of India. The findings are extremely valuable to show that: one size does not fit all; and that the strategies to optimise bystander CPR should be tailored to suit the local/ regional needs. In addition, the collaborative proposes to establish long term OHCA registries in the regions served by respective AIIMS, for surveillance and monitoring.