Message from the Chairman

Cardiopulmonary resuscitation (CPR) involves development of skills which are relevant to the practice of all medical specialities, particularly anaesthesiology, critical care, emergency medicine and surgery. Inappropriate and delayed resuscitation may result in adverse outcomes. The mortality in sudden cardiac arrest in India is approximately 4280/100,000 in contrast to 60–151/100,000 inhabitants in the United States. It also accounts for more than 60% of all cardiac deaths. Seventy per cent of out-of-hospital cardiac arrests occur at home and 90% of people who suffer out-of-hospital cardiac arrest die.

Major obstacles to successful CPR facility development in India include a large population, 70% of which resides in the rural areas, high rate of illiteracy and poorly developed emergency medical services / ambulance services. Hence, CPR, as recommended in the American Heart Association (AHA) guidelines, is not fully accessible due to scarce availability of ambulance services with trained personnel and automated external defibrillators. In addition, due to cultural beliefs, the majority of people are hesitant to perform mouth-to-mouth resuscitation.

Considering these limitations and recent developments, this practice guideline of CPR has been developed by the Resuscitation Council, formed by the Indian Society of Anaesthesiologists (ISA), for resuscitating cardiac arrest victims outside the hospital by a layperson — the Compression-Only Life Support (COLS). The aim of the COLS guideline is to provide a stepwise approach in accordance with core links for an optimal outcome. Compression-only CPR is as effective as conventional CPR for cardiac arrest at home, at work or in public.

The ISA has, in addition, issued guidelines for management of cardiac arrest patients both outside and inside the hospital by trained personnel — the Basic Cardiopulmonary Life Support and the Advanced Cardiopulmonary Life Support, respectively. The ISA has also recommended generation of a national database of resuscitation after cardiac arrest to facilitate updating of these guidelines in future.