Compression-only life support: A turning-point for Indian public health

At the outset, the authors of, “Compression-only life support (COLS) for cardiopulmonary resuscitation by layperson outside the hospital”[1] should be congratulated for undertaking the herculean task of reviewing the international guidelines and taking it upon themselves to formulate guidelines to adapt to the unique sociocultural framework of India.

The emphasis on “compressions-only” as an intervention to save lives achieves the two-fold purpose of circumventing the perceived social discomfort in providing mouth-to-mouth respiration and provides tools to train a larger population base in a short span of time. Recent clinical trials have shown that the patient outcomes are similar with bystander COLS and bystander cardiopulmonary resuscitation (CPR), probably due to the provision of uninterrupted high-quality chest compressions. With the help of COLS programs conducted throughout the country, a large number of nonmedical personnel have been trained not only to identify cardiac arrest but also to activate the chain of response and provide COLS till medical help arrives.

In association with the Indian Resuscitation Council, the Indian Society of Anaesthesiology has planned to conduct COLS training on a mass scale on the proposed “World Heart Restart Day,” 23 October, 2018.[2] With the mammoth target of wanting to reach out and train 1,00,000 people in one day, it is destined to be an event without a precedent.

COLS is an inspiring addition to the present guidelines for life-saving manoeuvres. As a practicing anesthesiologist who wishes to learn and teach the same, however, I have a few queries with regards to the conduct of COLS.

While COLS de-emphasizes check on respiration, it might be worthwhile to train people to identify abnormal breathing patterns to prevent the overzealous attempts of resuscitation on victims not requiring CPR, for instance, seemingly unconscious persons with alcohol intoxication or those in a state of post-ictal confusion.

The guidelines state that the rescuer must administer 120 compressions per minute and in cycles of 30 each. It is imperative that a trainer knows how much of a “hands-off” period the authors deem appropriate between two cycles so that they may impart the same set of instructions to those they teach.

The other pressing concern is the recommendation to turn patients over once a response is elicited. Given the potential for a cervical spine injury in a case of trauma-related unresponsiveness, perhaps it is worth mentioning an exception to the recommendation of lateralizing all patients on eliciting a response.

This being said, the COLS initiative is indeed remarkable and will definitely have a positive impact on public health and awareness regarding CPR in India.

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