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| COMMENTARY |
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| Year : 2019 | Volume
: 21
| Issue : 1 | Page : 81-82 |
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Active learning to spread knowledge about cardiopulmonary resuscitation
Vidhu Bhatnagar
Department of Anaesthesiology and Critical Care, INHS Asvini, Mumbai, Maharashtra, India
| Date of Submission | 17-Mar-2019 |
| Date of Acceptance | 22-Apr-2019 |
| Date of Web Publication | 19-Jun-2019 |
Correspondence Address:
Surg Capt Vidhu Bhatnagar
Department of Anaesthesiology and Critical Care, INHS Asvini, Near RC Church, Colaba, Mumbai - 400 005, Maharashtra
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/jmms.jmms_12_19
How to cite this article:
Bhatnagar V. Active learning to spread knowledge about cardiopulmonary resuscitation. J Mar Med Soc 2019;21:81-2 |
Awareness regarding cardiopulmonary resuscitation (CPR) and “bystander CPR” has increased in the last decade. The Indian Resuscitation Council on October 23, 2018, created a history by training more than a lakh people in compression-only life support. Bhoi et al. in 2016 concluded that basic emergency care course proved to be an effective initiative in refining the knowledge and skill of health care worker (HCW) and lay people (LP) in basic emergency care in India.[1]
However, when we talk about educating the grassroots, the training usually imparted includes CPR training for adults and it is a well-known fact that cardiac arrest (CA) characteristics (preventive measures, etiology, mechanism, and resuscitation maneuvers) in children are different than those for adults.[2] The annual incidence of pediatric out-of-hospital cardiac arrest (OHCA) is around 9–10 cases per 100,000 persons and only 2%–9.6% of these patients survive to hospital discharge.[3]
To reduce this mortality and morbidity, a sound knowledge of pediatric CPR with adequate resuscitation skills is essential in HCWs as well as LP. Hence, this article is a decent attempt to emphasize the importance of knowledge and skills regarding pediatric CPR in HCW and LP and most importantly documenting it. In 1988, when the pediatric advanced life support course was established for the first time, the outcomes from pediatric CA were dismal. Thus, the original course emphasized on the prevention of CA through early recognition and treatment of respiratory failure and shock.[4] The American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care has also incorporated prevention as the first step in chain of survival in pediatric CPR.[5] The survival rates of “in-hospital” CA has improved to 27% in the last two decades; the outcomes are worse in OHCA, which could be attributed to unwitnessed OHCA and prolonged periods of “no blood flow.” Nevertheless, it is proven that “bystander CPR” improves patient survival rates; thus, training LP in pediatric CPR is indispensable step toward improved survival of pediatric CA victims.[6]
CPR training is also peculiar because it necessitates understanding of theoretical knowledge, adequate experiential training for obtaining satisfactory skills, and refresher courses at regular intervals to prevent decay of the skills attained.[7]
The authors' attempt to bridge the knowledge with the help of an instructor-led precourse training for LP is praiseworthy, but one aspect which has been overlooked is the importance of refresher training. It needs to be recognized that resuscitation education must be delivered by employing proven methods that promote learning, retention, and practical application. The implementation also requires refreshing at regular intervals for finest results.[8],[9]
Evolving new training strategies such as simulation practice, constructive debriefing, adequately trained rapid response teams, and crisis team training can also improve the quality of interventions, thereby improving the outcomes.[10]
For improvement in resuscitation performance and patient outcomes, evidence-based instructional design is essential, tailored for the provider groups on basis of their cognitive, behavioral, and psychomotor skills, and retraining interval should be suitable to prevent decay of the skills.
The authors have been successful in initiating the process; the pin has started rolling, but the journey has just begun and many milestones are yet to be achieved.
| References | |  |
| 1. | Bhoi S, Thakur N, Verma P, Sawhney C, Vankar S, Agrawal D, et al. Does community emergency care initiative improve the knowledge and skill of healthcare workers and laypersons in basic emergency care in India? J Emerg Trauma Shock 2016;9:10-6.  [ PUBMED] [Full text] |
| 2. | Bhanji F, Donoghue AJ, Wolff MS, Flores GE, Halamek LP, Berman JM, et al. Part 14: Education: 2015 American Heart Association guidelines update for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation 2015;132:S561-73. |
| 3. | Young KD, Gausche-Hill M, McClung CD, Lewis RJ. A prospective, population-based study of the epidemiology and outcome of out-of-hospital pediatric cardiopulmonary arrest. Pediatrics 2004;114:157-64. |
| 4. | Atkins DL, Everson-Stewart S, Sears GK, Daya M, Osmond MH, Warden CR, et al. Epidemiology and outcomes from out-of-hospital cardiac arrest in children: The resuscitation outcomes consortium epistry-cardiac arrest. Circulation 2009;119:1484-91. |
| 5. | Atkins DL, Berger S, Duff JP, Gonzales JC, Hunt EA, Joyner BL, et al. Part 11: Pediatric basic life support and cardiopulmonary resuscitation quality: 2015 American Heart Association guidelines update for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation 2015;132:S519-25. |
| 6. | Topjian AA, Berg RA, Nadkarni VM. Pediatric cardiopulmonary resuscitation: Advances in science, techniques, and outcomes. Pediatrics 2008;122:1086-98. |
| 7. | Bhanji F, Mancini ME, Sinz E, Rodgers DL, McNeil MA, Hoadley TA, et al. Part 16: Education, implementation, and teams: 2010 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation 2010;122:S920-33. |
| 8. | Bhatnagar V, Tandon U, Jinjil K, Dwivedi D, Kiran S, Verma R, et al. Cardiopulmonary resuscitation: Evaluation of knowledge, efficacy, and retention in young doctors joining postgraduation program. Anesth Essays Res 2017;11:842-6. [ PUBMED] [Full text] |
| 9. | Perkins GD, Cooke MW. Variability in cardiac arrest survival: The NHS ambulance service quality indicators. Emerg Med J 2012;29:3-5. |
| 10. | Brilli RJ, Gibson R, Luria JW, Wheeler TA, Shaw J, Linam M, et al. Implementation of a medical emergency team in a large pediatric teaching hospital prevents respiratory and cardiopulmonary arrests outside the intensive care unit. Pediatr Crit Care Med 2007;8:236-46. |
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