Sudden cardiac arrest remains a leading cause  of mortality and  is responsible for approximately half of all deaths from cardiovascular disease worldwide despite important advancements in its prevention.

 As per the statistics, one-fifth of the deaths in India are from sudden cardiac arrest. By the end of year 2020, it will account for one-third of all the deaths in the country. There is an estimate of 45 million   patients with  Coronary Artery Disease in India, which is the most common and  independent risk factor for sudden cardiac arrest. With an increasing number of young Indians hooked to a roller-coaster lifestyle and falling prey to coronary artery disease, the future looks even grimmer.

Sudden cardiac arrest is not a heart attack (myocardial infarction). Heart attacks occur when there is a blockage in one or more of the coronary arteries, preventing the heart from receiving enough oxygen-rich blood. If the oxygen in the blood cannot reach the heart muscle, the heart becomes damaged. The longer the person with a heart attack goes without treatment, the greater the possible damage  to the heart muscle.

In contrast, sudden cardiac arrest occurs when the electrical system to the heart malfunctions and suddenly becomes very irregular. The heart beats dangerously fast. The ventricles may flutter or quiver (ventricular fibrillation), and blood is not delivered to the body. In the first few minutes, the greatest concern is that blood flow to the brain will be reduced so drastically that a person will lose consciousness. Therefore, within seconds ,the person becomes unresponsive and is not breathing. Death occurs within minutes unless emergency treatment is begun immediately.

Therefore, sudden cardiac arrest is an emergency and warrants immediate action with appropriate cardiopulmonary resuscitation (CPR) for an optimal outcome. 

Cardiac arrest can happen to anyone, at any time, at any place-on the street, at the home, or in a hospital emergency department, intensive care unit, or in-patient bed. The system of care is different depending on whether the patient has an arrest inside or outside the hospital. The links in the chain of survival, for the elements of the emergency cardiovascular care, differ based on whether the arrest occurs in or out  of the hospital.

For adult patients who are in the hospital, cardiac arrest usually happens as a result of   serious respiratory or circulatory conditions that get worse. Many of these arrests can be predicted and prevented by careful observation, and early treatment of pre-arrest conditions. Once a primary provider recognizes cardiac arrest, immediate   activation of the resuscitation team, early high quality CPR and rapid defibrillation are essential. After return of   spontaneous circulation, all cardiac arrest victims receive post cardiac arrest care. Patients outcome depends on the smooth interaction of the institution’s various departments and services and on the multidisciplinary team of professional providers, including physicians, nurses, respiratory therapists, and others.

Most out -of –hospital adult cardiac arrests happen unexpectedly and result from underlying cardiac problems. Successful outcome depends on early bystander CPR and rapid defibrillation in the first few   minutes after the arrest. Organized community programs that prepare the lay public to respond quickly to a cardiac arrest are critical to improving outcome after out -of –hospital cardiac arrest. Trained lay rescuers are expected to recognize the victim’s distress, activate the emergency response system, start high quality CPR and initiate public-access defibrillation until emergency medical services (EMS) arrives. EMS providers than take   over the  resuscitative efforts.

Basic Life Support (BLS) is the foundation for saving lives after cardiac arrest. Basic Life Support refers to an algorithmic structured plan for management of victims of cardiopulmonary arrest and life-threatening illnesses or injuries until they can be given full medical care at a hospital. It can be provided by trained medical personnel, including emergency medical technicians, paramedics, and by qualified bystanders. Fundamental aspects of adult BLS include immediate recognition of sudden cardiac arrest and activation of the emergency response system, early CPR, and rapid defibrillation with an automated external defibrillator (AED).

Advanced cardiac life support or advanced cardiovascular life support (ACLS) refers to a set of clinical interventions for the urgent treatment of cardiac arrest, stroke and other life-threatening medical emergencies, as well as the knowledge and skills to deploy those interventions. Only qualified health care providers can provide ACLS, as it requires the ability to manage the person's airway, initiate IV access, read and interpret electrocardiograms, and understand emergency pharmacology; these include physicians, pharmacists, dentists, advanced practice providers, respiratory therapists, nurses, paramedics and other advanced life support trained persons.

Therefore, in order to provide effective CPR , it is desirable for each nurse and doctor to regularly enhance their skills in Basic Life Support (BLS) and Advanced Cardiac Life Support (ACLS) based on the American Heart Association guidelines which are updated periodically. 

With Bhagwan’s loving support, at the Sri Sathya Sai Institute of Higher Medical Sciences, Prasanthigram, we have state-of-the-art ACLS rhythm simulator, advanced ACLS airway mannequin, AED trainers in addition to  basic essential material in the form of adult, pediatric and  infant mannequins, manuals and DVDs and other equipment, to facilitate the training at SSSIHMS, Prashantigram.

We provide in-house BLS training to all the medical and para-medical staff  on regular basis to  acquire professional competence  and hence improve  patient care. Our institute is an American heart association certified training site, which enables us to provide comprehensive training to doctors and nurses particularly working in the critical care areas of the institute. In these  training sessions, the participants enhance their skills through didactive  instructions, video presentations and active participation in simulated cases which makes them more competent in the  early recognition and  in prompt  intervention of the cardiopulmonary arrest, acute arrhythmia, stroke and acute coronary syndrome. Furthermore, we conduct cardiac arrest mock drill periodically with an objective to practice emergency response procedures, evaluate the effectiveness & capabilities of the participants followed by remediation to close the gaps.

In order to improve the   outcome from the out of hospital cardiac arrest, the institute organises various Basic Life Support awareness and training programs and participates in Safety Orientation Program Cum Training Sessions organized by Safety officer, Sri Satya Sai Central Trust, Prasanthi Nilayam in the Ashram premises with the objective to train the lay rescuers to respond promptly and efficiently.

 For India, availability of a larger number of CPR-trained laypersons is the need of the hour, as medical help may take time to reach the site of cardiopulmonary arrest. Therefore, as part of medical fraternity and most importantly as devotees  of our Beloved Bhagwan Sri Sathya Sai Baba, it is our social responsibility to know these guidelines to help our community if need arises. Hence let us  join our hands together  and train & retrain ourselves, our doctors, nurses, other  paramedics, friends  and  lay rescuers to make a healthier and longer life possible for everyone which is the basis for a healthy mind filled with love and service leading to a peaceful society. 

Jai Sai Ram