Recently, in a bid to address the pressing public health issue of Sudden Cardiac Arrest (SCA), Lancet, the renowned international journal formed a Commission on Sudden Cardiac Death. Bringing 30 international experts across varied disciplines under one roof, the Commission presented its findings at an event in Mumbai, led by Medicover Hospitals, Hyderabad.
“The fact that survival from sudden cardiac arrest (SCA) remains lower than 10 pc in most parts of the world should be unacceptable,” said Dr Kumar Narayanan, Senior Consultant Cardiologist, Electrophysiologist and Deputy Chair of The Lancet SCD Commission. In India, it is estimated that about 5-6 lakh people die every year due to sudden cardiac death (SCD), and a good proportion of them are under the age of 50.
The Lancet regularly comes up with Commissions on critical healthcare topics. They have done several commissions and the most recent one is on sudden cardiac deaths or SCDs.
This SCD Commission places strong emphasis on the need to make communities an active partner in responding to SCA, maximizing bystander cardiopulmonary resuscitation (CPR) in order to improve survival after SCA. Sudden cardiac death is a condition in which a person suddenly collapses. Sudden cardiac deaths are often confused with heart attacks but the two are very different, say doctors. "In heart attacks, people generally complain of chest pain and typically there is some time when they can go to hospitals and get treated. There is some time for response. But in SCD there's a sudden dangerous rhythm disturbance of the heart. The heart abruptly stops beating and the person collapses right away; the time for intervening is barely a few minutes. In some cases, sudden cardiac arrest might be preceded by warning symptoms but once the event happens, it is pretty much an abrupt collapse. In more than 90 per cent of cases, a sudden cardiac arrest leads to a sudden cardiac death," explains Dr Narayanan.
Patients of sudden cardiac arrest, mostly don't have the time to reach the hospital and unless we can intervene in minutes, there is no hope of survival. This is why, people including friends, family, relatives and bystanders who are at the scene witnessing somebody going through SCA, have a crucial role to play. If they know a life-saving skill called cardiopulmonary resuscitation or CPR, which means externally applying force on the patient's chest to revive the heart, they can respond immediately via a cardiac massage and buy precious time till an ambulance or emergency response team arrives at the scene with advanced medical care and the patient can be transported to the hospital. The Lancet Commission covers this aspect of sudden cardiac deaths along with underlying causes and risk factors.
"As such, SCDs aren't a new problem in India, but the country is now facing a sharply increasing burden of sudden cardiac arrests and eventual deaths. A rough estimate, which might be an underestimate, shows that annually around 5-6 lakh people are dying due to sudden cardiac deaths in India. In western nations, they have enough infrastructure to teach CPR to common public. We don't have that level of awareness and policies and that is why it is extremely crucial that communities are made a partner in responding to sudden cardiac arrests," adds Dr Narayanan.
What happens is even if somebody knows CPR, they might be afraid of administering it on the patient fearing legal hassles and wondering what if they are blamed for the death of the individual. Worldover, the rates of survival among the general population post a sudden cardiac arrest is something like 10 per cent. 90 per cent of the people will succumb to it because the time is so short, say experts.
"But, in countries like India where emergency medical care is lagging behind significantly, we can estimate that the survival rate is probably in the range of 1-2 pc. What we must learn from the West is that in certain areas they've impressively implemented the concept of 'bystander CPR’. This means common people, who are highly aware and trained to provide CPR, are present at all times in public areas should a medical emergency arise. They also have the public access automated external defibrillator which delivers an emergency shock to the chest in a bid to revive a victim of sudden cardiac arrest. With the installation of these in the public domain, it has been shown that the survival rate has gone up by as high as 60 to 70 per cent. So for a country like India, where the survival rates are depressingly lower, we need to raise public awareness and widely disseminate the training of CPR and AEDs, we can increase survival eight to tenfold," say experts associated with the Lancet study on SCDs.
Dr Sharath Reddy, Executive Director, Medicover India and Head of Department of Cardiology, Medicover Hospitals, Hyderabad, launched the “Heart Savers – CPR Training for Healthy World” initiative, aimed at improving public awareness, educating and empowering common citizens to be able to effectively respond and save lives in the emergency situation of a SCA.