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Communications to the Editor |

Code 99—An International Perspective FREE TO VIEW

Farhad N. Kapadia, MD
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Consultant Physician and Intensivist Hinduja National Hospital and Medical Center Mumbai, India



Chest. 1999;115(5):1483. doi:10.1378/chest.115.5.1483
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To the Editor:

I read with interest the correspondence between Crausman and Al-Bilbeisi1and the Editor-In-Chief of CHEST2 on “Code 99—Who’s Watching?”, and I would like to add an international perspective.

India is a developing country where a lot of change in medicine is economy driven. Cardiopulmonary resuscitation (CPR) occupies the bottom rung of the ladder of priorities. In a city like Mumbai with a population of 10 to 12 million, only one hospital has an organized CPR team.3 This is in a city where the average daily coronary artery bypass surgery numbers vary between 20 and 40. It is probable that the total number of CPR teams in our country (with a population of about 1 billion) is less than 10 or 20. In this scenario, the only way to get any sort of success in CPR is with active consultants and ICU staff participation.

Despite an intense, widely disseminated training program at the initiation of our CPR service, the skills of non-ICU medical and nursing staff remain poor. A rapid turnover adds to the problems, and one occasionally still faces a chaotic situation where a young, newly appointed doctor performs an intracardiac injection when venous access is available and freely uses steroids, bicarbonate, and so on. The more experienced nurses stand by helplessly watching the protocols being ignored. All this gets rectified only after a consultant arrives.

Despite all of these problems, and after a dismal start, we have finally achieved results compatible with international data.3 These results have been sustained; in the last year, the CPR team in our 320-bed hospital received 193 CPR calls. Eighteen were candidates who should have had advanced do not resuscitate orders, and CPR was rapidly terminated. Of the 175 who received CPR, 132 survived the initial CPR, but only 44 of these were finally discharged home. At the present time, these results could not have been obtained without the active participation of the ICU team and consultants.

Unfortunately, the prevailing medical culture among non-ICU consultants is that CPR is a job for juniors and nurses. In this depressing setting, there is no way in which CPR services will be created and evolve without someone senior watching.

Correspondence to: Farhad N. Kapadia, MD, Hinduja National Hospital & Medical Center, Veer Savarkar Marg, Mahim, Mumbai 400 016, India

References

Crausman, RS, Al-Bilbeisi, FF (1998) Code 99—who’s watching?Chest114,653. [PubMed]
 
Block, AJ Response. Chest. 1998;;114 ,.:653. [PubMed]
 
Bajan, KB, Raje, K, Hegde, A, et al In hospital cardiopulmonary resuscitation: a one year study.J Assoc Physicians India1998;46,793-795. [PubMed]
 

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References

Crausman, RS, Al-Bilbeisi, FF (1998) Code 99—who’s watching?Chest114,653. [PubMed]
 
Block, AJ Response. Chest. 1998;;114 ,.:653. [PubMed]
 
Bajan, KB, Raje, K, Hegde, A, et al In hospital cardiopulmonary resuscitation: a one year study.J Assoc Physicians India1998;46,793-795. [PubMed]
 
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