Consultant Physician and Intensivist
Hinduja National Hospital and Medical Center
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
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,
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