Objective
Out-of-Hospital Cardiac Arrest (OHCA) is a global public health problem. There is inadequate data on OHCA in India. The Warangal Area out-of-hospital Cardiac Arrest Registry (WACAR) was planned to understand OHCA in a regional setting in India.
Methods
WACAR is a prospective one-year observational cohort study of OHCA in the Warangal area, Telangana, India. The study included 814 subjects of OHCA of presumed cardiac etiology brought to the Mahatma Gandhi Memorial Hospital during January 1, 2018, and December 31, 2018. The data collected included; standard Utstein variables with additional data on clinical characteristics (modified Utstein template).
Results
The majority of OHCA subjects were male with a median age of 60 years, and mostly occurring in residential locations within 1 h of onset of symptoms. Individuals with knowledge of CVD risk factors were more likely to report symptoms before OHCA. Data on resuscitation characteristics were inadequate.
Conclusions
The WACAR study provides baseline data regarding OHCA in a regional setting in India. The study demonstrated barriers involving data collection, patient knowledge of CVD risk factors and disease, and access to healthcare, which; impacted the data registry.
Background:
Sudden Cardiac Arrest (SCA) is a leading cause of global mortality. In India, 700,000 people die from SCA annually, many of which are under the age of 50. Immediate bystander CPR improves chances of survival, however, CPR education and training are difficult in a developing country such as India. In collaboration with University of Illinois Global Health Program, the Indian American Medical Association (Illinois), SHARE INDIA, and the American Heart Association we studied native rural Indian populations, hoping to enhance CPR education and skills training. This is the first rural community CPR project in India involving a university residency-training program from the USA.
Methods:
We conducted hands-only CPR training (based on the latest AHA guidelines) in the Telangana State in India, recruiting 582 participants with the help of local health outreach workers. A pre-training survey was used to assess baseline knowledge and impressions of CPR. This was followed by training in hands-only CPR consisting of an oral presentation followed by interactive CPR manikin training. A post-course survey was conducted after training. Chi square test and McNemar’s test were used for the analysis of data using SAS.
Results:
Of 582 participants, 65% were males and the mean age was 19.4
+
5.9. Gender was not associated with pre/post-test CPR knowledge, comfort with CPR, or belief in CPR efficacy. However, in paired analysis, there were significant differences (p<0.0001) in all knowledge and perception measures from pre-to-post training. While only 6% knew the correct compression rate pre-training, 96% knew the correct answer post-training (4% vs. 94% in females, 6% vs. 96% in males). Similar results were seen for the compression depth variable. Training also improved comfort level in performing CPR (64% vs. 87% in females and 70% vs. 89% in males) and belief that CPR can save lives (49% vs. 96% in females and 51% vs. 97% in males).
Conclusions:
The program was successful in enhancing knowledge, comfort, and perceptions of CPR. Given the high prevalence of SCA in India, training the public in hands-only CPR can be a cost-effective care strategy in resource-limited areas. Due to the success of this pilot, we are planning to continue the program.
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