A middle-aged man dancing in a public gathering collapses. An actor on a stage listening to lines being delivered by a co-actor falls in a heap. A priest conducting a ritual sinks to his knees.
A chorus of gasps repeatedly filled the room as every incident is played out on a big screen. “What is the common factor in all these events?” the person conducting the screening asked aloud. “The victim was standing,” “active,” “exerting” — several answers came from the audience.
“Yes, all of that but what else?” he asked again. “Sudden cardiac arrest,” came another response, which he latched on to. “Yes, it was sudden. The person was apparently completely fit till that moment.”
“In Ahmedabad, where I come from, every year there are such deaths. During the Navratri garba hosted by the medical association in 2023, a doctor had collapsed like this,” he said. “There were hundreds of doctors around, four AEDs (automated external defibrillator) were kept at four corners of the venue; yet no one thought of using them. It took another 15-20 minutes for the ambulance staff to come and the doctor was declared dead on arrival at the nearest hospital,” said Dr Rasesh Diwan, director, training and education, of the Indian Resuscitation Council Federation.
If the general mood became sombre, it was more so because the audience in entirety comprised of doctors as well. The 1995 MBBS batch of Calcutta National Medical College was undergoing a basic life support course, which was being hosted at Alo Eye Care, in New Town.
“It is an internationally certified course conducted by the Indian Resuscitation Council, which works under the aegis of International Liaison Committee on Resuscitation,” said Diwan. It is a skill-based course and the skill needs to be refreshed every two years. This is because memory starts fading and with data collection going on all the while, the guidelines also change every five years,” said Dewan, who had flown over from Ahmedabad to retrain the doctors, who had passed out years ago, primarily in cardio pulmonary resuscitation (CPR).
Fit to fatal
In case of sudden cardiac arrests, there is no breathlessness, no dizziness, no chest pain, no discomfort till the moment it happens, the doctor explained.
Dr Kasturi Hossain Banerjee, one of the trainers, explains a point to a batch of doctors undergoing practical CPR training
Research shows that when a person has a cardiac arrest and the pump function of the heart stops, there is still some oxygen left in the blood and it takes some time for the oxygen level to go down. “The body has five litres of air in the lungs and five litres of blood in circulation. Before the lung stopped breathing, there was 14 to 18 per cent of oxygen in the lung volume. That content of oxygen is a large buffer. The goal is to circulate the oxygenated blood. You have to perfuse it to the brain,” the doctor said, explaining the logic behind offering CPR.
“If you don’t do compression, the brain does not survive beyond three-four minutes. Even if the heart starts pumping again, the brain dies.”
That is also the reason why one can do compression even without doing mouth-to-mouth resuscitation. “You do not need to oxygenate the blood by breathing into his mouth as the aid provider also needs to be safe and not end up being a victim in case the person has any communicable disease.”
If even compression-only life support is done on time, the neurological damage is less and chance of survival is higher, he pointed out.
Infant & pregnant
The doctors were also told about the specifications of performing CPR on children and pregnant women. “In babies, the anatomy and physiology are different, so may be the causes of heart stoppage. While in adults, it is arrhythmia, for children the cause may also be respiratory,” said Dr Ashok Verma of Manipal Hospital Broadway, one of the trainers.
While chest compression in adults is done at the centre of the chest between the nipples with the base of the palm of one’s dominant hand with the other hand placed over it using the weight of one’s body behind it, in children he advised single-hand compression and for infants one or two fingers to reduce the pressure.
Verma recalled encountering an accident on Ma flyover with his car being a bit behind the victim’s. “I found a gynaecologist on the site who asked me who I was. I told him I was an anaesthesiologist and we paired up for CPR. I gave compression and he opened the airway,” he said. As he described how the rescue was carried out and the person later regained full fitness with treatment, the audience applauded.
Choked airway
Dr Akshay Ghadre from Medica Superspeciality Hospital took a course on another emergency situation — choking. When he asked for volunteers to demonstrate Heimlich maneuvre, Dr Arya Kanka Ghosh, an intern from a Bangalore hospital, came forward to act the victim while Dr Udipta Ray, a general and gastrointestinal surgeon, offered to demonstrate how the arms are to be wrapped around the torso from the back, placing the hands just above the belly button and below the ribcage. Upward and inward pulls force air out of the lungs to expel the blockage. “I had done this at home when my mother had choked on a fish bone,” he recalled.
The doctors were divided into groups. Teams of three took turns to do compression, give breaths with an ambu bag and operate an AED. “Suppose you are informed that a patient has collapsed in the OPD (outpatient department). How will you proceed?” Dr Kasturi Hossain Banerjee of Medica Superspeciality Hospital, one of the four trainers, asked her group which then swung into action over a mannequin. “Thirty compressions over; now switch roles,” she directed the doctor couple Anirban and Shamita Chatterjee after a while.
Meanwhile, Dr Sushmita Roychowdhury had completed CPR practice with her group and hopped over to click daughter Dhriti, an MBBS student, do the same with a team of young doctors.
Fun learn
At lunchtime, the mood was serious and fun in equal measure. Someone was heard saying: “Emon compression dilam, amar mannequin-ey pran eshe gyalo,” as the listeners guffawed. Dr Arnab Biswas, the proprietor of Alo, switched role from student to host, and oversaw lunch arrangements.
Dr Udipta Ray demonstrates the Heimlich manoeuvre on a volunteer in an imagined scenario of choking
“As students, we were taught ABC — airway, breathing and then chest compression. Securing airway was the most important,” recalled Dr Sivaresmi Unnithan, a resident of DB Block. “It was only in 2012 that we heard compression had to be done first,” she said, as her friends nodded in agreement.
If they were students for a day, the day ended with another feature of student life — a written examination. “Full marks 25, pass mark 23,” announced Dewan to a chorus of bemused murmur.
As the multiple-choice questions came on screen, a buzz could be heard at the back. “College-ey jara answer bole dito, ekhono tarai bolchhe,” Dr Shamita Chatterjee, a general surgeon with SSKM Hospital, looked across the room with a resigned look. “But their answers don’t match,” Roychowdhury responded with a laugh.
There were 37 doctors taking the test. “Of them, 35 passed at one go while two needed a remediation for two marks,” said Diwan. Eight got full marks. “It is a proud moment,” smiled Dr Debashis Saha, a resident of NBCC Vibgyor Towers in CE Block, on being named one of the eight.
“Our CNMC reunion is in January and this will be the 30th anniversary of our MBBS batch passing out. So we want to give back to our alma mater in the form of holding a CPR training session for the interns. So a refresher course was suggested. Some of us had taken the course, while others had not. In any case, the certificate is valid for two years. When we were looking for a venue, Arnab offered his clinic,” said Dr Shamita Chatterjee.
Roychowdhury, a resident of Sanjeeva Town, said she had mooted the idea of asking children, who were medical students, to join. “When my daughter signed up for the course, others also got their children in. Thus there were 29 of us batchmates and four or five young medics from various hospitals. The rest were a few years junior to us,” said the pulmonologist.
“I was worried how seriously the boys would take the training, if they would go for frequent cigarette breaks. But it went well. It was so rejuvenating to do the training with classmates,” Chatterjee summed up with a smile.