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Organ donation following circulatory determination of death (DCDD) has contributed significantly to the donor pool in several countries, without compromising the outcomes of transplantation or the number of donations following brain death (BD). In India, majority of deceased donations happen following BD. While existing legislation allows for DCDD, there have been only a few reports of kidney transplantation following DCDD from the country. This document, prepared by a multi-disciplinary group of experts, reviews the international best practices in DCDD and outlines the path for furthering the same in India. The ethical, medical, legal, economic, procedural, and logistic challenges unique to India for all types of DCDD based on the Modified Maastricht Criteria have been addressed. India follows an opt-in system for organ donation that does not allow much scope for uncontrolled DCDD categories I and II. The practice of withdrawal of life-sustaining treatment (WLST) in India is in its infancy. The process of WLST, laid down by the Supreme Court of India, is considered time-consuming, possible only in patients in a permanent vegetative state, and considered too cumbersome for day-to-day practice. In patients where continued medical care is determined to be futile following detailed and repeated assessment, the procedure for WLST, as laid down and published by Vidhi Centre for Legal Policy in conjunction with leading medical experts is described. In controlled DCDD (category-III), the decision for WLST is independent of and delinked from the subsequent possibility of organ donation. Once families are inclined toward organ donation, they are explained the procedure including the timing and location of WLST, consent for antemortem measures, no-touch period, and the possibility of stand down and return to the intensive care unit without donation. While donation following neurologic determination of death (DNDD) is being increasingly practiced in the country, there are instances where the cardiac arrest occurs during the process of declaration of BD, before organ retrieval has been done. Protocol for DCDD category-IV deals with such situations and is described in detail. In DCDD category V, organ donation may be possible following unsuccessful cardiopulmonary resuscitation of cardiac arrest in the intensive care. An outline of organ-specific requisites for kidney, liver, heart, and lung transplantation following DCDD and the use of techniques such as normothermic regional perfusion and ex vivo machine perfusion has been provided. With increasing experience, the outcomes of transplantation following DCDD are comparable to those following DBDD or living donor transplantation. Documents and checklists necessary for the successful execution of DCDD in India are described. [ABSTRACT FROM AUTHOR]

Background: Bystander cardiopulmonary resuscitation (CPR) is the cornerstone in managing out-of-hospital cardiac arrest (OHCA). However, India lacks a formal sudden cardiac arrest (SCA) registry and the infrastructure for a robust emergency medical services (EMS) response system. Also, there exists an opportunity to improve widespread health literacy and awareness regarding SCA. Other confounding variables, including religious, societal, and cultural sentiments hindering timely intervention, need to be considered for better SCA outcomes., Objectives: We highlight the current trends and practices of managing OHCA in India and lay the groundwork for improving the awareness, education, and infrastructure regarding the management of SCA., Conclusion: Effective management of OHCA in India needs collaborative grassroots reformation. Establishing a large-scale SCA registry and creating official and societal guidelines will be pivotal for transforming OHCA patient outcomes., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Cardiological Society of India. Published by Elsevier, a division of RELX India, Pvt. Ltd. All rights reserved.)

Introduction: Providing cardiopulmonary resuscitation (CPR) to a coronavirus disease-2019 (COVID-19) patient is challenging for the healthcare providers (HCP). COVID-19 cases have specific CPR requirements, which differ from standard resuscitation efforts. Objective: This paper aims to evaluate whether online learning can be an effective methodology for imparting information on the management of cardiopulmonary arrest in COVID-19 patients due to a novel virus unknown to HCP based on evaluation of knowledge acquisition and satisfaction of the nurses in the new area of medicine and virology. Methodology: In a single-arm, one group before and after design, from a cohort of 160 nurses trained in comprehensive cardiac life support (CCLS) formulated by the Indian Resuscitation Council (IRC), 73 nurses participated in the study. After obtaining informed consent through the email from the nurses, baseline data including demographic profile and knowledge related to CPR in COVID-19 patients were collected. An online intervention spread over 1 week was given using a validated e-learning module. The online intervention was found to be effective (pre- and post-intervention knowledge score 13.65 ± 3.01 vs 19.92 ± 1.94, p = 0.001). The majority of nurses were highly satisfied with the content and the training methodology (37.23 ± 4.70). Conclusion: A well-structured, online study material can be used in imparting knowledge and demonstrating the basic and essential skills to nurses, required for giving CPR to COVID-19 patients. [ABSTRACT FROM AUTHOR]

Coronavirus disease (COVID-19) is an infectious disease caused by a newly discovered coronavirus. Most people infected with the COVID-19 virus will experience mild to moderate respiratory illness and recover without requiring special treatment. People in extremes of age and those having pre-existing disease are more prone to the infection. Transmission is by droplet/contact route or by airborne transmission in special circumstances i.e endotracheal intubation, bronchoscopy, tracheostomy, cardiopulmonary resuscitation etc. Not only the treatment of living infected subjects, handling of COVID-19 dead bodies is also having utmost importance to prevent the transmission of deadly virus to the body handlers (hospital staff/cremation staff/family members) in the hospital or at the cremation/burial site. Here in this review paper, we have discussed about the pros and cons of the cremation and burial of the body keeping in mind that no further spread of the virus could occur to the community. However for eg China and Sri Lankan authorities made cremation compulsory by official order while WHO, India and many other did not objected to either of them. In our opinion, cremation should be preferred for complete elimination of chances of infection. However keeping in mind the religious views of the family, if the burial of the body is requested, then it should be assured that the body is buried in a thick, air tight coffin and placed at normal depth of about 2 meter. It is recommended that the area above and adjacent to the grave should be cemented immediately as an additional precautionary to avoid scavenging by animal. [ABSTRACT FROM AUTHOR]

In the last two decades, India has seen a massive rise in the number of medical schools. As a result, numerous issues, including the availability of qualified teachers, have made medical education in India challenging. Faculty development (FD) has gained significant attention because of its importance in educational capacity building. FD programs help faculty become more aware of their professional responsibilities. Medical education units can play a vital role in FD and thus improve the quality of medical training by training the teachers. The National Teacher Training Centre (NTTC), Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, was the first center established by the Ministry of Health and Family Welfare, Government of India in 1975, with the assistance of the World Health Organization, to promote the training of health professionals in educational science and technology, including educational planning and research. This article describes the profile of activities of NTTC, which is functioning under the aegis of the Department of Medical Education (DME), JIPMER, and lists the outcomes that contributed to the success of DME with particular reference to the last decade. The establishment of DME is seen to affect the medical school positively. [ABSTRACT FROM AUTHOR]

Basic life support which was invented in 1960 is essential during cardiopulmonary resuscitation. In India, the research on knowledge regarding basic life support amongst dental students, dental specialists and staff is deficient. The objective of this study was to assess and compare the knowledge about basic life support amongst 2nd and 3rd year MDS students. The authors conducted a questionnaire study to compare and assess the knowledge of Basic Life Support in 2nd and 3rd year MDS students. The questionnaire was formulated after a thorough literature search. The questionnaire was validated and then sent to the students and the data was recorded and analyzed. It was found that the second years (N= 42) had low knowledge scores compared to the third years (N= 45). Out of the nine branches, participants belonging to the pedodontics department had the lowest score whereas those belonging to endodontics department had the highest score. The study concluded that 3rd year MDS students had better knowledge about Basic Life Support than the 2nd year MDS students. However, the residents of oral and maxillofacial surgery had higher knowledge compared to the other branches. [ABSTRACT FROM AUTHOR]

Background and aims: The prognosis of patients with cardiac arrest following trauma is poor. Our objectives were: (1) to determine outcomes of patients following in-hospital cardiac arrest posttrauma and admitted to the intensive care unit (ICU) and (2) to identify characteristics associated with in-hospital mortality. Materials and methods: This was a single-center retrospective analysis of patients admitted to ICU after resuscitation following in-hospital cardiac arrest between January 2017 and July 2018. Patients with isolated head injuries and multiple cardiac arrests were excluded. Bivariate analysis was done to determine a significant association between baseline characteristics and in-hospital mortality. Results: A total of 37 patients were included. About 35.1% of trauma subjects survived hospital discharge. Bivariate analysis showed positive association between admission Acute Physiology and Chronic Health Evaluation II (APACHE II) and Sequential Organ Failure Assessment (SOFA) scores with in-hospital mortality. Other characteristics, such as age, duration of cardiopulmonary resuscitation (CPR), and serum lactate levels on admission, were not associated with in-hospital mortality. Conclusion: Despite being at lower survival following a cardiac arrest after trauma, approximately one-third of the patients survived hospital discharge. This implies that aggressive support of this population is not necessarily futile. Optimization of postresuscitation physiological factors and their impacts on outcomes for these patients need further studies. [ABSTRACT FROM AUTHOR]

Introduction First Aid is the initial, immediate, life in curve rendered to an injured or sick person in life threatening situations by taking effective action to keep the injured or ill person alive in the best possible condition till emergency medical services and treatment can be obtained. First aid training among students is as an important capacity building component of pre-hospital care in communities. Aim: This literature review aimed to determine whether the published literature demonstrates the knowledge & skills about first aid and CPR in cases of emergency life saving skills developed by under graduate students who have learnt first aid from first aid providers. Methods An extensive search and numerous evaluation of the peer-reviewed literature was conducted for narrative review. Journal articles were retrieved from three databases (MEDLINE, CINAHL, ERIC) using the search terms 'first aid'; 'resuscitation'; 'training'; 'under graduate students'; and 'college'. Inclusion and exclusion criteria were applied and review findings organized thematically. Results The search yielded four primary studies of India & other countries under graduate students aged 18-23 years trained by professional first aid providers. Subsequent review identified emergent themes of resuscitative first aid and non-resuscitative first aid. Heterogeneity was apparent in training and evaluation methods, and study quality varied. Reported first aid knowledge retention was mixed. Conclusion There is a lack of quality evidence to guide optimal training methods and maximize first aid knowledge retention in under graduate college students. To date, research in this area has been limited. Further research is therefore recommended. Formal evaluation of first aid training providers can help guide training methods and maximize first aid knowledge retention in under graduate college students, thereby building more robust first aid capacity in the community. [ABSTRACT FROM AUTHOR]

Basic life support is an integral part of the learning curve in a clinicians life. Knowledge of this is important to every healthcare professional. It helps to deal with the emergencies arising with airway and breathing. A thorough knowledge of it can help saving the life of a patient in distress. It can pan out to be the critical element in saving a life of an individual. [ABSTRACT FROM AUTHOR]

BACKGROUND: The number of lay people willing to attempt cardiopulmonary resuscitation (CPR) in real life is increased by effective education in basic life support (BLS). However, little is known about access of general public to BLS training across the globe. This study aimed to investigate availability and key features of BLS courses proposed for lay people in India, Nigeria and the United Kingdom (UK). METHODS: A Google search was done in December 2018, using English keywords relevant for community resuscitation training. Ongoing courses addressing BLS and suitable for any adult layperson were included in the analysis. On-site training courses were limited to those provided within the country's territory. RESULTS: A total of 53, 29 and 208 eligible courses were found for India, Nigeria and the UK, respectively. In the UK, the number of courses per 10 million population (31.5) is 79 and 21 times higher than that in India (0.4) and Nigeria (1.5). Course geography is limited to 28% states and one union territory in India, 30% states and the Federal Capital Territory in Nigeria. In the UK, the training is offered in all constituent countries, with the highest prevalence in England. Courses are predominantly classroom-based, highly variable in duration, group size and instructors' qualifi cations. For India and Nigeria, mean cost of participation is exceeding the monthly minimum wage. CONCLUSION: In contrast to the UK, the availability and accessibility of BLS courses are critically limited in India and Nigeria, necessitating immediate interventions to optimize community CPR training and improve bystander CPR rates. [ABSTRACT FROM AUTHOR]

Objective: To inform interventions targeted towards reducing mortality from acute myocardial infarction (AMI) and sudden cardiac arrest in three megacities in China and India, a baseline assessment of public knowledge, attitudes and practices was performed.Methods: A household survey, supplemented by focus group and individual interviews, was used to assess public understanding of cardiovascular disease (CVD) risk factors, AMI symptoms, cardiopulmonary resuscitation (CPR) and automated external defibrillators (AEDs). Additionally, information was collected on emergency service utilisation and associated barriers to care.Results: 5456 household surveys were completed. Hypertension was most commonly recognised among CVD risk factors in Beijing and Shanghai (68% and 67%, respectively), while behavioural risk factors were most commonly identified in Bangalore (smoking 91%; excessive alcohol consumption 64%). Chest pain/discomfort was reported by at least 60% of respondents in all cities as a symptom of AMI, but 21% of individuals in Bangalore could not name a single symptom. In Beijing, Shanghai and Bangalore, 26%, 15% and 3% of respondents were trained in CPR, respectively. Less than one-quarter of participants in all cities recognised an AED. Finally, emergency service utilisation rates were low, and many individuals expressed concern about the quality of prehospital care.Conclusions: Overall, we found low to modest knowledge of CVD risk factors and AMI symptoms, infrequent CPR training and little understanding of AEDs. Interventions will need to focus on basic principles of CVD and its complications in order for patients to receive timely and appropriate care for acute cardiac events. [ABSTRACT FROM AUTHOR]

Introduction: There is a paucity of literature on prehospital care and epidemiology of traumatic cardiac arrest (TCA) in India. This study highlights the profile and characteristics of TCA. Methods: A retrospective cohort study was conducted to study epidemiological profile of TCA patients S1 year presenting to a level 1 trauma center of India. Results: One thousand sixty-one patients were recruited in the study. The median age (interquartile range) was 32 (23--45) years (male: female ratio of 5.9:1). Asystole (253), pulseless electrical activity (11), ventricular fibrillation (six), and ventricular tachycardia (five) were initial arrest rhythm. Road traffic crash (RTC) (57.16%), fall from height (18.52%), and assault (10.51%) were modes of injury. Prehospital care was provided by police (36.59%),ambulance (10.54%), relatives (45.40%), and bystanders (7.47% cases). Return of spontaneous circulation was seen in 69 patients, of which only three survived to hospital discharge. Conclusion: RTC in young males was a major cause of TCA. Asystole was the most common arrest rhythm. Police personnel were major prehospital service provider. Prehospital care needs improvement including the development of robust TCA registry. [ABSTRACT FROM AUTHOR]

Not for resuscitation in India still remains an abstract concept with no clear guidelines or legal frame work. Cardiopulmonary resuscitation is a complex medical intervention which is often used inappropriately in hospitalized patients and usually guided by medical decision making rather than patient-directed choices. Patient autonomy still remains a weak concept and relatives are expected to make this big decision in a short time and at a time of great emotional distress. This article outlines concepts around ethics and medico legal aspects of not for resuscitation, especially in Indian setting. [ABSTRACT FROM AUTHOR]