A video of a Chandigarh IAS officer attempting to perform CPR on a man went viral on social media on Wednesday, January 18. The video shows a man seated in a chair, while Chandigarh Health Secretary Yashpal Garg is seen standing in front of him and pumping his chest vigorously. During this process, the man’s eyes are open and he appears to be in a conscious state. CPR or cardiopulmonary resuscitation is a life-saving emergency procedure that can be performed by anyone, but even as the video was shared with the intent of appreciating the IAS officer’s efforts, scores of medical professionals rushed to point out that the technique was extremely flawed, and that it should have been performed only if the patient had been unresponsive.
The man who appears to have collapsed into a chair in the video is named Janak Lal, according to reports. He had reportedly visited the Chandigarh Housing Board (CHB) office in connection with a building violation case against him when he collapsed in the office chamber of Yashpal Garg, who is also the Chief Executive Officer of the CHB. When Yashpal was informed of the incident, he went to the chamber and started pumping Janak Lal’s chest.
According to Indian Express, Yashpal Garg admitted that he had no training to do CPR, but once saw a doctor performing the procedure on television. “I know the process I adopted might not be proper, but I did whatever came to my mind at that moment. Immediate attempt to save the life was more important than wasting any time on other things,” said Garg. Janak Lal was later admitted to the Chandigarh Government Multi-Speciality Hospital.
Among the many doctors who responded to the video in alarm and pointed out that it was flawed, was UAE-based neurosurgeon Dr Rahul Mally. “You do not give CPR to a semiconscious patient!!” he pointed out, adding that the patient should have been made to lie down on a flat surface, as most of the force used by Yashpal seemed to have gone into moving the chair. TNM spoke to him to understand better the dos and don’ts of CPR.
You do not give CPR to a semiconscious patient!! Second always place the patient on a flat hard surface like floor not on chair. Moreover most of force used in chest compressions is lost in moving back rest. https://t.co/gP2qmw0GX2
— Dr Rahul Mally (@drrahulmally) January 19, 2023
Shows the need for BLS training for everyone, not just for doctors or paramedics but for everyone. Appreciate the effort but he needs a BLS training to know that the poor guy didn’t need a CPR. Hope he didn’t end up with fractured ribs. #BLStrainingforevryone https://t.co/Q9C6UeCLnq
— Sudhir Venkatesh (@sudhirvenkatesh) January 19, 2023
Medical procedures like CPR requires training and education about the technique. Otherwise it results into events like this video where people are giving CPR to a conscious patient. #RIPCPR #MedTwitter #MedEd https://t.co/M5FGTUFodA
— Dr. Priyanka Rawat (@VinkyDings) January 19, 2023
CPR is an emergency lifesaving procedure performed when the heart stops beating. It can be performed by anyone, even if they aren’t trained health professionals. It is an ‘organised, sequential response to cardiac arrest’, involving chest compressions and mouth-to-mouth breaths.
Speaking to TNM, neurosurgeon Dr Rahul Mally said that there are two basic criteria for performing CPR – check if the person is unresponsive, or has no pulse. “If either of these functions is present, there is no need for CPR. The first step when a person falls unconscious is to check for responsiveness; that is if they are breathing and if there is a pulse, which means their lungs and heart are functioning,” he said.
He also stressed that CPR must not be performed if a person is conscious, drowsy or semi-conscious, and if he is breathing. Dr Rahul pointed out that in the Chandigarh instance, the basic criteria of a person being unresponsive itself was not satisfied and added, “Assuming that the person was unresponsive, CPR should always be done on a flat surface, and not while the person is seated.” This is when the compressions can be done adequately and effectively, he noted.
As per standard guidelines from medical institutions such as the American Red Cross and the American Heart Association, as well as Dr Rahul’s suggestions, these are the steps to be followed while performing CPR when a person seems to fall unconscious –
> Call the emergency medical services number for an ambulance
> Check if the person is breathing or has pulse. If neither is present, make them lie on a flat and hard surface. This ensures that the blood flow is eased.
> Place both palms – with one palm over the other – on the lower part of the chest, at the end of the sternum or breastbone
> Start the chest compressions. Each compression must be at least 5 cm deep, and the number of compressions must be 100-120 compressions per minute. It must be ensured that the chest recoils completely between two compressions
> If there are two persons who are trained in CPR, one person can administer chest compressions while the other can provide mouth-to-mouth breaths. At the end of every 30 compressions, two or three rescue breaths can be given. While mouth-to-mouth breaths are not mandatory, they can make CPR more effective
> CPR can be stopped if one of these three things happens – paramedics or healthcare workers arrive, the patient regains consciousness, or their pulse or breathing returns. However, it is important to continue monitoring the person, in case their pulse or breathing stops again. If it does stop, the entire process must be repeated.
Speaking about the possible outcomes of badly performed CPR, Dr Rahul said that in the worst-case scenario, it could lead to death. “Improper posture and pressure applied during chest compression can lead to the chest bones breaking. The broken bones can damage the lungs and eventually lead to death,” he said. He said that Basic Life Support (BLS) training, which includes performing CPR, must be provided to everyone at the school and college levels itself. “BLS can be performed by any person and when performed properly, can save lives during critical times,” he said.
“CPR is needed only if there is a cardiac arrest. In case a heart attack leads to cardiac arrest, the procedure can be followed,” Dr Rahul said. A heart attack happens when an artery is blocked and normal blood flow to the heart is cut off. A cardiac arrest is when the heart stops pumping blood.
Dr Rahul further said that an automated external defibrillator (AED) can be used if available at hand, or with a paramedic. AED is a medical device that can automatically analyse the heart's rhythm and deliver an electrical shock if needed, to revive it.