title: Cardiopulmonary Resuscitation in Resource-limited Health Systems-Considerations for Training and Delivery.
abstract: In the past 50 years, cardiopulmonary resuscitation (CPR) has gained widespread recognition as a life-saving skill that can be taught successfully to the general public. Cardiopulmonary resuscitation can be considered a cost-effective intervention that requires minimal classroom training and low-cost equipment and supplies; it is commonly taught throughout much of the developed world. But, the simplicity of CPR training and its access for the general public may be misleading, as outcomes for patients in cardiopulmonary arrest are poor and survival is dependent upon a comprehensive "chain-of-survival," which is something not achieved easily in resource-limited health care settings. In addition to the significant financial and physical resources needed to both train and develop basic CPR capabilities within a community, there is a range of ethical questions that should also be considered. This report describes some of the financial and ethical challenges that might result from CPR training in low- and middle-income countries (LMICs). It is determined that for many health care systems, CPR training may have financial and ethically-deleterious, unintended consequences. Evidence shows Basic Life Support (BLS) skills training in a community is an effective intervention to improve public health. But, health care systems with limited resources should include CPR training only after considering the full implications of that intervention.
authors.affiliation: 1Columbia University,Mailman School of Public Health,Department of Health Policy and Management,New York,New YorkUSA.
authors.forename: Jason
authors.initials: J
authors.lastname: Friesen
authors.affiliation: 1Columbia University,Mailman School of Public Health,Department of Health Policy and Management,New York,New YorkUSA.
authors.forename: Dean
authors.initials: D
authors.lastname: Patterson
authors.affiliation: 2Mt. Sinai Medical Center,Department of Emergency Medicine,New York,New YorkUSA.
authors.forename: Kevin
authors.initials: K
authors.lastname: Munjal
mesh_terms: D016887:Cardiopulmonary Resuscitation / Q000193:education* / Q000941:ethics*; D003906:Developing Countries; D006323:Heart Arrest / Q000401:mortality / Q000628:therapy*; D006801:Humans
keywords: AED automatic external defibrillator; BLS Basic Life Support; CPR cardiopulmonary resuscitation; EMS Emergency Medical Services; IHCA in-hospital cardiac arrest; LMIC low- and middle-income countries; OHCA out-of-hospital cardiac arrest; ROSC return of spontaneous circulation; training