Study on Knowledge of Cardiac Arrest and Its Management Among Health Care Professional Students in Chennai and Kanchipuram

Background: Cardiac arrest is the most common cause of death worldwide, and early intervention with high quality BLS improves a victim’s chances of survival. A patient in cardiac arrest is treated by early CPR and early de�brillation and administration of Emergency Drugs. Therefore, Every Health Care Professional student should be Knowledgeable about cardiac arrest and its management to save the precious life of patient. Objective: To assess the Knowledge of Cardiac Arrest and its management among Health Care Professional Students and to educate and create awareness and Knowledge about Cardiac arrest and its management among Heath Care Professional Students Methodology: A cross sectional study conducted in Chennai and Kanchipuram, from July 9 th 2022 to September 9 th 2022. Permission was obtained from IEC; a well-organized questionnaire was executed with 23 items using the Google Forms. Pre-structured questions were pre-validated by Experts. Google form contains the details such as socio-demographic, knowledge and its management-based questions. The Completed data was collected, entered in excel sheet and the results was analyzed with the proper statistical method. Results: According to the statistical analysis of data received, it results, only 4% (21 participants) of health care professional students have good knowledge about cardiac arrest and its management, only 36% (188 participants) of health care professional students have adequate knowledge about cardiac arrest and its management and 60% (316 participants) of health care professional students have inadequate knowledge about cardiac arrest and its management. Conclusion: This study highly suggests that training programs, simulation-based trainings, seminars and Lecture, etc.… need to be organized to the health care professional students to make them gain knowledge about cardiac arrest and its management to save the precious lives.


Introduction
Cardiac arrest is de ned as the cessation of cardiac mechanical activity resulting in the absence of circulating blood ow, which can be the abrupt loss of heart function in an individual who may or may not have been diagnosed with heart disease.Heart stops pumping the blood to vital organs, depriving them of oxygen, and, if left untreated, results in death [1] .It can come on suddenly or in the wake of other symptoms [1,2] .It is often fatal if appropriate management aren't taken immediately.It may be caused by irregular heart rhythms called arrhythmias [2,3] .Ventricular brillation is an arrhythmia commonly associated with cardiac arrest.The heart's lower chambers suddenly start beating chaotically and don't pump blood during ventricular brillation [3,4] .Commonly cardiac arrests occur when a diseased heart's electrical system malfunctions, This malfunction causes an abnormal heart rhythm such as ventricular tachycardia or ventricular brillation [2,5,6] .Some cardiac arrests are also caused by extreme slowing of the heart's rhythm (bradycardia) [2] .Other causes of Cardiac Arrest are, Scarring of the heart muscle tissues -It may be the result of a prior heart attack or another cause.scarred or enlarged heart from any cause is prone to develop life-threatening ventricular arrhythmias.The rst six months after a heart attack is a high-risk period for sudden cardiac arrest in patients with atherosclerotic heart disease [7] .
Thickened cardiac muscle (cardiomyopathy) -Damage to the heart muscle can be the result of high blood pressure, heart valve disease or other causes.A diseased heart muscle can make you more prone to sudden cardiac arrest, especially if the Patient also have heart failure [8] .
Heart medications -Under certain conditions, the stage for arrhythmias that cause sudden cardiac arrest.
(Even, antiarrhythmic drugs that treat arrhythmias can sometimes produce ventricular arrhythmias even at normal doses.This is called a "proarrhythmic" effect.)Signi cant changes in blood levels of potassium and magnesium, Diuretics may also cause life-threatening arrhythmias and cardiac arrest [9] .
Electrolyte imbalance may also cause cardiac arrest, especially Hyperkalemia can lead to ventricular brillation, So Electrolyte level must be maintained [10] .
Electrical abnormalities -These, including Wolff-Parkinson-White syndrome and Long QT syndrome, may cause sudden cardiac arrest in children and young people [10] .
Abnormalities of blood vessel -These rare cases occur particularly in the coronary arteries and aorta.
Adrenaline released during intense physical activity can trigger sudden cardiac arrest when these abnormalities are present [11] .Recreational drug use -This can occur in otherwise healthy people [11] .
Main Signs of cardiac arrest are, Sudden loss of responsiveness, No normal breathing, No carotid pulse and with or without Chest Pain.Pulseless cardiac arrest can be produced by these four rhythms; ventricular brillation (VF), rapid ventricular tachycardia (VT), pulseless electrical activity (PEA), and asystole [2] .Survival from these arrest rhythms requires both basic life support (BLS) and advanced cardiovascular life support (ACLS) [4,12,13] .
Cardiac arrest is the most common cause of death worldwide, and early intervention with high quality BLS improves a victim's chances of survival [4,14,15] .A patient in cardiac arrest is treated by early CPR and early de brillation and administration of Emergency Drugs [3,16,17,18] .Steps in CPR, Locate the carotid pulse behind the trachea on the side of the neck.A pulse may be hard to detect.Therefore, an attempt to feel the pulse should only be performed for about 5-10 seconds, if a pulse cannot be distinctly detected, assume that there is no pulse [3,19,20] (Figure 1).Start alternating 30 chest compressions and 2 breaths, Open the victim's airway by slightly lifting the chin [21,22] , Place the heel of the right hand (Dominant Hand) on the bottom of the victim's breastbone and then place the heel of left hand on top of the right hand, The arms and shoulders are straight and begin the chest compressions hard and fast [23,24,25] .According to 2021 CPR Guidelines, line of Survival sequence will be Compression -Airway -Breathing (CAB) [3] (Figure 2).
Effective chest compressions will be at least 2 to 2.4 inches deep for adults, The chest compression depth for Infants and children up to puberty is 1/3 the depth of the chest, which is about 1.5 inches (4 cm) in infants and 2 inches (5 cm) in children up to puberty, Infants under one year of age (excluding newborns): two ngers in the center of the chest, just below the nipple line [26,27] , (Figure 3).
The frequency of chest compressions should be 100 to 120 per minute, Chest compressions below 75 compressions per minute are associated with a lower ROSC (return of spontaneous circulation) in the victim [4,28,29] .The chest needs to fully expand between each compression to allow blood to ow into the victim's heart, leaning on the chest at any time during CPR is contraindicated, after 30 hard and fast chest compressions, tilt the head and chin to make sure the victim's airway is still open [3,30] .If the victim appears to have a neck injury, perform a jaw thrust to open the airway by gently moving the jaw forward, perform round of 30 chest compressions followed by 2 breaths (each breath per second) [31] .De brillator is used to assess the Cardiac rhythm and de brillation should be performed quickly and as directed, If de brillator can't be accessed, use Automated External De brillator (AED) to assess the Cardiac rhythm [32] , The AED analyzes the victim's heart rhythm and advises a therapeutic shock when appropriate.Administration of Emergency Drugs like Amiodarone, Lignocaine, Epinephrine, etc... can used to manage the Cardiac arrhythmias and saves the life of the Victim.
Therefore, Every Health Care Professional student should be Knowledgeable about cardiac arrest and its management to save the precious life of patient.

OBJECTIVES:
To We designed and implemented an online data collection tool using Google Forms via(docs.google.com/forms).The questionnaire assesses knowledge and management of Cardiac Arrest, which is pre-designed and pre-validated by professional experts in the eld.
A pilot study was conducted in o ine among 10% of study population, after analysis of the results, The questionnaire was approved as standardized questionnaires by the profession experts in the eld.
Google forms include socio-demographic details such as name, age, gender, year of study and course of the study, Institution name and Place, Informed Consent in one part and next section contains 23 Questions to check the knowledge of the students on cardiac arrest and its management.
Participants were asked to select the appropriate option, for each correct response 2 marks will be given, total score was converted into percentage, according to the percentage knowledge of healthcare professional student is assessed which includes Good Knowledge (above 80%), Adequate Knowledge (50-79%), Inadequate Knowledge (below 49%).
Completed data were collected, entered in excel sheet and the results were analyzed with the proper statistical method.

Results
A survey on knowledge of cardiac arrest and its management was conducted on health care professional students of I-year, II-year, III-year, Final year, and Interns which includes MBBS, AHS, Nursing, BPT, BOT, other health care professional students in Chennai and Kanchipuram.Around 525 students from various colleges in Chennai and Kanchipuram responded to this survey.
Among the 525 responses 26.9% of responders were from Nursing, 17.7% of responders were from MBBS, 15.6% of responders were from BPT, 10.1% of responders were from B.Sc. Cardio Pulmonary Technology, 8.8% of responders were from B.Sc. Anesthesia Technology, 8% of responders were from B.Sc. Perfusion Technology, 4.8% of responders were from B.Sc. Renal Dialysis Technology, 3.4% of responders were from B.Sc. Physician Assistant , 2.3% of responders were from B.Sc. Radio Imaging Technology, 1.1% of responders were from B.Sc. Medical Laboratory Technology, 0.8% of responders were from other AHS, 0.6% of responders were from Respiratory Therapy and 0.1% of responders were from BOT (Figure 4).
According to the statistical analysis of data received, 18.9% of the responders were a rst-year, 21.7% of the responders were second year, 39.8% of the responders were third year, 12% of the responders were fourth year and 7.6% of responders were Interns (Figure 5).
According to the statistical analysis of data received, Responses showing the gender of health care professional students participated in the study (Figure 6).
According to the statistical analysis of data received, Responses showing the age of health care professional students participated in the study (Figure 7).
According to the statistical analysis of data received, Responses showing the institutional place of health care professional students participated in the study (Figure 8).
According to the statistical analysis of data received, it results, only 4% of health care professional students have good knowledge about cardiac arrest and its management, only 36% of health care professional students have adequate knowledge about cardiac arrest and its management and 60% of health care professional students have inadequate knowledge about cardiac arrest and its management (Figure 9).

Discussion
The Study was conducted online in Chennai and Kanchipuram from July 9th, 2022, to September 9th, 2022.This study was aimed at assessing the knowledge of cardiac arrest and its management among health care professional students.
According to the statistical analysis of data received, it results, only 4% (21 participants) of health care professional students have good knowledge about cardiac arrest and its management, only 36% (188 participants) of health care professional students have adequate knowledge about cardiac arrest and its management and 60% (316 participants) of health care professional students have inadequate knowledge about cardiac arrest and its management.
Cardiac arrest is the most common cause of death worldwide, and early intervention with high quality BLS improves a victim's chances of survival.A patient in cardiac arrest is treated by early CPR, early de brillation, and the administration of emergency drugs.Quick and instant intervention using early, highquality CPR can be a good strategy to save numerous precious lives, especially as health care professional students are future clinicians, teachers, and researchers who will be at the forefront in educating and treating the general public.
An alarming nd in our study was that 38.1% of institutions doesn't motivates and provide the proper training on management of cardiac arrest to their health care professional students, According to the statistical analysis of data received, it results, only 21% of students are properly trained in BLS, and 17.3% of students are properly trained in ACLS, and just 13.9% of students are properly trained in PALS.
A victim under cardiac arrest can be saved by early CPR, early de brillation, and the administration of emergency drugs.Quick and instant intervention using early, high-quality CPR can be a good strategy to save numerous precious lives, Therefore, Every Health Care Professional student should be knowledgeable about cardiac arrest and its management to save the precious life of patient.
This study highlighted the gaps in knowledge of cardiac arrest and its management among health care profession students.Institutions should provide technical education and proper training to their students which is highly needed to make them knowledgeable to manage cardiac arrest and save the life of the victim.

Conclusion
Our study suggests that training programs, simulation-based training, seminars, and lectures, etc., need to be organized for health care professional students to enable them to gain knowledge about cardiac arrest and its management.Our study concludes that every healthcare professional student should be knowledgeable about cardiac arrest and able to manage it in an emergency condition to save the precious life of the victim.It certi es that the study was performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.
CONSENT TO PARTICIPATE: Written informed consent was obtained from all participants and from a parent and/or legal guardian.

CONSENT PUBLICATION
Represents the anatomical location of xiphoid process [Randall Benner, M.Ed., NREMT-P, Basic Life Support: Cardiopulmonary Resuscitation (CPR)] [33] Figure 4 Responses showing the course of study of health care professional students participated in the study.
Page 20/23 Responses showing the year of study of health care professional students participated in the study.
Responses showing the gender of health care professional students participated in the study.Responses showing the institutional place of health care professional students participated in the study.
Figure 9 represents the knowledge of cardiac arrest and its management among health care professional students participated in the study.

Figure 7 Responses
Figure 7

Figure 8
Figure 8 assess the Knowledge of Cardiac Arrest and its management among Health Care Professional Students To educate and create awareness and Knowledge about Cardiac arrest and its management among Heath Care Professional Students.The target population selected was full-time undergraduate Health Care Professional students in Chennai and Kanchipuram.The Study was conducted online in Chennai and Kanchipuram from July 9th, 2022, to September 9th, 2022.Permission was obtained from the Human Institutional Ethical Committee (IEC), MMCHRI, Kanchipuram, Approval Number (MMCH & RI IEC/UG/01/JUNE/22).

Table 1
d. Don't know 6.Where should you feel for a pulse in an unresponsive adult victim under Cardiac arrest?a. Radial artery