Cardiovascular diseases (CVDs) continue to be a leading cause of mortality worldwide, posing a significant burden on healthcare systems and communities. In emergencies involving cardiac arrest or severe cardiovascular events, timely and effective intervention is crucial to improving patient outcomes. Advanced Cardiovascular Life Support (ACLS) is a set of evidence-based clinical interventions and techniques designed to provide optimal care in such critical situations [1-3].

In the state of Himachal Pradesh, situated amidst the picturesque Himalayan mountains in India, healthcare professionals, particularly medical officers, play a pivotal role in addressing the healthcare needs of the population. Ensuring that medical officers possess the necessary knowledge and skills in ACLS is vital for enhancing the state's emergency healthcare response and, ultimately, saving lives [4-6].

ACLS encompasses a range of critical interventions, including cardiopulmonary resuscitation (CPR), defibrillation, airway management and administration of medications. Proficiency in ACLS enables healthcare providers to assess, intervene and stabilize patients experiencing cardiac arrest, stroke, or other life-threatening cardiovascular emergencies [7-9].

Globally, CVDs account for a substantial proportion of deaths. The World Health Organization (WHO) reports that cardiovascular diseases are the leading cause of death globally, with an estimated 17.9 million deaths annually [1]. In India, CVDs are responsible for a significant share of the disease burden, affecting both urban and rural populations. Given this context, healthcare providers, including medical officers in Himachal Pradesh, must be well-equipped with the latest knowledge and skills to respond effectively to cardiovascular emergencies [10-12].

This study aims to assess the knowledge levels of medical officers working in Himachal Pradesh regarding ACLS. By evaluating their familiarity with ACLS guidelines, protocols and hands-on skills, this research seeks to identify areas where training and education can be improved. The findings from this study are instrumental in enhancing the quality of emergency care, reducing mortality rates due to cardiovascular events and optimizing the state's healthcare infrastructure.

This study aligns with broader efforts to enhance emergency healthcare services and reduce CVD-related mortality in Himachal Pradesh. It seeks to identify areas where medical officers may require additional training or resources to ensure they can deliver ACLS interventions confidently and competently.

ACLS proficiency is not only a matter of professional competence but also an ethical obligation to provide the best possible care to patients in dire need. Timely and appropriate ACLS interventions can significantly increase the chances of survival and minimize the risk of disability following a cardiovascular event. Therefore, assessing the knowledge levels of medical officers in Himachal Pradesh is a critical step toward strengthening the state's healthcare system and safeguarding the well-being of its residents.

Objectives of the Study

To evaluate the Knowledge of Advanced Cardiovascular Life Support (ACLS) among medical officers working in the state of Himachal Pradesh.

• Research Approach: Descriptive

• Research Design: Cross-sectional survey design

• Study area: Hilly state of Himachal Pradesh

• Study duration: Between April 2023 to July 2023

• Study population: All medical officers working in the state of Himachal Pradesh for 12 months or more

• Sample size: 100 medical officers assuming 50% have adequate knowledge regarding Advanced Cardiovascular Life Support, 10% absolute error, 95% confidence level and 5% non-response rate.

• Sampling Technique: Convenience and snowball Sampling technique

• Study tool: A google form questionnaire consisting of questions regarding socio-demography and Advanced Cardiovascular Life Support was created. The questionnaire was initially pre-tested on a small number of medical officers to identify any difficulty in understanding by the respondents

Description of Tool 

• Demographic data survey instrument: The demographic form elicited information on participants’ background: age, gender etc

• Questionnaire: The questionnaire contains 20 structured questions regarding knowledge about Advanced Cardiovascular Life Support having multiple options. The participants have to choose right one. One mark was given for each correct answer and zero for incorrect answer. The maximum score was 20 and minimum score was zero in each category. Scoring was done on the basis of marks as >80% (16-20) = very good, 61-79% (12-15) = Good, 41-59% (8-11) = Fair, <40% (<8) = poor

• Validity of tool: By the experts in this field

• Inclusive Criteria: Who were willing to participate in the study

• Exclusion Criteria: Who were not willing to participate in the study

• Data collection: Data was collected under the guidance of supervisors. The google form questionnaire was circulated via online modes like e-mail and social media platforms like Whatsapp groups, Facebook, Instagram and Linkedin among medical officers working in the state of Himachal Pradesh till the 100 responses were collected. Responses were then recorded in a Google Excel spreadsheet

• Data analysis: Data was collected and entered in Microsoft excel spread sheet, cleaned for errors and analyzed with Epi Info V7 Software with appropriate statistical test in terms of frequencies and percentage

• Ethical Considerations: Participants confidentiality and anonymity was maintained

The present study was cross sectional descriptive study carried out to evaluate knowledge of Advanced Cardiovascular Life Support (ACLS) among 100 medical officers working in the state of Himachal Pradesh (Table 1).

Table 1: Responses to The Questions Regarding Advanced Cardiovascular Life Support (ACLS)

Table 1: Continue

In the present study, 26 study participants had very good knowledge (16-20 marks) regarding Advanced Cardiovascular Life Support, 45 had good knowledge (12-15 marks), 16 had fair knowledge (8-11 marks) and 13 had poor knowledge (<8 marks) regarding Advanced Cardiovascular Life Support (Figure 1).

Figure 1: Knowledge Regarding Advanced Cardiovascular Life Support (ACLS) Among Study Participants

Cardiovascular diseases (CVDs) remain a significant global health challenge, contributing substantially to mortality rates. In emergencies such as cardiac arrest or severe cardiovascular events, timely and effective intervention is crucial for improving patient outcomes. Advanced Cardiovascular Life Support (ACLS) plays a pivotal role in this regard, encompassing a range of interventions vital for patient stabilization and recovery. This study aimed to evaluate the knowledge of medical officers in Himachal Pradesh regarding ACLS, as they are frontline healthcare providers responsible for delivering emergency care.

The findings of this study reveal a diverse range of knowledge levels among medical officers regarding ACLS. It is notable that a substantial proportion of participants displayed good or very good knowledge, which indicates a solid foundation in ACLS principles. However, several knowledge gaps and areas requiring improvement are evident:

• Chest Compressions and Ratio of Compressions to Breaths: Approximately 72% of participants correctly identified the recommended rate for adult chest compressions (100-120 compressions per minute) and 73% knew the correct ratio of compressions to breaths (30:2). These findings are consistent with established ACLS guidelines [3] and demonstrate a commendable understanding of these fundamental aspects of resuscitation

• Ventilation: In terms of ventilations for an adult patient in respiratory arrest with a pulse via bag-valve-mask, 70% of participants correctly identified the recommended rate (10-12 times per minute). This knowledge is vital for maintaining oxygenation during resuscitation efforts

• Treatment of Hypotension: A notable 62% of participants correctly recognized that hypotension following cardiac arrest is not treated with IV calcium infusion. Understanding the appropriate management of post-arrest complications is essential in providing effective ACLS care [5]

• Team Resuscitation Leadership: About 68% of respondents correctly indicated that the leader in team resuscitation must be able to perform all the skills if needed. This underscores the importance of having a skilled team leader during resuscitation efforts [6]

• Timely Intervention for ST-segment Elevation Myocardial Infarction: An impressive 71% of participants correctly identified that patients experiencing an ST-segment elevation myocardial infarction should be taken to the cardiac catheterization lab for a balloon procedure within 90 minutes of entering the emergency department. Timely intervention is crucial in managing such cases effectively [3]

• Estimating CPR Effectiveness: The majority (74%) of participants recognized that the effectiveness of CPR can be estimated using quantitative waveform capnography, among other methods [12]

• Treatment of Tachycardia: A significant proportion of respondents 76% correctly identified that narrow-complex supraventricular tachycardia is best treated with adenosine. Accurate identification and management of arrhythmias are vital aspects of ACLS [4]

• Pulseless Electrical Activity (PEA): Most participants 72% correctly understood that hypocalcemia is not one of the reversible causes of PEA, often referred to as the "H's and T's" [4]

• STEMI Management: An encouraging 67% of participants correctly recognized that a patient with ST-segment elevation myocardial infarction (STEMI) should be taken to a hospital capable of providing Percutaneous Coronary Intervention (PCI) if it is 15 minutes away. This aligns with current guidelines for STEMI management [4]

• Cincinnati Prehospital Stroke Scale: A majority 73% accurately identified confusion or disorientation as part of the Cincinnati Prehospital Stroke Scale, a critical tool for assessing potential stroke patients [4]

• Importance of Early Defibrillation: An impressive 71% of participants understood that early defibrillation is the single most important therapy for survival of cardiac arrest [7]

While these findings reflect commendable knowledge levels among medical officers in Himachal Pradesh, there is still room for improvement. Areas requiring attention include the treatment of hypotension, leadership in team resuscitation and the management of tachycardia. Continuing education and regular ACLS training sessions could further enhance the proficiency of medical officers in these critical areas.

Comparing these findings with other studies conducted in different regions, it is evident that the level of ACLS knowledge among medical officers in Himachal Pradesh is relatively high. This is a positive sign for emergency healthcare in the region. However, ongoing training and skill retention programs are essential to ensure that this knowledge translates into effective ACLS interventions when needed [10].

This study assessed the knowledge of medical officers in Himachal Pradesh regarding ACLS. While a substantial proportion of participants demonstrated good to very good knowledge, some knowledge gaps were identified. These findings underscore the importance of regular ACLS training and continuing education to ensure that medical officers can provide effective ACLS interventions in critical situations. By strengthening ACLS proficiency among medical officers, Himachal Pradesh can improve emergency healthcare services, reduce mortality rates and ultimately enhance the well-being of its residents.

1. World Health Organization. Cardiovascular Diseases (CVDs). 2021, https://www.who.int/news-room/fact-sheets/detail/cardiovascular-diseases-(cvds)

2. Benjamin, E.J. et al. “Heart disease and stroke statistics—2019 update: A report from the American heart association.” Circulation, vol. 139, no. 10, 2019, pp. e56–e528. https://doi.org/10.1161/CIR.0000000000000659

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4. Neumar, R.W. et al. “Part 1: Executive summary: 2015 American Heart association guidelines update for cardiopulmonary resuscitation and emergency cardiovascular care.” Circulation, vol. 132, no. 18_suppl_2, 2015, pp. S315–S367. https://doi.org/10.1161/CIR.0000000000000252.

5. Morrison, L.J. et al. “Part 2: Evidence evaluation and management of conflicts of interest: 2010 American heart association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care.” Circulation, vol. 122, no. 18_suppl_3, 2010, pp. S665–S675. https://doi.org/10.1161/CIRCULATIONAHA.110.970947

6. Greif, R. et al. “European resuscitation council guidelines for resuscitation 2015: Section 10. education and implementation of resuscitation.” Resuscitation, vol. 95, 2015, pp. 288–301. https://doi.org/10.1016/j.resuscitation.2015.07.032

7. Chan, P.S. et al. “Delayed time to defibrillation after in-hospital cardiac arrest.” New England Journal of Medicine, vol. 358, no. 1, 2008, pp. 9–17. https://doi.org/10.1056/NEJMoa0706467

8. Perkins, G.D. et al. “Cardiac arrest and cardiopulmonary resuscitation outcome reports: Update of the Utstein resuscitation registry templates for out-of-hospital cardiac arrest.” Circulation, vol. 132, no. 13, 2015, pp. 1286–1300. https://doi.org/10.1161/CIR.0000000000000144

9. Meaney, P.A. et al. “Cardiopulmonary resuscitation quality: improving cardiac resuscitation outcomes both inside and outside the hospital: A consensus statement from the American heart association.” Circulation, vol. 128, no. 4, 2013, pp. 417–435. https://doi.org/10.1161/CIR.0b013e31829d8654

10. Smith, K.K., D. Gilcreast and K. Pierce. “Evaluation of staff’s retention of ACLS and BLS skills.” Resuscitation, vol. 78, no. 1, 2008, pp. 59–65. https://doi.org/10.1016/j.resuscitation.2008.02.007

11. Kornhall, D.K. et al. “A randomized clinical trial of the provision of audiovisual feedback during cardiopulmonary resuscitation and training.” Critical Care, vol. 21, no. 1, 2017, pp. 1–8. https://doi.org/10.1186/s13054-017-1867-8

12. Meaney, P.A. et al. “Cardiopulmonary resuscitation quality: improving cardiac resuscitation outcomes both inside and outside the hospital: A consensus statement from the American heart association.” Circulation, vol. 128, no. 4, 2013, pp. 417–435. https://doi.org/10.1161/CIR.0b013e31829d8654