Ask Dr KK: What is the significance of gasping respiration in CPR or CCCR?

Agonal/gasping respiration is ineffective respiration and should be an indication for cardiac resuscitation. In fact, gasping is the sign that your resuscitation is likely to be successful.

About the author: Dr K K Aggarwal is Padmashri and Dr B C Roy National Awardee, President Heart Care Foundation of India, Dean Board of Medical Education Moolchand Medcity, Sr. Physician & Cardiologist, Visiting professor Clinical Research DIPSAR, Past President Delhi Medical Association, Past Academic and Research Wing Head IMA, Chairman Ethics Committee Delhi Medical Council.  

Ask Dr KK: How effective should be breathing in CPR?

One should not push more than 50% of the tidal volume in each breath. Don’t push air into the stomach as it will impair hemodynamics. If the respiratory rate is more, it will also impair hemodynamics.

About the author: Dr K K Aggarwal is Padmashri and Dr B C Roy National Awardee, President Heart Care Foundation of India, Dean Board of Medical Education Moolchand Medcity, Sr. Physician & Cardiologist, Visiting professor Clinical Research DIPSAR, Past President Delhi Medical Association, Past Academic and Research Wing Head IMA, Chairman Ethics Committee Delhi Medical Council.  

Ask Dr KK: In CPR what should be the compression to breathing ratio?

When giving cardiopulmonary resuscitation involving breathing–chest compression cycles, the ratio should be 30 compressions: 2 breaths. This ratio should not be more than five cycles in two minutes.

About the author: Dr K K Aggarwal is Padmashri and Dr B C Roy National Awardee, President Heart Care Foundation of India, Dean Board of Medical Education Moolchand Medcity, Sr. Physician & Cardiologist, Visiting professor Clinical Research DIPSAR, Past President Delhi Medical Association, Past Academic and Research Wing Head IMA, Chairman Ethics Committee Delhi Medical Council.  

Ask Dr KK: Who should lead the chest compression cardiac resuscitation?

When multiple rescuers are available, the person highest trained should become the leader, direct and take the first two minutes of the resuscitation cycle.

About the author: Dr K K Aggarwal is Padmashri and Dr B C Roy National Awardee, President Heart Care Foundation of India, Dean Board of Medical Education Moolchand Medcity, Sr. Physician & Cardiologist, Visiting professor Clinical Research DIPSAR, Past President Delhi Medical Association, Past Academic and Research Wing Head IMA, Chairman Ethics Committee Delhi Medical Council.  

Ask Dr KK: How long to wait before starting chest compression cardiac resuscitation?

Do not waste more than 10 seconds to check pulse or breathing before starting chest compression cardiac resuscitation [CCCR]. Even second’s delay matters. Therefore, CCCR should be started without delay.

About the author: Dr K K Aggarwal is Padmashri and Dr B C Roy National Awardee, President Heart Care Foundation of India, Dean Board of Medical Education Moolchand Medcity, Sr. Physician & Cardiologist, Visiting professor Clinical Research DIPSAR, Past President Delhi Medical Association, Past Academic and Research Wing Head IMA, Chairman Ethics Committee Delhi Medical Council.  

Ask Dr KK: In sudden cardiac arrest how to defibrillate?

While giving defibrillation, one should use the maximum Jules available in the machine. After defibrillation, one should not wait to watch for the rhythm but continue chest compression cardiac resuscitation [CCCR] uninterrupted for the next two minutes.

About the author: Dr K K Aggarwal is Padmashri and Dr B C Roy National Awardee, President Heart Care Foundation of India, Dean Board of Medical Education Moolchand Medcity, Sr. Physician & Cardiologist, Visiting professor Clinical Research DIPSAR, Past President Delhi Medical Association, Past Academic and Research Wing Head IMA, Chairman Ethics Committee Delhi Medical Council.  

Ask Dr KK: Is chest compression cardiac resuscitation effective in children?

Only chest compression cardiac resuscitation [CCCR] is more effective in adults. In other conditions like children, unwitnessed cardiac arrest and non cardiac arrests, one may have to do complete cardiac pulmonary resuscitation involving breathing and chest compression cycles.

About the author: Dr K K Aggarwal is Padmashri and Dr B C Roy National Awardee, President Heart Care Foundation of India, Dean Board of Medical Education Moolchand Medcity, Sr. Physician & Cardiologist, Visiting professor Clinical Research DIPSAR, Past President Delhi Medical Association, Past Academic and Research Wing Head IMA, Chairman Ethics Committee Delhi Medical Council.  

Ask Dr KK: What is chest compression cardiac resuscitation [CCCR]

It involves compressing the chest with a speed of 100 per minute. The Mantra is to push as hard and as fast as possible. Each compression should lower the sternum by 1.5 to 2 inches, should be continuous and allow full recoil of the sternum.


One person can effectively carry out chest compression for only 1–2 minutes. After that fatigue will invariably set in. Therefore, it is important to switch resuscitations between available bystanders.

About the author: Dr K K Aggarwal is Padmashri and Dr B C Roy National Awardee, President Heart Care Foundation of India, Dean Board of Medical Education Moolchand Medcity, Sr. Physician & Cardiologist, Visiting professor Clinical Research DIPSAR, Past President Delhi Medical Association, Past Academic and Research Wing Head IMA, Chairman Ethics Committee Delhi Medical Council.  

Ask Dr KK: How to treat cardiac arrest presenting after 10 minutes of the arrest?

The patient after ten minutes of arrest is in metabolic phase.  Only hypothermia system can work here.

About the author: Dr K K Aggarwal is Padmashri and Dr B C Roy National Awardee, President Heart Care Foundation of India, Dean Board of Medical Education Moolchand Medcity, Sr. Physician & Cardiologist, Visiting professor Clinical Research DIPSAR, Past President Delhi Medical Association, Past Academic and Research Wing Head IMA, Chairman Ethics Committee Delhi Medical Council.  

Ask Dr KK: How to treat a cardiac arrest presenting between 5-10 minutes of the arrest?

The 5-10 minutes of cardiac arrest is the Hemodynamic phase.  Ventricular fibrillation persists and the patient, in addition, has hemodynamic instability. These patients require effective two minutes of chest compression cardiac resuscitation [CCCR] before defibrillation is attempted followed by two minutes of CCCR again.

About the author: Dr K K Aggarwal is Padmashri and Dr B C Roy National Awardee, President Heart Care Foundation of India, Dean Board of Medical Education Moolchand Medcity, Sr. Physician & Cardiologist, Visiting professor Clinical Research DIPSAR, Past President Delhi Medical Association, Past Academic and Research Wing Head IMA, Chairman Ethics Committee Delhi Medical Council.  

Ask Dr KK: How to treat cardiac arrest in the first 5 minutes?

The first 5 minutes after cardiac arrest is the clinical phase. In this phase ventricular fibrillation is the main electrical activity. The treatment of choice is defibrillation followed by chest compression cardiac resuscitation (CCCR).

About the author: Dr K K Aggarwal is Padmashri and Dr B C Roy National Awardee, President Heart Care Foundation of India, Dean Board of Medical Education Moolchand Medcity, Sr. Physician & Cardiologist, Visiting professor Clinical Research DIPSAR, Past President Delhi Medical Association, Past Academic and Research Wing Head IMA, Chairman Ethics Committee Delhi Medical Council.  

Ask Dr KK: What are three clinical phases after a sudden cardiac arrest?

1. Clinical phase: which lasts 0–5 minutes where ventricular fibrillation is the main electrical activity and the treatment of choice is defibrillation followed by chest compression cardiac resuscitation [CCCR].
2. Hemodynamic phase: which lasts 5–10 minutes. Ventricular fibrillation persists and the patient, in addition, has hemodynamic instability. These patients require effective two minutes of chest compression cardiac resuscitation [CCCR] before defibrillation is attempted followed by two minutes of CCCR again.
3. Metabolic phase: phase beyond 10 minutes. Only hypothermia system can work here.

About the author: Dr K K Aggarwal is Padmashri and Dr B C Roy National Awardee, President Heart Care Foundation of India, Dean Board of Medical Education Moolchand Medcity, Sr. Physician & Cardiologist, Visiting professor Clinical Research DIPSAR, Past President Delhi Medical Association, Past Academic and Research Wing Head IMA, Chairman Ethics Committee Delhi Medical Council.  

Ask Dr KK: How common is sudden cardiac death?

About 4-500,000 people in US, 700,000 in Europe and 2 million in India die every year directly due to Sudden Cardiac Death. In India, majority of them die before reaching the hospital and 75% of them can be revived if chest compression cardiac resuscitation (CCCR) is taught to all.

About the author: Dr K K Aggarwal is Padmashri and Dr B C Roy National Awardee, President Heart Care Foundation of India, Dean Board of Medical Education Moolchand Medcity, Sr. Physician & Cardiologist, Visiting professor Clinical Research DIPSAR, Past President Delhi Medical Association, Past Academic and Research Wing Head IMA, Chairman Ethics Committee Delhi Medical Council.  

Ask Dr KK: How is sudden cardiac death different from sudden cardiac arrest?

Sudden cardiac arrest is cessation of cardiac activity which can get revived after resuscitation. On the other hand, Sudden Cardiac Death is unsuccessful sudden cardiac arrest.

About the author: Dr K K Aggarwal is Padmashri and Dr B C Roy National Awardee, President Heart Care Foundation of India, Dean Board of Medical Education Moolchand Medcity, Sr. Physician & Cardiologist, Visiting professor Clinical Research DIPSAR, Past President Delhi Medical Association, Past Academic and Research Wing Head IMA, Chairman Ethics Committee Delhi Medical Council.