Fact Check: Can CPR be performed on a conscious person?

A viral video shows CPR being performed on a conscious person. Many tweets including on by the railway minister related to this video hailed the person performing the CPR for saving the person's life. However, video has been slammed by doctors pointing out that CPR on conscious person is not safe and can lead to dangerous consequences.  

Claim

A viral video circulating on Instagram shows a Travelling Ticket Examiner administering cardiopulmonary resuscitation to a 70-year-old passenger on a train.

The video was shared by Railway Minister Ashwini Vaishnaw and the Ministry of Railways, capturing the Travelling Ticket Examiner (TTE) providing medical assistance in the general coach of train number 15708, Amarpali Express. Reports indicate the elderly passenger experienced a cardiac issue and required immediate attention. The TTE performed cardiopulmonary resuscitation (CPR), and the passenger was reportedly conscious during the intervention.

The post shared by the official page of the Ministry of Railways was captioned "TTE's alertness gave a new lease of life to the passenger. While traveling in the general coach of train number 15708 Amrapali Express, a 70-year-old passenger suffered a heart attack. The TTE deployed there immediately performed CPR and saved the life of the passenger. The passenger was later sent to a hospital at Chhapra railway station," The same video was shared by Railway Minister Ashwini Vaishnaw "Our dedicated Indian Railways’ team(sic)."In reply to the same post, the Minister wrote: "CPR should be stopped when a person becomes conscious or follows commands, which are signs of return of spontaneous circulation(sic)."

The video was initially praised by the audience, and numerous articles were published by various portals, however was soon slammed by many for being unscientific 

However, video is available online and can be accessed here.

Fact Check: Can CPR be performed on a conscious person?

CPR (cardiopulmonary resuscitation) is a life-saving procedure meant only for unresponsive individuals who are not breathing or have abnormal breathing, such as agonal gasps. Performing CPR on a conscious patient is inappropriate and can cause serious harm, including internal injuries. CPR should only be used in cases of cardiac or respiratory arrest, as guided by trained responders.

As per the American Heart Association, "CPR chest compressions should be performed on an unresponsive adult who has no pulse or who is not breathing normally".

Therefore, CPR should only be performed on unresponsive individuals who are not breathing or exhibiting abnormal breathing, as performing it on conscious patients can cause unnecessary harm. Therefore, the video showing the CPR being performed on conscious person is misleading and the claim that this is leading to save life is False

Dr Aman Rathore, DNB, Critical Care Medicine, Max Super Speciality Hospital shared his views on the viral video circulating, "CPR is not meant for a conscious individual. It is only performed on someone unresponsive and not breathing. Administering chest compressions and rescue breaths to a person who is awake and has normal heart and lung function can result in significant harm. CPR is a life-saving measure designed for people in cardiac arrest. Attempting it on a conscious person is both unnecessary and dangerous. In emergencies, understanding proper protocols is critical to avoid causing harm."

Dr Karan Juneja, IMA JDN National Co-convenor further explained, "Performing CPR on a conscious person is potentially harmful. CPR involves chest compressions and rescue breaths to support circulation and oxygen delivery when the heart has stopped or the person is not breathing. On a conscious individual who is breathing adequately, this procedure could cause injuries like rib fractures or harm their heart unnecessarily. This claim is false and may spread dangerous misconceptions about CPR. It’s crucial to only administer CPR when it is truly needed, following proper training and guidelines."

The video also attracted considerable backlash from the medical community, leading to extensive media coverage. A report by Times Of India report was headlined "Doctor performs life saving CPR on patient in train, but health experts are upset: Know why" while India TV ran a report titled "When is the right time to perform CPR? Viral Railways video raises question"

Dr. Sam Ghali, a US-based emergency medicine physician shared his insights regarding the video. He said, "Hi, ER Doc here. I can’t believe I actually have to say this but do NOT perform mouth-to-mouth CPR on awake people who are literally talking to you."

An Indian Hepatologist TheLiverDoc on his X account also shared his perspective on the video shared by the Ministry. He wrote, "Dear Railways (Reels) Minister, it is imperative that you delete this post of yours. It showcases your lack of medical science literacy, and the utter lack of basic health literacy of the Railways team currently working under you.

At least ask your PR team to take advice from a doctor or some medical health professional (non-Ayush) before you post something as idiotic as this.

CPR or cardiopulmonary resuscitation is an emergency procedure that helps restart breathing and a person's heartbeat when they have stopped.

Before starting CPR, check:

-Is the environment safe for the person?

-Is the person conscious or not conscious?

-If the person appears to be not conscious, tap or shake their shoulder and ask loudly, "Are you OK?"

-If the person doesn't respond and you're with someone else who can help, have one person call the local emergency number and get an automated external defibrillator (AED) if one is available.

-Please note, start CPR only in an unconscious patient.

Cardiopulmonary resuscitation should never be performed on a conscious patient as it is designed for individuals who are unconscious and not breathing. Again, in case you or your trained staff did not understand, "If a person is conscious and breathing, even if they are experiencing discomfort, do not initiate CPR."

This video is ALL SORTS OF WRONG. The railway person is harming the patient. His chest compressions are wrong, crude and he is impairing the chances of spontaneous breathing and increasing the risk of rib fractures and chest trauma. What utter nonsense is this?

Also, he stole a kiss from the passenger without his consent, in the name of "treatment." He should be booked for criminal offence. Is this some kind of fetish from your staff?

In India, kissing someone without consent would be considered a crime under the law of sexual harassment, specifically falling under Section 354 of the Indian Penal Code (IPC, now BNS) - essentially, any non-consensual physical contact, including a kiss, can be considered sexual assault and is punishable by law.

Delete this abomination. It is a request from a citizen. We already have so much disgrace to deal with as a nation.

Read about CRP properly please. You can join a course or ask your staff to join, if you are busy with uploading content: cprindia.in"