When we talk about health disparities, we talk about socially disadvantaged populations. The disadvantages can be defined locally if we are talking about local communities, regionally if we are talking about regional populations, nationally if we are talking about national residents, and globally if we are talking about global humans. Local, regional, national, and global economic disparities may define corresponding health disparities.
One among economic disparities can be technology disparities during cardiopulmonary cerebral resuscitation (CPCR). At the rate at which CPCR guidelines are evolving, it may be difficult for local, regional, national, and global institutions to apply CPCR guidelines homogeneously, especially when CPCR guidelines are just recommended and not mandated. While it is understandable to keep the options open for local, regional, national and global institutions to adhere and operate according to recommended and not mandated CPCR guidelines, the economy of local, regional, national, and global institutions may play a major role in what they can afford unless their economy dictates what and how much they choose in terms of keeping up with rapidly evolving CPCR guidelines. The technology disparities emanating from economic realities of local, regional, national, and global institutions can include but are not limited to:
The unavailability of automated external defibrillators (AEDs) may lead to CPCR providers falling back on rarely, if ever, used metaphorical and historical precordial thumps to release therein mechanically generated electricity hoping to maybe defibrillate those needing CPCR without using the unavailable AEDs.
The unavailability of continuous quantitative end-tidal waveform capnography may lead CPCR providers to fall back on visible chest rise to subjectively quantify the adequacy of ventilation during CPCR when continuous quantitative end-tidal waveform capnography would have objectively quantified not only ventilation during CPCR but also circulation induced by high-quality chest compressions during CPCR with early recognition of the return of spontaneous circulation during CPCR.
The unavailability of mechanical chest compressors may lead CPCR providers to fall back on themselves who humanely cannot homogeneously deliver high-quality chest compressions continuously for long periods, unlike mechanical chest compressors, which are limited only by accessibility to their replaceable rechargeable battery power at hand.
The unavailability of automated head-up position (AHUP) devices may lead CPCR providers to fall back on traditional supine CPCR, wherein survival outcomes comparable to AHUP CPCR may not be achieved. Especially more so when manual AHUP CPCR dependent on available CPCR providers slowly adapting to deliver high-quality chest compressions on inclined planes may potentially lag behind mechanical AHUP CPCR dependent on the availability of mechanical chest compressors which can be rapidly adapted to deliver high-quality chest compressions on inclined planes.
The bottom line is that technology disparities may potentially lead to premature cessations in CPCR efficiencies without the availability of recommended tools for efficient CPCR unless such tools have been mandated in due course of time so that local, regional, national and global economies do not have or get to choose what and how much when it comes to technology disparities during CPCR.
Deepak Gupta is an anesthesiologist.
Image credit: Shutterstock.com
