TY - JOUR AU1 - Baldi, Enrico AU2 - Savastano, Simone AB - The chances of survival during an out of hospital cardiac arrest (OHCA) strongly depend on early and high-quality Cardio-Pulmonary Resuscitation associated with a rapid use of an Automated External Defibrillator (AED).1 The relationship between the widespread use of AEDs and the increase of OHCA victims’ survival have been recently pointed out2,3 and, additionally, the 2015 guidelines highlighted that the use of AED by untrained laypeople is safe and effective and must be encouraged.1 However, data of AED use before the arrival of Emergency Medical Services (EMS) in Italy are limited and most them are not recent or not presented according to the Utstein style.4–10 Therefore, we wanted to verify how many AEDs were used before EMS arrival in 2½ years in our Province and if that improved survival after an OHCA. We considered all the patients who suffered an OHCA between October 2014 and March 2017 using data from the Pavia Province Cardiac Arrest Registry (Pavia CARe). We calculated the rate of AED use before EMS arrival in the Utstein comparator group, namely patients whose cardiac arrest was witnessed by bystander and whose first rhythm was shockable: an AED was used by bystander in just 9 of 140 patients (6.4%). We then performed a second analysis on the patients, both bystander witnessed or unwitnessed, who received bystander CPR and had a shockable rhythm. We divided the patients in two groups depending on whether AED was used before EMS arrival (Public Access Defibrillation group—10 patients) or by EMS (EMS group—99 patients). The two groups were similar in terms of age and sex. The rate of survival at 30 days with Cerebral Performance Category (CPC) Scale score of 1 or 2 was significantly higher in PAD group (60%) compared to EMS group (24%) (P = 0.02) and the time from cardiac arrest to the first shock was significantly shorter in the first group (5 min) compared to the second one (12 min). We confirmed that AED use before EMS arrival increases survival by about three times with good neurological outcome also in our Province. On the other hand, the rate of AED use before EMS arrival is low (6.4%). This is despite the large number of AEDs accessible to the public in our province, 503 AEDs (1/1093 inhabitants), and CPR instruction in the population carried out by various training centres during the last years.11–13 Therefore, the low use of AEDs is not to be sought only in the difficulty of finding an available AED or in the poor awareness of the population, but rather in the fact that in Italy the law restricts the use of AEDs. Notably, Italy is one of the European Countries in which the law states that a layperson requires a certificate to use an AED.14 We can confirm that in countries where there is a law similar to the Italian one, such as Ireland and Qatar,15,16 the percentage of AEDs used is similar to that of our province, respectively, 5% and 2.4%. To the contrary, where a ‘Good Samaritan’ law is present allowing all citizens to use an AED, as in Switzerland, Denmark, Sweden, and Netherland, the percentage use of AEDs before EMS arrival is by far higher, 15–20% of cases or more.2,17–20 This allows us to reasonably conclude that a Good Samaritan law in Italy could also increase the use of AEDs by bystanders and moreover, its implementation is encouraged by 2015 Guidelines.1 Another important element that should be improved in our region is the response system to an OHCA. There are much evidences that in areas where laypersons, police officers, and fire brigade personnel are involved in the response system and alerted for an OHCA, also by mobile phone-based Apps, the rate of bystander CPR and the use of AEDs before EMS arrival and the survival are increased.21–25 In summary, we believe that in Italy there should be a revision both of both the law and of the response system to an OHCA, to increase the use of AEDs before EMS arrival and, therefore, survival after an OHCA. Conflict of interest: none declared. References References are available as supplementary material at European Heart Journal online. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2018. For permissions, please email: journals.permissions@oup.com. This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/about_us/legal/notices) TI - AED use before EMS arrival JF - European Heart Journal DO - 10.1093/eurheartj/ehy196 DA - 2018-05-14 UR - https://www.deepdyve.com/lp/oxford-university-press/aed-use-before-ems-arrival-03H1EI5UbX SP - 1664 EP - 1664 VL - 39 IS - 19 DP - DeepDyve ER -