AED use before EMS arrival: When survival becomes a matter of law and system in Italy, which can be improved

AED use before EMS arrival: When survival becomes a matter of law and system in Italy, which can... 1664 CardioPulse Acknowledgements References We acknowledge the help extended by the office of Professor Iradj References are available as supplementary material at European Heart Gandjbakhch, the present President of ADICARE for preparing this Journal online. article. Conflict of interest: none declared. doi:10.1093/eurheartj/ehy196 AED use before EMS arrival When survival becomes a matter of law and system in Italy, which can be improved The chances of survival during an out of hospital cardiac arrest (OHCA) Notably, Italy is one of the European Countries in which the law strongly depend on early and high-quality Cardio-Pulmonary Resuscitation states that a layperson requires a certificate to use an AED. We can associated with a rapid use of an Automated External Defibrillator confirm that in countries where there is a law similar to the Italian one, 1 15,16 (AED). The relationship between the widespread use of AEDs and the such as Ireland and Qatar, the percentage of AEDs used is similar 2,3 increase of OHCA victims’ survival have been recently pointed out and, to that of our province, respectively, 5% and 2.4%. To the contrary, additionally, the 2015 guidelines highlighted that the use of AED by where a ‘Good Samaritan’ law is present allowing all citizens to use an untrained laypeople is safe and effective and must be encouraged. AED, as in Switzerland, Denmark, Sweden, and Netherland, the per- However, data of AED use before the arrival of Emergency Medical centage use of AEDs before EMS arrival is by far higher, 15–20% of 2,17–20 Services (EMS) in Italy are limited and most them are not recent or not cases or more. This allows us to reasonably conclude that a 4–10 presented according to the Utstein style. Therefore, we wanted to Good Samaritan law in Italy could also increase the use of AEDs by verify how many AEDs were used before EMS arrival in 2 = years in bystanders and moreover, its implementation is encouraged by 2015 our Province and if that improved survival after an OHCA. Guidelines. We considered all the patients who suffered an OHCA between Another important element that should be improved in our region October 2014 and March 2017 using data from the Pavia Province is the response system to an OHCA. There are much evidences that in Cardiac Arrest Registry (Pavia CARe). We calculated the rate of AED areas where laypersons, police officers, and fire brigade personnel are use before EMS arrival in the Utstein comparator group, namely involved in the response system and alerted for an OHCA, also by patients whose cardiac arrest was witnessed by bystander and whose mobile phone-based Apps, the rate of bystander CPR and the use of 21–25 first rhythm was shockable: an AED was used by bystander in just 9 of AEDs before EMS arrival and the survival are increased. 140 patients (6.4%). In summary, we believe that in Italy there should be a revision both We then performed a second analysis on the patients, both of both the law and of the response system to an OHCA, to increase bystander witnessed or unwitnessed, who received bystander CPR the use of AEDs before EMS arrival and, therefore, survival after an and had a shockable rhythm. We divided the patients in two groups OHCA. depending on whether AED was used before EMS arrival (Public Access Defibrillation group—10 patients) or by EMS (EMS group—99 Enrico Baldi MD Corresponding author School of Cardiovascular Disease patients). The two groups were similar in terms of age and sex. The University of Pavia, 27100 Pavia, Italy. Division of Cardiology rate of survival at 30 days with Cerebral Performance Category (CPC) Fondazione IRCCS Policlinico San Matteo 27100 Pavia, Italy. Via Sauro 34, 27038 Robbio (PV), Italy Scale score of 1 or 2 was significantly higher in PAD group (60%) com- Email: enrico.baldi88@gmail.com Tel: +39 3293556062 pared to EMS group (24%) (P¼ 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). Simone Savastano, MD We confirmed that AED use before EMS arrival increases survival Division of Cardiology Fondazione IRCCS Policlinico San Matteo by about three times with good neurological outcome also in our 27100 Pavia, Italy. Email: s.savastano@smatteo.pv.it Tel: 3332553575 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 Conflict of interest: none declared. instruction in the population carried out by various training centres 11–13 during the last years. Therefore, the low use of AEDs is not to be References sought only in the difficulty of finding an available AED or in the poor References are available as supplementary material at European Heart awareness of the population, but rather in the fact that in Italy the law Journal online. restricts the use of AEDs. Downloaded from https://academic.oup.com/eurheartj/article-abstract/39/19/1664/4995731 by Ed 'DeepDyve' Gillespie user on 21 June 2018 http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png European Heart Journal Oxford University Press

AED use before EMS arrival: When survival becomes a matter of law and system in Italy, which can be improved

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Oxford University Press
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2018. For permissions, please email: journals.permissions@oup.com.
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0195-668X
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10.1093/eurheartj/ehy196
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Abstract

1664 CardioPulse Acknowledgements References We acknowledge the help extended by the office of Professor Iradj References are available as supplementary material at European Heart Gandjbakhch, the present President of ADICARE for preparing this Journal online. article. Conflict of interest: none declared. doi:10.1093/eurheartj/ehy196 AED use before EMS arrival When survival becomes a matter of law and system in Italy, which can be improved The chances of survival during an out of hospital cardiac arrest (OHCA) Notably, Italy is one of the European Countries in which the law strongly depend on early and high-quality Cardio-Pulmonary Resuscitation states that a layperson requires a certificate to use an AED. We can associated with a rapid use of an Automated External Defibrillator confirm that in countries where there is a law similar to the Italian one, 1 15,16 (AED). The relationship between the widespread use of AEDs and the such as Ireland and Qatar, the percentage of AEDs used is similar 2,3 increase of OHCA victims’ survival have been recently pointed out and, to that of our province, respectively, 5% and 2.4%. To the contrary, additionally, the 2015 guidelines highlighted that the use of AED by where a ‘Good Samaritan’ law is present allowing all citizens to use an untrained laypeople is safe and effective and must be encouraged. AED, as in Switzerland, Denmark, Sweden, and Netherland, the per- However, data of AED use before the arrival of Emergency Medical centage use of AEDs before EMS arrival is by far higher, 15–20% of 2,17–20 Services (EMS) in Italy are limited and most them are not recent or not cases or more. This allows us to reasonably conclude that a 4–10 presented according to the Utstein style. Therefore, we wanted to Good Samaritan law in Italy could also increase the use of AEDs by verify how many AEDs were used before EMS arrival in 2 = years in bystanders and moreover, its implementation is encouraged by 2015 our Province and if that improved survival after an OHCA. Guidelines. We considered all the patients who suffered an OHCA between Another important element that should be improved in our region October 2014 and March 2017 using data from the Pavia Province is the response system to an OHCA. There are much evidences that in Cardiac Arrest Registry (Pavia CARe). We calculated the rate of AED areas where laypersons, police officers, and fire brigade personnel are use before EMS arrival in the Utstein comparator group, namely involved in the response system and alerted for an OHCA, also by patients whose cardiac arrest was witnessed by bystander and whose mobile phone-based Apps, the rate of bystander CPR and the use of 21–25 first rhythm was shockable: an AED was used by bystander in just 9 of AEDs before EMS arrival and the survival are increased. 140 patients (6.4%). In summary, we believe that in Italy there should be a revision both We then performed a second analysis on the patients, both of both the law and of the response system to an OHCA, to increase bystander witnessed or unwitnessed, who received bystander CPR the use of AEDs before EMS arrival and, therefore, survival after an and had a shockable rhythm. We divided the patients in two groups OHCA. depending on whether AED was used before EMS arrival (Public Access Defibrillation group—10 patients) or by EMS (EMS group—99 Enrico Baldi MD Corresponding author School of Cardiovascular Disease patients). The two groups were similar in terms of age and sex. The University of Pavia, 27100 Pavia, Italy. Division of Cardiology rate of survival at 30 days with Cerebral Performance Category (CPC) Fondazione IRCCS Policlinico San Matteo 27100 Pavia, Italy. Via Sauro 34, 27038 Robbio (PV), Italy Scale score of 1 or 2 was significantly higher in PAD group (60%) com- Email: enrico.baldi88@gmail.com Tel: +39 3293556062 pared to EMS group (24%) (P¼ 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). Simone Savastano, MD We confirmed that AED use before EMS arrival increases survival Division of Cardiology Fondazione IRCCS Policlinico San Matteo by about three times with good neurological outcome also in our 27100 Pavia, Italy. Email: s.savastano@smatteo.pv.it Tel: 3332553575 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 Conflict of interest: none declared. instruction in the population carried out by various training centres 11–13 during the last years. Therefore, the low use of AEDs is not to be References sought only in the difficulty of finding an available AED or in the poor References are available as supplementary material at European Heart awareness of the population, but rather in the fact that in Italy the law Journal online. restricts the use of AEDs. Downloaded from https://academic.oup.com/eurheartj/article-abstract/39/19/1664/4995731 by Ed 'DeepDyve' Gillespie user on 21 June 2018

Journal

European Heart JournalOxford University Press

Published: May 11, 2018

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