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ESC Congress 2003: Defibrillators save lives also in lay volunteers' hands

September 02, 2003

IMPORTANT: This press release accompanies both a presentation and an ESC press conference given at the ESC Congress 2003. Written by the investigator himself/herself, this press release does not necessarily reflect the opinion of the European Society of Cardiology

ESC Congress 2003: Cold comfort - cough for your life

In the study which took place in Piacenza, Italy, researchers found that when defibrillator devices were broadly disseminated throughout the community, early intervention by lay volunteers trained to use semiautonamic defibrillator was enabled to occur in 5 minutes from the event, 2 minutes faster than traditional Emergency Medical System. This doubled the survival rate from out-of-hospital sudden death, due to myocardial infarction or to other cardiac causes.

Over 300,000 sudden cardiac deaths occur every year in Europe. The main cause is a fast ventricular arrhythmia, but the victim can be successfully converted to the normal rhythm and saved only if he/she undergoes to defibrillation in the shortest time interval as possible. However actually no more than 1% to 5% of the victims survives.

This is caused by delays in the prompt defibrillation which for several reasons is performed too late to save vital functions. In fact it is necessary that the defibrillator is applied in less than 5 minutes ('golden 5 minutes') to restore the normal activity of the heart before irreversible damage to vital organ due to lack of oxygen, such as the brain, occurs and persists even if the patient is successfully resuscitated later.

However during the last three decades, despite enormous efforts to improve survival by bettering the organization of the Emergency Medical Systems (with the formation of the '911 system' in USA, and the '118' or '112' in Europe) and by widespread of the culture and knowledge of the traditional cardiopulmonary resuscitation, no rise in survival for this dramatic event has been observed: cardiac arrest outside hospital still makes a disproportionately large contribution to mortality in the Western world.

Many people, used to seeing heroic rescues on TV shows, have an exaggerated idea of the life-saving potential of traditional resuscitation. In real life, this traditional rescue method rarely works and most people who get cardiopulmonary resuscitation die. Such sobering statistics have caused a rethinking about the way rescue is usually portrayed and taught. A major Cardiological Associations, the American Heart Association, is considering whether to simplify traditional resuscitation in an effort to get more bystanders to perform the procedure and to do a better job of it. It is necessary that a defibrillator, the life-saving device, is widely distributed and easily accessible and to train the largest number of lay volunteers in its use to save damaged hearts from infarction to be saved,

Recently a new and intelligent model of defibrillator has been created, able to automatically diagnose and recognise the dangerous arrhythmias, and to defibrillate the patients via two pads to re-activate the heart. The machines are simple: diagrams show the rescuer where to place the pads on the victim. The machine then assesses the patient, and a recorded voice tells whether to administer a shock, and so it can be used also by non-medical personnel. It has been demonstrated to be safe both for the rescuer and for the patient.

Strategies to reduce the delay in performing defibrillation (the main factor determining survival) include placing defibrillators in busy public places (such as stations, airports, malls, sports arena) for use by those present, or equipping first responders who can reach a victim before an ambulance.

Early of experiences of such strategies developed in the nineties in the US, in small towns such as Seattle and Rochester, demonstrating the feasibility of these projects and now more than 300 lives each year are saved thanks to them.

In Europe the community that first develops a project to improve public access to early defibrillation is Piacenza, where this experience has been imported by Alessandro Capucci, chief of the Cardiology Division of the local General District Hospital: "Four years age in Seattle I had this idea, and immediately we started the project of developing a network of automatic defibrillator to cover the town and its regional areas, and to train lay personnel in its use". This project has been called the "Piacenza Progetto Vita" to serve the 195,716 residents in the region. A total of 59 semiautomatic, external biphasic defibrillators were distributed throughout the community. Twenty-one placed in high-risk locations, 18 in lay-staffed ambulances, and 12 in police cars. A total of 1925 lay volunteers were trained to use the defibrillators without the traditional education in cardiopulmonary resuscitation.

"Two Minutes Make A Difference" Between Life And Death
Because the time factor is crucial, in this project the survival of a patients is mainly based on the prompt intervention of the lay-staffed ambulances or police cars whose arrival time is closed to the "golden 5 minutes" and to apply the defibrillators before the term when the intervention is ineffective. The medics and paramedics of the Emergency Medical System will refine the intervention and perform traditional cardiac respiratory resuscitation if necessary and therefore they will bring the victim to the Hospital Emergency Rooms where specialized doctors will be able to renew the different phases of the succor intervention, by reviewing the 'black box' of the defibrillator, a PC card, where all the ECG tracing and voices have been recorded.

The integration of early defibrillation performed by lay volunteers into the Emergency System allowed to dramatically reduce mortality rates, thereby doubling overall and neurologically intact survival rates from sudden cardiac arrest. During the first 40 months, volunteers in the programme treated almost 50% of the cases of sudden death cases (446 out of a total of 947). In these cases, in fact they arrived earlier: they took an average of 5.4 minutes for their arrival after a call was made, 2 minutes faster than traditional Emergency Medical System (which took 7.4 minutes).

This determines a higher survival among those victims first treated by the Progetto Vita volunteers. In fact overall, 6.4% of those patients survived to leave the hospital, compared with 3.3% of those who were treated by traditional System. For witnessed sudden death, the survival to discharge was 9.3% in the volunteer group, compared with 4.4% for the traditional Emergency System group.

In the Italian cohorts of patients with shockable rhythm the use of defibrillators by volunteer group was found to save life in the 34% of the patients and in 18.7% in the group treated by Emergency System.

This effort could become reality only thanks to the crucial contribution of the charity organization, 'Il Cuore di Piacenza' ('The Heart of Piacenza'), which took care of widespread the message of early defibrillation among the general public and fund rising.

The importance of an early defibrillation programme by lay volunteers equipped with defibrillators in Europe is now well documented. The programme is reliable, safe, and cost-effective.

Early defibrillation programmes have the potential to be the single greatest advance in the treatment of prehospital sudden cardiac arrest and automatic defibrillators have to be part of the culture, just like fire extinguishers.


(ORIGINAL ABSTRACT : Sudden Cardiac Arrest Reduction via Early Defibrillation, Without Traditional Education in Cardiac-Pulmonary Resuscitation)

Massimo F.Piepoli
Cardiology dept. Guglielmo da Saliceto Hospital,
*Emergency Medical System - Piacenza
Italy

European Society of Cardiology (ESC)