Community-based AED only resuscitation for Out of Hospital Cardiac Arrest victims

Background: Speed is the cornerstone of rescue for out-of-hospital cardiac arrest (OOHCA). As a consequence, community participation programs have been initiated to decrease response times. Even in the very best of these programs, however, short-term survival rates hover around 10% and long-term survival rates are half that. In the majority of locales, survival is far worse. In Piacenza, Italy, responders have been trained for over a decade to use publicly available AEDs and eschew the performance of CPR. It is known locally as ―Progetto Vita.‖ Methods: From 2001 to 2014, we prospectively collected outcome data on all Progetto Vita treated patients and all 3271 standard Emergency Medical Services (EMS) patients. Progetto Vita rescuers simply accessed a public AED, turned it on, and only followed its instructions. Progetto Vita rescuers did not do CPR of any sort. If EMS arrived prior to initiation or even completion of the Progetto Vita protocol, EMS supplanted Progetto Vita efforts and patients were not included in the Progetto Vita cohort. Follow-up was collected by each responders data files, chart review, and use of the Italian system death index. All cardiac arrest patient death status was validated in 100% of victims through August 1, 2014. Findings: Survival to hospital discharge occurred in 39 of the 95 patients (41.4%) treated by Progetto Vita and in 193 of the 3271 EMS patients (5.9%). At 13-years follow-up, the Kaplan Meier estimates of survival were 31.8% when AEDs only were used and 2.4% for standard EMS/CPR response. Estimates of survival are significantly better for Progetto Vita AED only therapy when survival was stratified by time to respond, gender, location of cardiac arrest, and shockable rhythm. Relative to the 95 EMS patients with the fastest response times, Progetto Vita intervention was associated with a more than 2-fold increased rate of survival. Interpretation: This is the first demonstration of excellent long-term survival from out-of-hospital cardiac arrest by promoting speed and ease of lay AED response without CPR. Funding: Cassa di Risparmio di Piacenza e Vigevano Foundation. AC C EP TE D M AN U SC R IP T ACCEPTED MANUSCRIPT INTRODUCTION Out-of-hospital cardiac arrest (OOHCA) is peerless in its unpredictability, logistical obstacles, and the time-urgency of interventions. Speed is the cornerstone of any rescue strategy for OOHCA. Without speed, the best of therapeutic interventions fails. As a consequence, multiple community participation programs have been initiated to decrease response times. However, even in premier programs, short-term survival rates hover around 10%. 1,2 In many locales, survival is far worse. 3,4 In this study, we broke with tradition and promoted simplicity and speed of AED use over traditional interventional training of the lay populace. We used a unique venue, Piacenza, Italy, where community responders were only trained to use publicly available AEDs and to eschew the performance of CPR. It is known locally as Progetto Vita (Project Life) and was the first early defibrillation effort established in Europe. 5 Progetto Vita runs in parallel to the city’s Emergency Medical Services (EMS) system with its standardly structured Basic Life Support (BLS) and Advanced Life Support (ALS) vehicle response systems that follow international guidelines for response to OOHCA. Initial short-term survival results from this program were reported in 2002. 5 In this report, we report long-term survival of this unique approach to OOHCA.