Improved Survival With Automated External Defibrillator-Only Training in a Public-Access Defibrillation Program: A...

Out-of-hospital cardiac arrest remains a significant public health challenge, characterized by poor overall survival. Early defibrillation is crucial to manage fatal arrhythmias. The use of automated external defibrillators is a promising tool in minimizing time to defibrillation and enhancing survival.

PV (Progetto Vita) in Piacenza pioneered the first community-based automated external defibrillator project in Europe. We present survival data spanning 23 years for all cases of out-of-hospital cardiac arrest managed under both PV and standard emergency medical services interventions.

A total of 6996 out-of-hospital cardiac arrests were recorded. Among these, 156 cases were managed by PV volunteers (PV group). The PV group managed a significantly higher proportion of shockable rhythms than the emergency medical services group (69.9% versus 10.9%). Mean time to arrival was shorter (5.7 versus 10.2 minutes), and survival rates better with favorable neurological outcomes (46.2% versus 2.9%, overall). Survival rates declined with time. However, a higher proportion of patients in the PV -group demonstrated favorable neurological outcomes, even up to 9 minutes from the call, compared with the EMS group. Over the study period, the increasing number of automated external defibrillators in fixed public places coincided with a substantial rise in ventricular fibrillation survival in the PV group patients (22% for 2003-2012 to 73% for 2013-2022, P<0.001). Both time from call to arrival and PV-group intervention emerged as independent predictors of survival (odds ratio 1.08 and 0.28, respectively).

Our simplified automated external defibrillator-focused training for community has shown higher survival rates and emerges as a highly successful strategy in a small city.