Search Results (5)

Out-of-hospital cardiac arrest (OHCA) remains a leading cause of sudden death worldwide, with wide variation in reported incidence and outcomes driven by heterogeneity in registries, emergency medical services (EMS) organization, and case definitions. Despite substantial advances in resuscitation systems, survival after EMS-treated OHCA generally remains below 10%, and outcomes are critically time dependent. Delays in emergency call activation, bystander cardiopulmonary resuscitation (CPR), and—most importantly—early defibrillation are associated with a rapid decline in return of spontaneous circulation and favorable neurological recovery. This narrative review synthesizes current evidence and implementation strategies aimed at reducing “time-to-CPR” and “time-to-shock,” with a specific focus on public-access defibrillation (PAD) as a tool to mitigate avoidable delay. Randomized trials and large registry studies consistently demonstrate that automated external defibrillator (AED) use before EMS arrival is a key determinant of survival in patients with shockable rhythms. However, the real-world effectiveness of PAD remains limited by suboptimal AED placement, restricted 24/7 accessibility, low public awareness, and underutilization driven by fear and lack of confidence. We compare different PAD delivery models—including EMS-based, police and first-responder-based, and fully integrated community systems—and summarize evidence supporting targeted, high-yield AED deployment and cost-effectiveness. In addition, we review emerging strategies to reduce avoidable delay and strengthen the early links of the chain of survival, such as school-based training programs, smartphone- and SMS-based citizen-responder networks, improved dispatch recognition of cardiac arrest (including artificial intelligence–supported tools), and drone-enabled AED delivery. Across these approaches, patient benefit critically depends on system integration, alert performance, and true AED accessibility. Finally, we describe the Italian “Progetto Vita” experience as a community-integrated model explicitly designed to minimize avoidable delay through widespread AED deployment, lay responder training, and real-time integration with EMS. We conclude by outlining future priorities, including the development of robust national OHCA registries and scalable solutions for the high burden of cardiac arrests occurring at home, such as population-level deployment of low-cost, ultra-portable AEDs. Full article

The most effective strategy to save the life of a victim of out-of-hospital cardiac arrest (OHCA) is to provide aid as early as possible. To achieve this objective, widespread dissemination of knowledge on basic life support and defibrillation (BLSD) in the general population is necessary. In recent years, evidence has been emerging supporting the effectiveness of public-access defibrillation (PAD) programs; the diffusion of automatic external defibrillators (AEDs) and the knowledge of their correct use among lay rescuers are associated with a higher survival rate and better neurological outcomes among OHCA victims. This study aims to implement and monitor a BLSD training program involving an entire city in Italy. Since 2016, a PAD program has been implemented in Busca (CN), a small town in the northwest of Italy. The project was divided into three phases: (1) the diffusion of AEDs in the most-frequented places in the city; (2) BLSD training aimed at reaching the most significant possible number of citizens; (3) the training of all schoolchildren in the basics of first aid. The retention of the concepts learned was assessed via a multiple-choice questionnaire proposed months after the training events. From 2016 to 2023, 42 BLSD courses were held, which trained 1302 adults (12.8% of citizens) with a female/male ratio of 0.9 and a median age of 46 (range: 32–59 years). The participants in the courses were volunteers from associations (59%), athletes (16%), ordinary citizens (13%), school staff (10%), and municipal employees (2%). At the start of the project in 2016, the first 11 AEDs were positioned. To date, the municipal area can count on 25 always-available defibrillators to reach each area within 4 minutes. Furthermore, 1500 school pupils were trained. The retention of the learned notions was excellent. After training, 92% of adult participants and 90% of the schoolchildren reported being willing to provide help in the event of cardiac arrest. The project combined the widespread diffusion of AEDs with a significant number of citizens able to use them, effectively providing cardiopulmonary resuscitation. This project ensured that an entire community shared the goal of saving the lives of people affected by OHCA. Full article

The problem of cardiac arrest, particularly out-of-hospital cardiac arrest (OHCA), is the subject of continuous research. The aim of this study was to analyze the use of an automated external defibrillator (AED) during the resuscitation of an adult in public places in Poland between 2015 and 2020. A retrospective analysis of the selected documentation obtained from AED distributors, the medical records obtained from the emergency call center, and the emergency medical teams was conducted. During the analysis period, there were 100 cases of recorded and documented use of AEDs in OHCAs in public places. In 70% of the cases, defibrillation was performed with an AED. This result could be higher, but the study’s methodology and limited access to data only allowed for this result. In Poland, there are no legal acts on the registration of automatic external defibrillators and their implementation. Appropriate registries should be introduced nationwide as soon as possible. Due to the inadequacy of the medical records of the emergency medical teams to record the use of automated external defibrillators by a bystander to an incident, changes to these documents should be pursued. Based on such a small cohort, it is not possible to conclude that the return of spontaneous blood circulation is correlated with the use of AEDs and public access to defibrillation PADs. Full article

Public Access Defibrillation (PAD) is the leading strategy in reducing time to first defibrillation in cases of Out-Of-Hospital Cardiac Arrest (OHCA), but PAD programs are underperforming considering their potentiality. Our aim was to develop an analysis and optimization framework, exploiting georeferenced information processed with Geographic Information Systems (GISs), specifically targeting residential OHCAs. The framework, based on an historical database of OHCAs, location of Automated External Defibrillators (AEDs), topographic and demographic information, proposes new strategies for AED deployment focusing on residential OHCAs, where performance assessment was evaluated using AEDs “catchment area” (area that can be reached within 6 min walk along streets). The proposed framework was applied to the city of Milan, Lombardy (Italy), considering the OHCA database of four years (2015–2018), including 8152 OHCA, of which 7179 (88.06%) occurred in residential locations. The proposed strategy for AEDs deployment resulted more effective compared to the existing distribution, with a significant improvement (from 41.77% to 73.33%) in OHCAs’ spatial coverage. Further improvements were simulated with different cost scenarios, resulting in more cost-efficient solutions. Results suggest that PAD programs, either in brand-new territories or in further improvements, could significantly benefit from a comprehensive planning, based on mathematical models for risk mapping and on geographical tools. Full article

Out-of-hospital cardiac arrests (OHCA) have a poor outcome. Firefighters, police or emergency medical services are generally unable to reach patients with an OHCA within the 5 minutes required for a successful defibrillation. Based on our experience and the existing literature, we demonstrate the advantage of early defibrillation by laypersons (public access defibrillation [PAD]). The rate of survival of 9% (4/43) at hospital discharge in patients treated by the emergency medical service of the Kantonsspital Baden lies within the worldwide average reported in the international literature. Totally 3 out of 12 defibrillated patients (25%) left the hospital alive. Only one of the surviving patients was, however, defibrillated by the emergency medical service. One patient survived an OHCA with only minimal neurological dysfunctions thanks to the use of an automated external defibrillator (AED) by a layperson. Several studies on PAD show a trend to reduce mortality in OHCA. AEDs can be used safely and cost-effectively by laypersons. Efforts of the Swiss Resuscitation Council (SRC) to promote AEDs in Switzerland in order to minimise the collapse to defibrillation time have not been successful so far. Presently there is no data in this country available about early defibrillation by laypersons to confirm the successful use of PAD. In order to improve the rate of survival after OHCA in Switzerland, sufficient funding and manpower to further promote the use of AEDs in public places with a high probabilty of OHCA is essential. Full article