The first large-scale study to see whether trained volunteers and lay people can use defibrillators to save the lives of cardiac arrest (CA) victims has concluded that their use by lay people is safe, and if the response time can be shortened to within eight minutes there is the potential to save the lives of 15 out of 100 people who collapse suddenly with CA.
Brescia in Italy – a large mixed rural and urban county with an area of more than 4,800 square kilometres and a population of well over a million – was the site for the Brescia Early Defibrillation Study (BEDS), the results of which are reported (Thursday 1 December) in the European Society of Cardiology's journal European Heart Journal.
Dr Riccardo Cappato from Policlinico San Donato, University of Milan, and colleagues from the University of Brescia and the University of Washington in Seattle, USA, initiated BEDS after Italy passed a law allowing the use of automated external defibrillators (AEDs) by non-medical personnel.
A total of 2,186 volunteers and lay people received five hours of training involving theory and practical instruction, including training in basic life support, from 14 qualified instructors. One AED was supplied for every 22,700 of the population, in addition to the existing manually operated defibrillators used by the county's 10 hospitals and in five medically equipped ambulances. The new volunteers were then organised into groups.
The study started in 2000, but for a two year period before that the team collected data to set the parameters for the study, including the numbers of CAs that happened outside of hospitals, the time it took for help to arrive and the number of patients who survived free of any neurological impairment one year after their heart attack. Further data were collected during a six-month pilot study. The historical cohort of 692 acted as comparisons for the prospective study, which involved 702 similar patients between 2000 and 2002.
Dr Cappato, who is Professor of Electrophysiology and Chief of the Arrhythmia and Electrophysiology Center in Milan, said: "Overall, we found that three out of a hundred patients in the prospective study survived to one year without any neurological problems, compared with under one out of a hundred of the earlier comparison group, even though the time from dispatching help to arriving with the patient was similar.
"There was an increase in survival for patients in both urban and rural areas, although it was significantly larger in the city than the countryside due to the shorter response time and larger number of defibrillators available. In the urban areas, survival rose from just under one and half persons per hundred in the earlier group to four per 100 in the study. In the rural areas it rose from one per two hundred in the earlier group to two and a half per hundred in the study. When you look at the relative gains though, as opposed to the absolute values, there was more benefit for the rural areas.
"However, there was a more than three times higher incidence of defibrillator teams being dispatched to CAs in urban areas (0.7 per 1,000 per year) than in the countryside (0.2 per 1,000 per year). This appears either to be mainly due to worse access in the country because of a higher incidence of CAs happening with no witnesses around, or a lower tendency for witnesses in rural areas to call out help."
For every quality adjusted life year (QALY) saved during the study it cost less than 24,000 Euro (around 39,000 Euro during the start-up phase). The set-up costs were over one million Euro and the running costs once the system was established were around 681,000 Euro.