Capucci Alessandro, Aschieri Daniela, Piepoli Massimo F, Bardy Gust H, Iconomu Efrosini, Arvedi Maurizio
Division of Cardiology, Gugliemo da Saliceto Hospital, Piacenza, Italy.
Circulation. 2002 Aug 27;106(9):1065-70. doi: 10.1161/01.cir.0000028148.62305.69.
Early defibrillation is the most important intervention affecting survival from sudden cardiac arrest (SCA). To improve public access to early defibrillation, we established Piacenza Progetto Vita (PPV), the first system of out-of-hospital early defibrillation by first-responder volunteers.
The system serves a population of 173 114 residents in the Piacenza region of Italy. Equipment for the system comprises 39 semiautomatic external biphasic defibrillators (AEDs): 12 placed in high-risk locations, 12 in lay-staffed ambulances, and 15 in police cars; 1285 lay volunteers trained in use of the AED, without traditional education in cardiac pulmonary resuscitation, responded to all cases of suspected SCA, in coordination with the Emergency Medical System (EMS). During the first 22 months, 354 SCA occurred (72+/-12 years, 73% witnessed). The PPV volunteers treated 143 SCA cases (40.4%), with an EMS call-to-arrival time of 4.8+/-1.2 minutes (versus 6.2+/-2.3 minutes for EMS, P=0.05). Overall survival rate to hospital discharge was tripled from 3.3% (7 of 211) for EMS intervention to 10.5% (15 of 143) for PPV intervention (P=0.006). The survival rate for witnessed SCA was tripled by PPV: 15.5% versus 4.3% in the EMS-treated group (P=0.002). A "shockable" rhythm was present in 23.8% (34 of 143) of the PPV patients versus 15.6% (33 of 211) of the EMS patients (P=0.055). The survival rate from shockable dysrhythmias was higher for PPV versus EMS: 44.1% (15 of 34) versus 21.2% (7 of 33), P=0.046. The neurologically intact survival rate was higher in PPV-treated versus EMS-treated patients: 8.4% (12 of 143) versus 2.4% (5 of 211), P=0.009.
Broad dissemination of AEDs for use by nonmedical volunteers enabled early defibrillation and tripled the survival rate for out-of-hospital SCA.
早期除颤是影响心脏骤停（SCA）患者生存的最重要干预措施。为提高公众获得早期除颤的机会，我们建立了皮亚琴察生命计划（PPV），这是首个由急救志愿者进行院外早期除颤的系统。
该系统服务于意大利皮亚琴察地区的173114名居民。系统设备包括39台半自动体外双相除颤器（AED）：12台放置在高危地点，12台配备于非专业救护人员驾驶的救护车中，15台配备于警车上；1285名未接受过传统心肺复苏培训但接受过AED使用培训的非专业志愿者，与紧急医疗系统（EMS）协作，对所有疑似SCA病例做出响应。在最初的22个月里，共发生354例SCA（年龄72±12岁，73%为目击情况）。PPV志愿者处理了143例SCA病例（40.4%），EMS呼叫到抵达时间为4.8±1.2分钟（而EMS为6.2±2.3分钟，P = 0.05）。总体出院生存率从EMS干预的3.3%（211例中的7例）提高到PPV干预的10.5%（143例中的15例）（P = 0.006）。PPV使目击SCA的生存率提高了两倍：分别为15.5%和4.3%（EMS治疗组）（P = 0.002）。PPV患者中有23.8%（143例中的34例）出现“可除颤”心律，而EMS患者中为15.6%（211例中的33例）（P = 0.055）。PPV组可除颤性心律失常的生存率高于EMS组：44.1%（34例中的15例）对21.2%（33例中的7例），P = 0.046。PPV治疗的患者神经功能完好的生存率高于EMS治疗的患者：8.4%（143例中的12例）对2.4%（211例中的5例），P = 0.009。
广泛分发AED供非医疗志愿者使用可实现早期除颤，并使院外SCA的生存率提高两倍。
