Volunteer-Operated Defibs are Lifesavers

Study shows they improve survival even in rural areas

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By Ed Edelson
HealthDay Reporter

THURSDAY, Dec. 1, 2005 (HealthDay News) -- Training volunteers in the emergency use of defibrillators to restart failing hearts does saves lives, even in thinly populated rural areas, a new Italian study shows.

Previous trials in the United States and Canada have shown that survival can be improved for people who suffer cardiac arrest by making defibrillators available and by teaching people how to use them.

But this study is different, said Dr. Riccardo Cappato, a professor of electrophysiology at the University of Milan, and lead author of a report in the December issue of the European Heart Journal.

"We used a very large area, not an urban area," Cappato said. "We were covering more than 1 million inhabitants in the largest county of Italy, one-sixteenth of the entire Italian area."

The trial enlisted 2,186 volunteers, each of who got an initial five hours of training in the theory and practice of defibrillation, with a two-hour refresher course provided every six months. Residents of the region were told to call a central number when someone collapsed, and the volunteer nearest to the emergency site was dispatched. After the initial defibrillation, the patient was taken to the nearest hospital.

There were 702 such episodes during the two-year trial, Cappato said, with 10 percent of the affected persons achieving return of circulation, 8 percent surviving long enough to be admitted to the hospital, 4 percent living to leave the hospital and 3 percent surviving after one year.

Those numbers might not seem impressive to the untrained eye, but they did impress Mary F. Hazinski, a clinical nurse specialist in emergency and clinical care at Vanderbilt University and a spokeswoman for the American Heart Association. In the two years before the trial began, fewer than 1 percent of those suffering cardiac arrest in the region survived for one year -- meaning that the availability of defibrillation tripled survival, she noted.

The Italian trial was important for several reasons, Hazinski said. It looked at all causes of cardiac arrest, while most trials have concentrated on a single cause, the abnormal heart rhythm called atrial fibrillation. Here again, survival was tripled -- from about 3 percent before the trial began to 10 percent during the trial.

The fact that much of Brescia is a rural area makes the report "a very important paper, one about a population about which we need more information," Hazinski said. "This is the largest study of which I am aware that included rural areas."

Because the response time was shorter and more defibrillators were available, survival was inevitably better in urban areas. It rose from under 1.5 per hundred to four per hundred in the study. In the rural areas, it rose from 0.5 to 2.5 per hundred.

Those numbers show that "if communities can develop systems where they have trained responders, there is more hope for improvement," Hazinski said. "We have to develop community resources to provide first responders until EMS [emergency medical services] arrives."

The Italian program is being expanded, Cappato noted.

"We started with 49 devices and now we have about 180 of them," he said. "We are also educating a much larger number of volunteers and lay persons, increasing from 2,600 to more than 5,000 people being instructed."

More information

There's more on emergency defibrillation at the American Heart Association.

SOURCES: Riccardo Cappato, M.D., professor, electrophysiology, University of Milan, Italy; Mary F. Hazinski, R.N., clinical nurse specialist, emergency and clinical care, Vanderbilt University, Nashville, Tenn.; December 2005 European Heart Journal

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