Abstract 12846: Resuscitation of Out-of-Hospital Cardiac Arrest Without CPR: The 13-Year Experience of Progetto Vita

Abstract

Introduction: Cardiopulmonary resuscitation (CPR) currently represents standard of care in out-of-hospital cardiac arrest (OOHCA) despite the demonstration of its many side effects. To date, CPR has never been tested in a randomized, prospective clinical trial against an automated external defibrillator (AED) quick deployment, as such a trial is considered impossible for ethical reasons. Nevertheless, insights on the effective role of CPR when an AED is quickly available can be provided from the Progetto Vita of Piacenza, Italy: the first early defibrillation project established in Europe. Hypothesis: To compare differences in 13-year survival between OOHCA victims rescued by standard care and patients rescued by AED-only trained responders. Methods: Prospective, non-randomized parallel study comparing mortality when rescuers only used automated external defibrillators (AEDs) and did not perform CPR with mortality from the standard Emergency Medical Services (EMS) response, including CPR. Survival was followed over 13 years, from June 2001 to July 2014. Results: In 3366 OOHCAs, survival to hospital discharge occurred in 39 of the 95 patients treated with an AED only and in 193 of the 3271 patients treated by standard EMS (41.4% vs. 5.9%; p<0.001) The Kaplan Meier estimates of survival after 13-years follow-up are 31.8% when AEDs only were used versus 2.4% for standard EMS response. Estimates of survival also are significantly better for Progetto Vita when survival was stratified by gender and location of cardiac arrest. Presence of a shockable rhythm at rescuers arrival was associated with a 16.8-fold increased chance of survival to discharge. Progetto Vita intervention was independently associated with a 2.8-fold increased chance of survival to discharge, regardless of minutes from dispatch to arrival, cardiac arrest location, rhythm presentation, and age. Conclusions: Progetto Vita demonstrates excellent long-term survival from out-of-hospital cardiac arrest without CPR use compared with standard resuscitation. The findings from the present study could provide solid "real-world" evidence for the broadscale dissemination of AEDs quickly available to layperson rescuers.