Public access defibrillation programs: Progetto Vita, current legal aspects and challenges for the future

Abstract

Out-of-hospital cardiac arrest (OHCA) represents a significant healthcare issue that is often underestimated. OHCA predominantly affects the general population, with staggering numbers: 400 000 cases annually in Europe and 350 000 in the United States, contributing to 50% of cardiovascular-related deaths. The vast majority of OHCA cases begin with a shockable rhythm, making effective treatment possible through early defibrillation, even by non-medical personnel using automated external defibrillators (AEDs). Despite the availability of such devices, survival from OHCA remains below 10%, with no substantial improvements over the last 25 years. Public access defibrillation programs, which reduce response times with AEDs, have demonstrated a significant increase in survival chances for OHCA victims. Particularly, the "Progetto Vita" in Piacenza is an emblematic example of early defibrillation in Europe, tripling survival rates in OHCA patients treated by laypersons compared to patients treated with the traditional system. This experience contributed to the approval of Law 116, dated August 4, 2021, in Italy, aimed at promoting the distribution and use of AEDs in sports facilities, public venues, transportation, and public services. The law also emphasizes that AEDs can be used without the need for specific training, thus promoting wider usage. In this article, we will briefly examine the epidemiology of OHCA and delve into the organizational model of the "Progetto Vita", which aligns with the principles of Law 116/2021. The goal is to provide some insights into organizational aspects that could facilitate the nationwide expansion of early defibrillation programs in the near future.