title: Prospective assessment of integrating the existing emergency medical system with automated external defibrillators fully operated by volunteers and laypersons for out-of-hospital cardiac arrest: the Brescia Early Defibrillation Study (BEDS).
abstract: OBJECTIVE
  There are few data on the outcomes of cardiac arrest (CA) victims when the defibrillation capability of broad rural and urban territories is fully operated by volunteers and laypersons.
  
  
  RESULTS
  In this study, we investigated whether a programme based on diffuse deployment of automated external defibrillators (AEDs) operated by 2186 trained volunteers and laypersons across the County of Brescia, Italy (area: 4826 km(2); population: 1 112 628), would safely and effectively impact the current survival among victims of out-of-hospital CA. Forty-nine AEDs were added to the former emergency medical system that uses manual EDs in the emergency department of 10 county hospitals and in five medically equipped ambulances. The primary endpoint was survival free of neurological impairment at 1-year follow-up. Data were analysed in 692 victims before and in 702 victims after the deployment of the AEDs. Survival increased from 0.9% (95% CI 0.4-1.8%) in the historical cohort to 3.0% (95% CI 1.7-4.3%) (P=0.0015), despite similar intervals from dispatch to arrival at the site of collapse [median (quartile range): 7 (4) min vs. 6 (6) min]. Increase of survival was noted both in the urban [from 1.4% (95% CI 0.4-3.4 %) to 4.0% (95% CI 2.0-6.9 %), P=0.024] and in the rural territory [from 0.5% (95% CI 0.1-1.6%) to 2.5% (95% CI 1.3-4.2%), P=0.013]. The additional costs per quality-adjusted life year saved amounted to euro39 388 (95% CI euro16 731-49 329) during the start-up phase of the study and to euro23 661 (95% CI euro10 327-35 528) at steady state.
  
  
  CONCLUSIONS
  Diffuse implementation of AEDs fully operated by trained volunteers and laypersons within a broad and unselected environment proved safe and was associated with a significantly higher long-term survival of CA victims.
authors.affiliation: Arrhythmias and Electrophysiology Center, Policlinico San Donato, University of Milan, Via Morandi 30, 20097 San Donato Milanese, Milan, Italy. rcappato@libero.it
authors.forename: Riccardo
authors.initials: R
authors.lastname: Cappato
authors.forename: Antonio
authors.initials: A
authors.lastname: Curnis
authors.forename: Paolo
authors.initials: P
authors.lastname: Marzollo
authors.forename: Giosuè
authors.initials: G
authors.lastname: Mascioli
authors.forename: Tania
authors.initials: T
authors.lastname: Bordonali
authors.forename: Sonia
authors.initials: S
authors.lastname: Beretti
authors.forename: Fausto
authors.initials: F
authors.lastname: Scalfi
authors.forename: Luca
authors.initials: L
authors.lastname: Bontempi
authors.forename: Adriana
authors.initials: A
authors.lastname: Carolei
authors.forename: Gust
authors.initials: G
authors.lastname: Bardy
authors.forename: Luigi
authors.initials: L
authors.lastname: De Ambroggi
authors.forename: Livio
authors.initials: L
authors.lastname: Dei Cas
mesh_terms: D001331:Automation; D004554:Electric Countershock / Q000295:instrumentation* / Q000592:standards; D004630:Emergencies; D004632:Emergency Medical Services / Q000592:standards*; D004638:Emergency Treatment / Q000295:instrumentation* / Q000592:standards; D005260:Female; D006323:Heart Arrest / Q000628:therapy*; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D016019:Survival Analysis; D014838:Volunteers