title: Survival After Ventricular Fibrillation Cardiac Arrest in the Sao Paulo Metropolitan Subway System: First Successful Targeted Automated External Defibrillator (AED) Program in Latin America.
abstract: BACKGROUND
  Targeted automated external defibrillator (AED) programs have improved survival rates among patients who have an out-of-hospital cardiac arrest (OHCA) in US airports, as well as European and Japanese railways. The Sao Paulo (Brazil) Metro subway carries 4.5 million people per day. A targeted AED program was begun in the Sao Paulo Metro with the objective to improve survival from cardiac arrest.
  
  
  RESULTS
  A prospective, longitudinal, observational study of all cardiac arrests in the Sao Paulo Metro was performed from September 2006 through November 2012. This study focused on cardiac arrest by ventricular arrhythmias, and the primary endpoint was survival to hospital discharge with minimal neurological impairment. A total of 62 patients had an initial cardiac rhythm of ventricular fibrillation. Because no data on cardiac arrest treatment or outcomes existed before beginning this project, the first 16 months of the implementation was used as the initial experience and compared with the subsequent 5 years of full operation. Return of spontaneous circulation was not different between the initial 16 months and the subsequent 5 years (6 of 8 [75%] vs. 39 of 54 [72%]; P=0.88). However, survival to discharge was significantly different once the full program was instituted (0 of 8 vs. 23 of 54 [43%]; P=0.001).
  
  
  CONCLUSIONS
  Implementation of a targeted AED program in the Sao Paulo Metro subway system saved lives. A short interval between arrest and defibrillation was key for good long-term, neurologically intact survival. These results support strategic expansion of targeted AED programs in other large Latin American cities.
authors.affiliation: Heart Institute (InCor)-Medicine School of Sao Paulo University, Sao Paulo, SP, Brazil (R.G.O., M.M.G., C.B.V., S.T., R.K.F.).
authors.forename: Renan
authors.initials: R
authors.lastname: Gianotto-Oliveira
authors.affiliation: Heart Institute (InCor)-Medicine School of Sao Paulo University, Sao Paulo, SP, Brazil (R.G.O., M.M.G., C.B.V., S.T., R.K.F.).
authors.forename: Maria Margarita
authors.initials: MM
authors.lastname: Gonzalez
authors.affiliation: Heart Institute (InCor)-Medicine School of Sao Paulo University, Sao Paulo, SP, Brazil (R.G.O., M.M.G., C.B.V., S.T., R.K.F.).
authors.forename: Caio Brito
authors.initials: CB
authors.lastname: Vianna
authors.affiliation: Sao Paulo Metropolitan Company (Sao Paulo Metro), Sao Paulo, SP, Brazil (M.M.A.).
authors.forename: Maurício
authors.initials: M
authors.lastname: Monteiro Alves
authors.affiliation: Heart Institute (InCor)-Medicine School of Sao Paulo University, Sao Paulo, SP, Brazil (R.G.O., M.M.G., C.B.V., S.T., R.K.F.).
authors.forename: Sergio
authors.initials: S
authors.lastname: Timerman
authors.affiliation: Heart Institute (InCor)-Medicine School of Sao Paulo University, Sao Paulo, SP, Brazil (R.G.O., M.M.G., C.B.V., S.T., R.K.F.).
authors.forename: Roberto
authors.initials: R
authors.lastname: Kalil Filho
authors.affiliation: Division of Cardiovascular Medicine, Sarver Heart Center, University of Arizona, Tucson, AZ (K.B.K.).
authors.forename: Karl B
authors.initials: KB
authors.lastname: Kern
mesh_terms: D000368:Aged; D001938:Brazil; D016887:Cardiopulmonary Resuscitation / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D016757:Death, Sudden, Cardiac / Q000517:prevention & control*; D047548:Defibrillators; D004554:Electric Countershock / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D004632:Emergency Medical Services; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D058687:Out-of-Hospital Cardiac Arrest / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D010343:Patient Admission; D010351:Patient Discharge; D015397:Program Evaluation; D011446:Prospective Studies; D011890:Railroads; D020127:Recovery of Function; D012307:Risk Factors; D013997:Time Factors; D061665:Time-to-Treatment; D014187:Transportation of Patients; D016896:Treatment Outcome; D019037:Urban Health Services; D014693:Ventricular Fibrillation / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*
keywords: automatic external defibrillation; cardiopulmonary resuscitation; ventricular fibrillation