The heart stops. The breath stops. Every year, in Europe, this emergency occurs approximately according to estimates in more than 400,000 people, about 60,000 in Italy. It is estimated that in 33% of cases it is possible to restore the circulation (ROSC, Return of Spontaneous Circulation), but the people who survive after hospitalization are only 8% of the total cases. How can this situation be improved? Through compulsory training at school, thanks to the spread of defibrillators and the use of apps that allow you to immediately geolocate the defibrillator capable of giving the “shock” that can restart the heart. In addition, it is necessary that the operators of 112 or 118, if you prefer, immediately give instructions on the telephone to the people who have called on how to carry out cardiopulmonary resuscitation. Those who are close to those who have lost consciousness and are in cardiac arrest can in fact be of great help, but unfortunately the percentage of people who witness cardiac arrest and who intervene with life-saving maneuvers (heart massage, ventilations) is on average 58% on a European scale. And the use of the defibrillator does not reach 30%.
The chain of survival
To design these objectives are the new European guidelines on cardiopulmonary resuscitation published on Resuscitation and developed by the experts of the European Resuscitation Council (ERC), of which the representatives of the Italian Resuscitation Council (IRC) belong to our country. First aid guidelines are updated regularly, also because there is still a long way to go. And it is essential that as many people as possible are able to “intervene” in the event of cardiac arrest. “The chance of survival from cardiac arrest decreases by 10% for every minute that passes,” he explains Giuseppe Ristagno, president of the Italian Resuscitation Council “For this reason, the new guidelines want to lay the foundations for a ‘chain of survival’ which provides, also through the direct involvement of citizens, the rapid recognition of cardiac arrest, the call to 112, the start of life-saving maneuvers and the use of the defibrillator. It is important that these points, which are based on strong scientific evidence and which have as a fundamental premise the need to train as many people on first aid, have been fixed inside of the European guidelines because from now on they will represent a model for States and health systems to adapt to and on which to build more effective intervention procedures. “
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First aid training at school
According to the experts, it appears essential that the very young (and not only) know the behaviors to follow. For this reason, one of the central points of the European document, which is also available in its full version on the European Resuscitation Council website, is the training of citizens, whose involvement is essential to make aid faster and more effective. Europeans to introduce compulsory first aid training at school and to promote initiatives to train as many citizens as possible. Trained persons, in fact, are able to carry out the necessary operations in case of emergency, awaiting the arrival of help: recognize cardiac arrest, immediately call 112 (118), immediately start life-saving maneuvers (heart massage, ventilations), use AED when available.
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The call for help on the telephone: uniform criteria
If people experiencing cardiac arrest are not trained, it is essential that the 112 (118) operators give them instructions on what to do over the phone. According to the guidelines, operators must adopt uniform and effective criteria to understand quickly if the report received concerns cardiac arrest. In this case the operators must give indications on how to carry out cardiopulmonary resuscitation (if the victim does not respond, he hears or does not regulate). That the lessons at school are also important in terms of outcomes, however, is demonstrated by science. According to a survey conducted in Greece presented on the platform of the European Society of Cardiology (the courses were held by over 700 specially trained volunteers of the European Resuscitation Council and the program involved 42,000 people, 38,500 students and 3,500 teachers) in the last three years as many as 18 people have been successfully rescued by young people who have taken up the initiative. In four hours of teaching, at school, many children aged at least ten have learned how to behave in the event of a sudden loss of consciousness in a person, from the need to call for help immediately to cardiopulmonary resuscitation, the position to be maintained, and employment. of an defibrillator possibly available. Why we need to act now Even if we talk about cardiac arrest, in reality often in these situations the heart “goes to a thousand”, but it is practically out of speed.
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Every minute that passes, the chance of survival drops by 8%
And if action is not taken soon, the chances of saving a life become increasingly slim. In practice, the heart is suddenly hit by an electrical storm that paralyzes it: there is no time to ask for help and one can only hope that around us there is someone who can save us. When this “paralysis” due to a malignant arrhythmia occurs (the most frequent is ventricular fibrillation) there are only three things that can save us. Two of these can also be done by any citizen who has been trained in resuscitation with a short course (the BLSD or Basic Life Support Defibrillation): heart massage, the use of the defibrillator and the call of the rescue system. At that point, health workers can intervene. But before, saving a life depends on who is nearby to those who suffer: on average, every minute that passes, in fact, reduces the chance of survival by 8 percent. That knowledge of the maneuver is crucial is proven by research conducted in Sweden, published in Circulation, the result of the coordinated work of Swedish hospital and university cardiologists. The study examined five different periods (2000-2005, 2006-2010, 2011-2017) and shows that the number of people getting busy is growing: based on data on more than 30,000 people who went to cardiac arrest the number of subjects has increased approximately sixfold in the past 18 years. The intervention is associated with a doubling of the chances of surviving before help arrives. The impact of technology
Geo-locate the defibrillators available in the area: the use of an app is essential
The experts in the guidelines also ask European states to adopt technologies and applications for mobile phones that allow to alert 112 more quickly (118) and to geo-locate the defibrillators available in the territory to understand where the one closest to the place is located. emergency. The same technology would allow you to also geo-locate potential rescuers (doctors or people trained in first aid) who are in the area and who, having downloaded the application, have given their willingness to intervene in case of need. These innovations envisaged by the new guidelines have already been included, also on the initiative of the IRC, in the first aid bill which today is awaiting final approval by the Senate Hygiene and Health Commission, after having already obtained the yes of the Chamber. in 2019. On the other hand, that the smartphone, equipped with special Apps, can become essential to gain time and therefore hope of survival for those affected by arrest outside the hospital is testified by a study published in Academic Emergency Medicine and conducted in France, under the coordination of Clement Derkenne, expert in Emergency Medicine at the Paris Fire Brigade.
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The Stayng Alive app
The approach is based on a simple smartphone application, called “Staying Alive” free to download and available in 18 different languages. Thanks to this tool, always within reach of a “mobile phone”, relief efforts were accelerated. In the French capital, thanks to the App and geolocation, it was possible to notify the emergency services of the area in which the event took place, with a consequent return message that allows on the one hand to know where the nearest automatic defibrillator is located and from the Another is to activate the rapid rescue units close to the person who has had the arrest, thus allowing immediate rescue. According to the results of the survey, by combining the results of these “solicitations”, the warning system has been improved. In short, the road is still long. But the dissemination of information and defibrillators, in addition to knowledge A step forward, even in the certainty that in terms of outcomes and costs we cannot yet draw certain indications.
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