Abstract P57: Preliminary Results of the Public-Access Defibrillation Program in the Subway of Sao Paulo, Brazil
Background: The subway of Sao Paulo (SP) is an important transport system, with 3.3 million people using the subway each day. Over the last 3 years, the guards and subway workers received first aid, CPR and automated external defibrillation (AED) training. We hypothesized that survival outcomes would improve for subway system sudden cardiac arrest victims over time, concurrent with implementation of a PAD program in the subway.
Methods: 2,196 subway workers received first aid, CPR and AED training, with AEDS at 20 stations in 2006. Increased training with AEDS in 55 stations was accomplished by 2007. We prospectively analyzed the charts of sudden cardiac arrest victims in the subway system with ventricular fibrillation as initial rhythm of cardiac arrest (CA) from September 2006 to April 2009. Data were collected according to the Utstein format for out-of-hospital cardiac arrest including outcomes: return of spontaneous circulation, and hospital survival with good neurological function.
Results: In this period from 44 patients with sudden collapse, 30 patients were definitely in CA: 20/30 (67%) had ventricular fibrillation (VF) as initial rhythm. VF occurred inside of the train for 35%. The median age of patients was 58 years old, and from survivors was 37 years old, 90 % were male. Return of spontaneous circulation was achieved in 70%, and survival to hospital discharge with good cerebral performance in 20%. Bystander CPR was initiated in only 15%, with resultant 50% survival. Compared to 2006–2007, increased survival in 2008 and 2009 was significant for subway system cardiac arrests, 0% vs. 36%. By 2008, implementation of AEDs was accomplished in all stations (55) and intensive training of the major number of subway system workers.
Conclusions: Survival outcomes significantly improve for subway system sudden cardiac arrest victims between 2006–2009, concurrent with implementation of a PAD program in the subway. Further improvement in bystander CPR implementation is warranted.