The role of citizens and new technology for a better management of Out-of-Hospital Cardiac Arrest

Out-of-hospital cardiac arrest (OHCA) is the third leading cause of de ath in European countries, affecting more than 400,000 people every year. The strategies identified to reduce mortality are, in addition to a timely and effective intervention of prehospital emergency medical ser vices (EMS), the early identification of cardiac arrest and the role of by standers as potential first responders able to perform cardiopulmonary resuscitation (CPR). Several studies reported that CPR performed by by standers achieved a percentage of return to a spontaneous circulation in more than 30% of cases, doubling the survival rate of CPR carried out only by EMS providers (9.1% vs 4.3%) (EuReCa1 study, 2014; EuReCa2 study, 2017). This encouraging data led to a general agreement among scientific societies, emphasizing the importance of bystanders and promoting inter ventions to increase the number of lay people able to perform CPR in ca se of OHCA. The concept behind this is that engaging laypeople and first responders to perform CPR before the arrival of an ambulance represents a key feature in minimizing the free treatment interval in cardiac arrest patients, reducing the no-flow time and, thus, achieving better outcomes. This participative approach is based on a strict cooperation between EMS dispatch centers and lay people, involving some essential and fun damental elements: • CPR training for an increasing number of citizens, starting from the school context and from primary school (as provided by the Italian Law 116/2021); • the availability on the territory of an adequate number of semi-au tomatic defibrillators (at least 2/km2 ), accessible and mapped through computerized systems managed by EMS dispatch centers; • alert and geolocation of first responders through text messages or ap plications installed on smartphones; • the ability of EMS dispatchers to provide instructions to bystanders on how to perform CPR. Dispatcher-assisted CPR instructions can be pro vided by phone or through video-communication systems, currently available on most smartphones. The main objective of this lecture is to analyze the state-of-the-art of the literature, the advantages of these innovative strategies, and their po tential development in the future. In particular, the different facets of dispatcher-assisted CPR instructions, the interactions between laypeople and EMS dispatchers, and their availability in Italian EMS services (inclu ding the use of new technologies) will be discussed