Emerg. Care Med., Volume 1, Issue 3 (September 2024) – 2 articles

The most effective strategy to save the life of a victim of out-of-hospital cardiac arrest (OHCA) is to provide aid as early as possible. To achieve this objective, widespread dissemination of knowledge on basic life support and defibrillation (BLSD) in the general population is necessary. In recent years, evidence has been emerging supporting the effectiveness of public-access defibrillation (PAD) programs; the diffusion of automatic external defibrillators (AEDs) and the knowledge of their correct use among lay rescuers are associated with a higher survival rate and better neurological outcomes among OHCA victims. This study aims to implement and monitor a BLSD training program involving an entire city in Italy. Since 2016, a PAD program has been implemented in Busca (CN), a small town in the northwest of Italy. The project was divided into three phases: (1) the diffusion of AEDs in the most-frequented places in the city; (2) BLSD training aimed at reaching the most significant possible number of citizens; (3) the training of all schoolchildren in the basics of first aid. The retention of the concepts learned was assessed via a multiple-choice questionnaire proposed months after the training events. From 2016 to 2023, 42 BLSD courses were held, which trained 1302 adults (12.8% of citizens) with a female/male ratio of 0.9 and a median age of 46 (range: 32–59 years). The participants in the courses were volunteers from associations (59%), athletes (16%), ordinary citizens (13%), school staff (10%), and municipal employees (2%). At the start of the project in 2016, the first 11 AEDs were positioned. To date, the municipal area can count on 25 always-available defibrillators to reach each area within 4 minutes. Furthermore, 1500 school pupils were trained. The retention of the learned notions was excellent. After training, 92% of adult participants and 90% of the schoolchildren reported being willing to provide help in the event of cardiac arrest. The project combined the widespread diffusion of AEDs with a significant number of citizens able to use them, effectively providing cardiopulmonary resuscitation. This project ensured that an entire community shared the goal of saving the lives of people affected by OHCA. Full article

Gastrointestinal bleeding is the main cause of admission to the emergency services of patients taking direct-acting oral anticoagulants (DOACs). Little is known about the effects of treatment modification on the risk of readmission, especially in elderly patients. This retrospective observational study included elderly patients with atrial fibrillation who were on DOACs and who were admitted to the emergency department due to gastrointestinal bleeding from 2018 to 2023. To evaluate the risk factors for readmission 90 days after discharge, a multivariate analysis was conducted, which included patient comorbidities, concomitant treatment, changes in anticoagulant treatment, and the prescription of DOACs at discharge. One hundred and thirty-nine patients were included. At discharge, anticoagulant therapy was modified in 44 (31.6%) patients, 16 (36.3%) patients were switched from one DOAC to another, 23 (52.2%) to heparins, and 5 (11.3%) to vitamin K antagonists. A total of 21 (15.1%) patients returned to the emergency department within 90 days after discharge due to new bleeding events. No significant differences were observed depending on the modification of treatment at discharge. The presence of cognitive impairment was the only factor associated with readmission at 90 days. Patients who undergo treatment with DOACs and have gastrointestinal bleeding at discharge are at risk of readmission to the emergency room due to new bleeding events. No benefit was observed in modifying anticoagulant treatment at discharge. Full article