The impact of the italian law mandating an automatic external defibrillation in all sports venues on sudden cardiac arrest survival

Funding Acknowledgements

Type of funding sources: None.

Introduction

The chances of surviving a sport-related cardiac arrest depend strictly on resuscitation efforts. Since 2015, all Italian recreational and competitive sport venues must be equipped with automated external defibrillators (AEDs), and trained staff must be present during competitions. The aim of the study was to evaluate the incidence and survival rates of cardiac arrests in sport Venues in the Lombardia region of Italy before and after 2015.

Methods

We collected retrospectively data regarding all sudden cardiac arrests of presumed cardiac origin that involved both athletes and non-athletes (coaches, referees, spectators, etc.) and which occurred in sports venues of the Lombardia region in the period 2015-2019 versus those that occurred in the period 2011-2014, when automatic external defibrillators were not mandatory yet. All cases have been gathered thanks to the database built by the regional territorial emergency service (AREU) of the Lombardia region and consulting the news reported by the local and national press.

Results

Between 2015 and 2019, the incidence of cardiac arrest of presumed cardiac origin which affected athletes in sports venues of the Lombardia region was 0.19 per 100,000 inhabitants/year, versus 0.28 per 100,000 inhabitants/year in the period 2011-2014 (p<0.005). The average age of the victims was 49.9 years in 2015-2019 and 52 years in 2011-2014 (p=0.96). After the enactment of the "compulsory AED law", the proportion of cardiac arrests treated with onsite AEDs increased from 15% to 42.1% (p<0.001) and the return of spontaneous circulation (successful resuscitation) increased from 67% to 80% (p<0.05). The association between mandatory presence of AEDs in sports venues and resuscitation success in terms of ROSC was found significant (p<0.05).

Conclusions

Cardiac arrest in sports venues is a rare event and involves mainly male athletes older than 30 years old. A nationwide law mandating the presence of AEDs in all sport venues significantly increased the proportion of individuals suffering cardiac arrest who received defibrillation before the emergency medical system arrival and favorably influenced survival rates.

Interspecies pharmacokinetic comparisons and allometric scaling of napsagatran, a low molecular weight thrombin inhibitor

The objective of this work was to assess the pharmacokinetics of napsagatran, a low molecular weight thrombin inhibitor, after intravenous administration in a variety of laboratory animals, and prospectively to help design the first pharmacokinetic studies in man. Napsagatran is actively excreted into the bile and urine of various species and pronounced species-differences in its pharmacokinetics are observed. It is, therefore, an interesting compound to use in tests of the limitations of presently available inter-species scaling methods. The present data suggest that allometric exponent values which are consistent with the values expected for physiological processes and small organic molecules are not necessarily associated with successful predictions in man when active transport processes are involved in the disposition of the compounds. For example, compared with the values observed in man, the clearance (CL), non-renal clearance (CL(nr)) and the volume of distribution at steady state (Vd(ss)) were over-predicted by 3-, 7- and 2-fold, respectively, by use of allometry. Of the species tested, the cynomolgus monkey seemed to be the most useful for predicting kinetics in man when the approach based on concentration-time transformations was used. Thus, for half-life (t(1/2)), CL and Vd(ss), the observed mean values of 1.7 h, 459 mL min(-1) and 24 L kg(-1) in man were very close to the values predicted from the cynomolgus monkey (1.7 h, 652 mL min(-1) and 22 L kg(-1), respectively). The results show that there are large inter-species differences for kidney and liver excretion of napsagatran. This is probably because of the involvement of active transport processes, which compromised the kinetic extrapolation from animal to man, although a more thorough investigation of the transporters involved in the disposition of napsagatran is necessary to enable better understanding of the species differences observed.