Letter to the Director

Quotidiano Sanita, Italy

April 18th - Dear Director,

The sudden death of Mattia Giani on an Italian soccer field, which occurred on Sunday, April 14th, 2024 (tragically the same day 12 years after the emblematic cardiac arrest occurred to another young Italian footballer, Piermario Morosini), mandates an urgent reflection on strategies for helping the victims of cardiac arrest. The exact dynamics of the event are still being reconstructed, but his tragic passing dramatically refocuses attention on what should be done in the event of aiding a person who has lost consciousness and stopped breathing normally (the two signs of cardiac arrest): recognize the arrest, call 112, start chest compressions, and apply an AED as soon as possible, whoever is the bystander.

Tragic events like those of the two soccer players impact public opinion more significantly but remind us that in Italy, about 60,000 victims suffer from sudden cardiac arrest every year (1 per 1,000 inhabitants).

In our country, much has been done both in terms of laws and awareness to combat this slaughter of lives that could be saved by a few simple manoeuvres. As early as 2013, a few months after Morosini's emblematic death, a national law required all sports clubs and associations to be equipped with an external defibrillator and trained personnel, still the only case in Italy of mandatory provision in a specific activity context.

Also in 2013, upon invitation from the European Parliament, the Italian Resuscitation Council launched in Italy "Viva! The week for cardiopulmonary resuscitation” which has since been repeated annually around October 16th, subsequently recognized as the World Restart a Heart Day.

The subsequent virtuous path of collaboration between parliamentary institutions, experts, and associations led to the approval of law 116/2021, which includes all the most effective interventions to facilitate immediate intervention by bystanders in collaboration with local emergency systems.

While reiterating the mandatory nature of equipping and sharing the AED in both competitions and training activities, the law has introduced many other elements that form around the victim a "system" capable of offering the maximum possibility of survival: widespread distribution of AEDs in crowded and travel places, legal protection of the rescuer (very important to defuse fears of legal consequences), the possibility of using the AED even by those who are not trained (possibly with remote guidance from a 112 operator), the localization of AEDs and engagements of potential rescuers through a phone application, the obligation for the dispatch operator to guide the rescuer by phone to perform the manoeuvres and use the AED, training and awareness initiatives in schools.

Despite this excellent law, Mattia's death imposes continuous reflection and tireless commitment. How can we prevent avoidable deaths (if they actually are)? First of all, by committing to apply what is already provided and available.

Primary prevention (i.e., the mandatory medical examination for those in Italy who engage in competitive sports but strongly recommended for amateurs as well) remains a cornerstone to identify those at increased risk of cardiac arrest. However, if cardiac arrest occurs despite screening, it is necessary to be ready to recognize and manage it immediately according to the indications that medical evidence has provided us clearly and appropriately for years.

This, however, does not only mean having the AED available: in both the cases of Morosini and Giani (as it seems at the moment), the AED was there but was not used. The dissemination and availability of AEDs must be combined with a growing "rescue culture" that can only be created by sensitizing, informing, and training: reassuring about the responsibilities of the rescuer, creating motivation with correct information, facilitating communication with 112 operators, providing essential directions, and promoting the acquisition of practical and lasting skills. This is all more effective the earlier it is learned. For this reason, training in schools remains a crucial junction for the creation of this culture; for this reason, the involvement of sports institutions (another environment for social education) must be convinced and supported; for this reason, workplaces, living spaces, and residences must also foresee these pathways.

Cardiac arrest is a dramatic and tragic event for the victim but also for those who assist and for the family and social context. Let's not leave alone those who can be involved: let's apply the norms, spread culture, and save lives if possible.

Andrea Scapigliati, President Italian Resuscitation Council (IRC)

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