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Soumagnac T, Raphalen JH, Bougouin W, Vimpere D, Ammar H, Yahiaoui S, Dagron C, An K, Mungur A, Carli P, Hutin A, Lamhaut L. Extracorporeal cardiopulmonary resuscitation for hypothermic refractory cardiac arrests in urban areas with temperate climates. Scand J Trauma Resusc Emerg Med 2023; 31:68. [PMID: 37907994 PMCID: PMC10619216 DOI: 10.1186/s13049-023-01126-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 10/03/2023] [Indexed: 11/02/2023] Open
Abstract
BACKGROUND Accidental hypothermia designates an unintentional drop in body temperature below 35 °C. There is a major risk of ventricular fibrillation below 28 °C and cardiac arrest is almost inevitable below 24 °C. In such cases, conventional cardiopulmonary resuscitation is often inefficient. In urban areas with temperate climates, characterized by mild year-round temperatures, the outcome of patients with refractory hypothermic out-of-hospital cardiac arrest (OHCA) treated with extracorporeal cardiopulmonary resuscitation (ECPR) remains uncertain. METHODS We conducted a retrospective monocentric observational study involving patients admitted to a university hospital in Paris, France. We reviewed patients admitted between January 1, 2011 and April 30, 2022. The primary outcome was survival at 28 days with good neurological outcomes, defined as Cerebral Performance Category 1 or 2. We performed a subgroup analysis distinguishing hypothermic refractory OHCA as either asphyxic or non-asphyxic. RESULTS A total of 36 patients were analysed, 15 of whom (42%) survived at 28 days, including 13 (36%) with good neurological outcomes. Within the asphyxic subgroup, only 1 (10%) patient survived at 28 days, with poor neurological outcomes. A low-flow time of less than 60 min was not significantly associated with good neurological outcomes (P = 0.25). Prehospital ECPR demonstrated no statistically significant difference in terms of survival with good neurological outcomes compared with inhospital ECPR (P = 0.55). Among patients treated with inhospital ECPR, the HOPE score predicted a 30% survival rate and the observed survival was 6/19 (32%). CONCLUSION Hypothermic refractory OHCA occurred even in urban areas with temperate climates, and survival with good neurological outcomes at 28 days stood at 36% for all patients treated with ECPR. We found no survivors with good neurological outcomes at 28 days in submersed patients.
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Affiliation(s)
- Tal Soumagnac
- SAMU de Paris-ICU, Necker University Hospital, 149 rue des Sèvres, Paris, 75015, France
- Sorbonne University, 21 rue de l'école de médecine, 75006, Paris, France
| | - Jean-Herlé Raphalen
- SAMU de Paris-ICU, Necker University Hospital, 149 rue des Sèvres, Paris, 75015, France
| | - Wulfran Bougouin
- Jacques Cartier Hospital, 6 avenue du Noyer Lambert, Massy, 91300, France
- INSERM U970, Team 4 "Sudden Death Expertise Center"; 56 rue Leblanc, Paris, 75015, France
| | - Damien Vimpere
- SAMU de Paris-ICU, Necker University Hospital, 149 rue des Sèvres, Paris, 75015, France
| | - Hatem Ammar
- SAMU de Paris-ICU, Necker University Hospital, 149 rue des Sèvres, Paris, 75015, France
| | - Samraa Yahiaoui
- SAMU de Paris-ICU, Necker University Hospital, 149 rue des Sèvres, Paris, 75015, France
| | - Christelle Dagron
- SAMU de Paris-ICU, Necker University Hospital, 149 rue des Sèvres, Paris, 75015, France
| | - Kim An
- SAMU de Paris-ICU, Necker University Hospital, 149 rue des Sèvres, Paris, 75015, France
| | - Akshay Mungur
- SAMU de Paris-ICU, Necker University Hospital, 149 rue des Sèvres, Paris, 75015, France
| | - Pierre Carli
- SAMU de Paris-ICU, Necker University Hospital, 149 rue des Sèvres, Paris, 75015, France
- Paris Cité University, 15 rue de l'Ecole de Médecine, Paris, 75006, France
| | - Alice Hutin
- SAMU de Paris-ICU, Necker University Hospital, 149 rue des Sèvres, Paris, 75015, France
- INSERM U955, Team 3; 1 rue Gustave Eiffel, Créteil, 94000, France
| | - Lionel Lamhaut
- SAMU de Paris-ICU, Necker University Hospital, 149 rue des Sèvres, Paris, 75015, France.
- INSERM U970, Team 4 "Sudden Death Expertise Center"; 56 rue Leblanc, Paris, 75015, France.
- Paris Cité University, 15 rue de l'Ecole de Médecine, Paris, 75006, France.
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Raphalen JH, Soumagnac T, Blanot S, Bougouin W, Bourdiault A, Vimpere D, Ammar H, Dagron C, An K, Mungur A, Carli P, Hutin A, Lamhaut L. Kidneys recovered from brain dead cardiac arrest patients resuscitated with ECPR show similar one-year graft survival compared to other donors. Resuscitation 2023; 190:109883. [PMID: 37355090 DOI: 10.1016/j.resuscitation.2023.109883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 05/27/2023] [Accepted: 06/13/2023] [Indexed: 06/26/2023]
Abstract
INTRODUCTION Among patients treated with extracorporeal cardiopulmonary resuscitation (ECPR) as a second line of treatment for refractory out-of-hospital cardiac arrest (OHCA), some may develop brain death and become eligible for organ donation. The objective of this study was to evaluate long-term outcomes of kidney grafts recovered from these patients. MATERIAL AND METHODS We conducted a retrospective monocentric observational study between January 1, 2011, and December 31, 2017. We exclusively included patients eligible for planned donation after brainstem death and from whom at least one organ graft was retrieved and transplanted. We compared two groups of brain dead patients: those treated with ECPR for refractory OHCA (ECPR group) and a diverse group of patients who did not receive ECPR, from which only 5/23 (22%) had OHCA (control group). The primary outcome was one-year kidney graft survival. RESULTS We included 45 patients, 23 in the control group and 22 in the ECPR group. Although patients in the ECPR group were younger and had a lower prevalence of chronic renal disease (p = 0.01), their kidney function was more severely impaired upon admission in the ICU. A total of 68 kidney grafts were retrieved, transplanted, and studied, 34 in each study group. There was no significant difference between the two groups in terms of one-year kidney graft survival (p = 0.52). CONCLUSION Organ transplantation from patients treated with ECPR after refractory OHCA showed one-year kidney graft survival rates comparable to those of patients not treated with ECPR.
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Affiliation(s)
- Jean-Herlé Raphalen
- SAMU de Paris-ICU, Necker University Hospital, Greater Paris University Hospitals, Paris, France
| | - Tal Soumagnac
- SAMU de Paris-ICU, Necker University Hospital, Greater Paris University Hospitals, Paris, France
| | - Stéphane Blanot
- Pediatric and Obstetric ICU, Necker University Hospital, Greater Paris University Hospitals, Paris, France
| | - Wulfran Bougouin
- INSERM U970, Team 4 "Sudden Death Expertise Center", Paris, France; Jacques Cartier Hospital, Massy, France
| | - Alexandre Bourdiault
- SAMU de Paris-ICU, Necker University Hospital, Greater Paris University Hospitals, Paris, France
| | - Damien Vimpere
- SAMU de Paris-ICU, Necker University Hospital, Greater Paris University Hospitals, Paris, France
| | - Hatem Ammar
- SAMU de Paris-ICU, Necker University Hospital, Greater Paris University Hospitals, Paris, France
| | - Christelle Dagron
- SAMU de Paris-ICU, Necker University Hospital, Greater Paris University Hospitals, Paris, France
| | - Kim An
- SAMU de Paris-ICU, Necker University Hospital, Greater Paris University Hospitals, Paris, France
| | - Akshay Mungur
- SAMU de Paris-ICU, Necker University Hospital, Greater Paris University Hospitals, Paris, France
| | - Pierre Carli
- SAMU de Paris-ICU, Necker University Hospital, Greater Paris University Hospitals, Paris, France; Paris Cité University, Paris, France
| | - Alice Hutin
- SAMU de Paris-ICU, Necker University Hospital, Greater Paris University Hospitals, Paris, France; INSERM U955, Team 3, Créteil, France
| | - Lionel Lamhaut
- SAMU de Paris-ICU, Necker University Hospital, Greater Paris University Hospitals, Paris, France; INSERM U970, Team 4 "Sudden Death Expertise Center", Paris, France; Paris Cité University, Paris, France.
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Wise S, Lanternier F, Cotteret C, Chasport C, Juin‐Leonard V, Cantat A, Scemla A, Delage C, Mantz B, Telion C, Carli P, Frange P, Cisternino S. Setting up of a hospital Covid‐19 vaccination center: A descriptive study. Health Sci Rep 2022; 6:e968. [PMCID: PMC9713314 DOI: 10.1002/hsr2.968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 11/10/2022] [Accepted: 11/17/2022] [Indexed: 12/03/2022] Open
Abstract
Background and Aims The coronavirus pandemic challenged countries worldwide in a race against contaminations and variants. Vaccination campaigns were the answer to such an infectious spread. This descriptive study presents the organizational process of the setting up of a Covid‐19 vaccination center in a French University Hospital in January 2021, the issues encountered along the way and assessment of adaptability. Methods Three major stakeholders: SARS CoV‐2 crisis referent, referring vaccination medical doctor and referring vaccination pharmacist retraced key moments and identified issues encountered during the setting up of the vaccination center and its long term maintenance, threw a series of meetings. Records of crisis and periodic meetings that took place threw out the vaccination campaign were consulted. Results A multidisciplinary crisis steering committee with nine different professionals was created January 3. Logistics for the vaccination center opening were discussed: location, informatics, appointment‐scheduling, pharmaceutical circuit, internal circuit, human resources, and information communication. The vaccination center was ready to welcome healthcare workers in less than 24 h on January 4. The first month, 2757 1st shots were administered, leading up to a total of 9167 1st shots during 6 months of activity. From January to June 2021, the multidisciplinary group dealt and adapted its processes to challenging and unexpected situations. Indeed, issues encountered with Pfizer BioNTech's and AstraZeneca's vaccine, were: supply shortages, vaccine manipulation, targeted populations, pharmacovigilance, and general communication. Conclusion This descriptive study provides an exclusive insight on how a hospital vaccination center was organized and adapted during Covid‐19 pandemic to ensure healthcare workers' security and resilience, and to protect high risk patients of severe Covid‐19 infection.
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Affiliation(s)
- Scarlett Wise
- Pharmacy, Hôpital Universitaire Necker—Enfants Malades, Assistance Publique des Hôpitaux de Paris, AP‐HPParisFrance
| | - Fanny Lanternier
- Department of Infectious Diseases and Tropical MedicineHôpital Universitaire Necker—Enfants Malades, Assistance Publique des Hôpitaux de Paris, AP‐HPParisFrance
| | - Camille Cotteret
- Pharmacy, Hôpital Universitaire Necker—Enfants Malades, Assistance Publique des Hôpitaux de Paris, AP‐HPParisFrance
| | - Céline Chasport
- Pharmacy, Hôpital Universitaire Necker—Enfants Malades, Assistance Publique des Hôpitaux de Paris, AP‐HPParisFrance
| | - Virginie Juin‐Leonard
- Administrative Management, Hôpital Universitaire Necker‐Enfants Malades, Assistance Publique des Hôpitaux de Paris, AP‐HPParisFrance
| | - Amélie Cantat
- Administrative Management, Hôpital Universitaire Necker‐Enfants Malades, Assistance Publique des Hôpitaux de Paris, AP‐HPParisFrance
| | - Anne Scemla
- Department of Nephrology and Adult Kidney TransplantationHôpital Universitaire Necker‐Enfants Malades, Assistance Publique des Hôpitaux de Paris, AP‐HPParisFrance
| | - Claire Delage
- Department of Nephrology and Adult Kidney TransplantationHôpital Universitaire Necker‐Enfants Malades, Assistance Publique des Hôpitaux de Paris, AP‐HPParisFrance
| | | | | | | | - Pierre Frange
- Infection Control Unit, Laboratory of Clinical MicrobiologyHôpital Universitaire Necker‐Enfants Malades, Assistance Publique des Hôpitaux de Paris, AP‐HPParisFrance
| | - Salvatore Cisternino
- Pharmacy, Hôpital Universitaire Necker—Enfants Malades, Assistance Publique des Hôpitaux de Paris, AP‐HPParisFrance,INSERM UMR‐S 1144Université Paris CitéParisFrance
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Lascarrou JB, Dumas F, Bougouin W, Legriel S, Aissaoui N, Deye N, Beganton F, Lamhaut L, Jost D, Vieillard-Baron A, Nichol G, Marijon E, Jouven X, Cariou A, Agostinucci J, Aissaoui-Balanant N, Algalarrondo V, Alla F, Alonso C, Amara W, Annane D, Antoine C, Aubry P, Azoulay E, Beganton F, Billon C, Bougouin W, Boutet J, Bruel C, Bruneval P, Cariou A, Carli P, Casalino E, Cerf C, Chaib A, Cholley B, Cohen Y, Combes A, Coulaud J, Da Silva D, Das V, Demoule A, Denjoy I, Deye N, Diehl J, Dinanian S, Domanski L, Dreyfuss D, Dubois-Rande J, Dumas F, Duranteau J, Empana J, Extramiana F, Fagon J, Fartoukh M, Fieux F, Gandjbakhch E, Geri G, Guidet B, Halimi F, Henry P, Jabre P, Joseph L, Jost D, Jouven X, Karam N, Lacotte J, Lahlou-Laforet K, Lamhaut L, Lanceleur A, Langeron O, Lavergne T, Lecarpentier E, Leenhardt A, Lellouche N, Lemiale V, Lemoine F, Linval F, Loeb T, Ludes B, Luyt C, Mansencal N, Mansouri N, Marijon E, Maury E, Maxime V, Megarbane B, Mekontso-Dessap A, Mentec H, Mira J, Monnet X, Narayanan K, Ngoyi N, Perier M, Piot O, Plaisance P, Plaud B, Plu I, Raphalen J, Raux M, Revaux F, Ricard J, Richard C, Riou B, Roussin F, Santoli F, Schortgen F, Sharshar T, Sideris G, Spaulding C, Teboul J, Timsit J, Tourtier J, Tuppin P, Ursat C, Varenne O, Vieillard-Baron A, Voicu S, Wahbi K, Waldmann V. Differential Effect of Targeted Temperature Management Between 32 °C and 36 °C Following Cardiac Arrest According to Initial Severity of Illness: Insights From Two International Data Sets. Chest 2022; 163:1120-1129. [PMID: 36445800 DOI: 10.1016/j.chest.2022.10.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Revised: 10/10/2022] [Accepted: 10/23/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Recent guidelines have emphasized actively avoiding fever to improve outcomes in patients who are comatose following resuscitation from cardiac arrest (ie, out-of-hospital cardiac arrest). However, whether targeted temperature management between 32 °C and 36 °C (TTM32-36) can improve neurologic outcome in some patients remains debated. RESEARCH QUESTION Is there an association between the use of TTM32-36 and outcome according to severity assessed at ICU admission using a previously derived risk score? STUDY DESIGN AND METHODS Data prospectively collected in the Sudden Death Expertise Center (SDEC) registry (France) between May 2011 and December 2017 and in the Resuscitation Outcomes Consortium Continuous Chest Compressions (ROC-CCC) trial (United States and Canada) between June 2011 and May 2015 were used for this study. Severity at ICU admission was assessed through a modified version of the Cardiac Arrest Hospital Prognosis (mCAHP) score, divided into tertiles of severity. The study explored associations between TTM32-36 and favorable neurologic status at hospital discharge by using multiple logistic regression as well as in tertiles of severity for each data set. RESULTS A total of 2,723 patients were analyzed in the SDEC data set and 4,202 patients in the ROC-CCC data set. A favorable neurologic status at hospital discharge occurred in 728 (27%) patients in the French data set and in 1,239 (29%) patients in the North American data set. Among the French data set, TTM32-36 was independently associated with better neurologic outcome in the tertile of patients with low (adjusted OR, 1.63; 95% CI, 1.15-2.30; P = .006) and high (adjusted OR, 1.94; 95% CI, 1.06-3.54; P = .030) severity according to mCAHP at ICU admission. Similar results were observed in the North American data set (adjusted ORs of 1.36 [95% CI, 1.05-1.75; P = .020] and 2.42 [95% CI, 1.38-4.24; P = .002], respectively). No association was observed between TTM32-36 and outcome in the moderate groups of the two data sets. INTERPRETATION TTM32-36 was significantly associated with a better outcome in patients with low and high severity at ICU admission assessed according to the mCAHP score. Further studies are needed to evaluate individualized temperature control following out-of-hospital cardiac arrest.
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Affiliation(s)
- Jean Baptiste Lascarrou
- Université Paris Cité, INSERM, PARCC, Paris, France; Médecine Intensive Réanimation, University Hospital Center, Nantes, France; AfterROSC Network Group, Paris, France.
| | - Florence Dumas
- Université Paris Cité, INSERM, PARCC, Paris, France; Emergency Department, Cochin University Hospital, APHP, Paris, France
| | - Wulfran Bougouin
- Université Paris Cité, INSERM, PARCC, Paris, France; AfterROSC Network Group, Paris, France; Medical-Surgical Intensive Care Unit, Hopital Privé Jacques Cartier, Massy, France
| | - Stephane Legriel
- Université Paris Cité, INSERM, PARCC, Paris, France; AfterROSC Network Group, Paris, France; Medical Surgical Intensive Care Unit, Mignot Hospital, Le Chesnay, France
| | - Nadia Aissaoui
- Université Paris Cité, INSERM, PARCC, Paris, France; AfterROSC Network Group, Paris, France; Medical Intensive Care Unit, Cochin Hospital (APHP) and University of Paris, Paris, France
| | - Nicolas Deye
- AfterROSC Network Group, Paris, France; Medical Intensive Care Unit, Lariboisière University Hospital, INSERM U942, Paris, France
| | | | - Lionel Lamhaut
- AfterROSC Network Group, Paris, France; SAMU de Paris-DAR Necker University Hospital-Assistance, Paris, France
| | - Daniel Jost
- Brigade des Sapeurs-Pompiers de Paris, Paris, France
| | - Antoine Vieillard-Baron
- Medical Intensive Care Unit, Ambroise Paré University Hospital, APHP, Boulogne-Billancourt, France
| | - Graham Nichol
- University of Washington-Harborview Center for Prehospital Emergency Care, University of Washington, Seattle, WA
| | - Eloi Marijon
- Université Paris Cité, INSERM, PARCC, Paris, France
| | | | - Alain Cariou
- Université Paris Cité, INSERM, PARCC, Paris, France; AfterROSC Network Group, Paris, France; Medical Intensive Care Unit, Cochin Hospital (APHP) and University of Paris, Paris, France
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Dagron C, Nivet CM, Carli P, Lamhaut L. Organisation des TGV sanitaires « Chardon » pendant la crise COVID-19. Médecine de Catastrophe - Urgences Collectives 2022. [PMCID: PMC8786629 DOI: 10.1016/j.pxur.2022.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Lamhaut L, Hutin A, Dagron C, Baud F, An K, Carli P. A new hybrid technique for extracorporeal cardiopulmonary resuscitation for use by nonsurgeons. Emergencias 2021; 33:156-157. [PMID: 33750062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Affiliation(s)
- Lionel Lamhaut
- SAMU de Paris-ICU, Necker University Hospital, París Francia. René Descartes University, París, Francia
| | - Alice Hutin
- SAMU de Paris-ICU, Necker University Hospital, París Francia
| | | | - Frédéric Baud
- SAMU de Paris-ICU, Necker University Hospital, París Francia. René Descartes University, París, Francia
| | - Kim An
- SAMU de Paris-ICU, Necker University Hospital, París Francia
| | - Pierre Carli
- SAMU de Paris-ICU, Necker University Hospital, París Francia. René Descartes University, París, Francia
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Riou B, Nemitz B, Braun F, Tazarourte K, Charpentier S, Pateron D, Carli P. Numéro d’appel d’urgence santé : il faut garantir le respect du secret médical. Ann Fr Med Urgence 2021. [DOI: 10.3166/afmu-2021-0339] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Soar J, Böttiger BW, Carli P, Couper K, Deakin CD, Djärv T, Lott C, Olasveengen T, Paal P, Pellis T, Perkins GD, Sandroni C, Nolan JP. Corrigendum to "European Resuscitation Council Guidelines 2021: Adult Advanced Life Support" [Resuscitation 161 (2021) 115-151]. Resuscitation 2021; 167:105-106. [PMID: 34482004 DOI: 10.1016/j.resuscitation.2021.08.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Jasmeet Soar
- Southmead Hospital, North Bristol NHS Trust, Bristol, UK.
| | - Bernd W Böttiger
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Cologne, Cologne, Germany
| | - Pierre Carli
- SAMU de Paris, Centre Hospitalier Universitaire Necker Enfants Malades, Assistance Publique Hôpitaux de Paris, and Université Paris Descartes, Paris, France
| | - Keith Couper
- Critical Care Unit, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK; Warwick Medical School, University of Warwick, Coventry, UK
| | - Charels D Deakin
- University Hospital Southampton NHS Foundation Trust, Southampton, UK; South Central Ambulance Service NHS Foundation Trust, Otterbourne, UK
| | - Therese Djärv
- Dept of Acute and Reparative Medicine, Karolinska University Hospital, Stockholm, Sweden, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Carsten Lott
- Department of Anesthesiology, University Medical Center, Johannes Gutenberg-Universitaet Mainz, Germany
| | - Theresa Olasveengen
- Department of Anesthesiology, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Norway
| | - Peter Paal
- Department of Anaesthesiology and Intensive Care Medicine, Hospitallers Brothers Hospital, Paracelsus Medical University, Salzburg, Austria
| | - Tommaso Pellis
- Department of Anaesthesia and Intensive Care, Azienda Sanitaria Friuli Occidentale, Italy
| | - Gavin D Perkins
- University of Warwick, Warwick Medical School and University Hospitals Birmingham NHS Foundation Trust, Coventry, UK
| | - Claudio Sandroni
- Department of Intensive Care, Emergency Medicine and Anaesthesiology, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Rome, Italy; Institute of Anaesthesiology and Intensive Care Medicine, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Jerry P Nolan
- University of Warwick, Warwick Medical School, Coventry, CV4 7AL; Royal United Hospital, Bath, UK
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Baud FJ, Seif V, Houzé P, Raphalen JH, Pilmis B, Carli P, Lamhaut L. Elimination of three doses of gentamicin over three consecutive days using a polyacrylonitrile-derived filter: An in vitro assessment. Int J Artif Organs 2021; 44:641-650. [PMID: 34348515 DOI: 10.1177/03913988211032236] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Adsorption of gentamicin in a polyacrylonitrile filter was previously evidenced in a session lasting 6 h using the NeckEpur model. We extended the study over three consecutive days to mimic the 72-h life span of a filter. METHODS Prismaflex® monitor and ST150® filter were used in the continuous diafiltration (CDF) mode at a 2.5 L/h flowrate. The daily session started with a 6-h session of CDF. Thereafter, the 5-L central compartment was changed using a bag free of gentamicin to assess gentamicin release over the following 18 h. Experiments were repeated on Day 2 and stopped at the end of the 6-h session of CDF on Day 3. The experiment was performed in duplicate. RESULTS At a 2.5 L/h diafiltration flowrate, the mean daily clearances of gentamicin were 5.5, 4.0, and 3.3 L/h, respectively. The mean diafiltration and adsorption ratios in the daily elimination of gentamicin were 32/68%, 58/42%, and 88/12%, respectively. During days 1 and 2, the mean amount of gentamicin released from the ST150® filter were 14 and 34 mg, respectively. CONCLUSION The pharmacokinetics of gentamicin over 3 days is strongly altered by adsorption in the same filter with a progressive decrease of elimination by adsorption, suggesting saturation of the filter. One limitation of our study results from the mode of administration using a bolus dose instead of an infusion over 30 min. Adsorption adds a clearance to those of diafiltration. The time-dependency of gentamicin clearance precludes using a constant dosage regimen over the filter's life span.
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Affiliation(s)
- Frédéric J Baud
- Adult Intensive Care Unit, Department of Anesthesiology - SAMU de Paris, Assistance Publique - Hôpitaux de Paris, University Hospital Necker, Paris, France.,EA7323 Evaluation of Therapeutics and Pharmacology in Perinatality and Pediatrics - Hôpitaux Universitaires Cochin - Broca - Hôtel Dieu, Site Tarnier, Université Paris Descartes, Paris, France.,Université de Paris - Paris Diderot, Paris, France
| | - Vanessa Seif
- Assistance Publique - Hôpitaux de Paris, Hôpital Necker, Paris, France
| | - Pascal Houzé
- CNRS UMR 8258 - U1022, Faculty of Pharmacy, Unité de Technologies Chimiques et Biologiques pour la Santé, Paris, France
| | - Jean-Herlé Raphalen
- Adult Intensive Care Unit, Department of Anesthesiology - SAMU de Paris, Assistance Publique - Hôpitaux de Paris, University Hospital Necker, Paris, France
| | - Benoît Pilmis
- Molecular Mycology Unit, CNRS UMR 2000, Pasteur Institute, Paris, France
| | - Pierre Carli
- Adult Intensive Care Unit, Department of Anesthesiology - SAMU de Paris, Assistance Publique - Hôpitaux de Paris, University Hospital Necker, Paris, France.,Université de Paris - Paris Descartes, Paris, France
| | - Lionel Lamhaut
- Adult Intensive Care Unit, Department of Anesthesiology - SAMU de Paris, Assistance Publique - Hôpitaux de Paris, University Hospital Necker, Paris, France.,Université de Paris - Paris Descartes, Paris, France
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10
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Affiliation(s)
- Alice Hutin
- SAMU de Paris, Necker University Hospital, Assistance Publique-Hôpitaux de Paris, Paris 75730, France; INSERM U955, École Nationale Vétérinaire d'Alfort, Université Paris-Est Créteil, Paris, France.
| | - Pierre Carli
- SAMU de Paris, Necker University Hospital, Assistance Publique-Hôpitaux de Paris, Paris 75730, France; INSERM U955, École Nationale Vétérinaire d'Alfort, Université Paris-Est Créteil, Paris, France; Université de Paris, Paris, France
| | - Lionel Lamhaut
- SAMU de Paris, Necker University Hospital, Assistance Publique-Hôpitaux de Paris, Paris 75730, France; INSERM U955, École Nationale Vétérinaire d'Alfort, Université Paris-Est Créteil, Paris, France; Université de Paris, Paris, France; INSERM U970, Paris, France
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Birnbaum R, Bitton R, Pirracchio R, Féral-Pierssens AL, Constant AL, Dubost C, Chousterman B, Lescot T, Lortat-Jacob B, Harrois A, Abback PS, Belbachir A, Basto E, Castier Y, Laitselart P, Carli P, Lapostolle F, Tourtier JP, Langlois M, Raux M, Mounier R. Terror in Paris: Incidence and risk factors for infections related to high-energy ammunition injuries. Anaesth Crit Care Pain Med 2021; 40:100908. [PMID: 34174462 DOI: 10.1016/j.accpm.2021.100908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 03/25/2021] [Accepted: 03/26/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND We aimed to assess the incidence and the risk factors for secondary wound infections associated to high-energy ammunition injuries (HEAI) in the cohort of civilian casualties from the 2015 terrorist attacks in Paris. METHODS This retrospective multi-centric study included casualties presenting at least one HEAI who underwent surgery during the first 48 h following hospital admission. HEAI-associated infection was defined as a wound infection occurring within the initial 30 days following trauma. Risk factors were assessed using univariate and multivariate analysis. RESULTS Among the 200 included victims, the rate of infected wounds was 11.5%. The median time between admission and the surgical revision for secondary wound infection was 11 days [IQR 9-20]. No patient died from an infectious cause. Infections were polymicrobial in 44% of the cases. The major risk factors for secondary wound infection were ISS (p < 0.001), SAPS II (p < 0.001), MGAP (p < 0.001), haemorrhagic shock (p = 0.003), use of vasopressors (p < 0.001), blood transfusion (p < 0.001), abdominal penetrating trauma (p = 0.003), open fracture (p = 0.01), vascular injury (p = 0.001), duration of surgery (p = 0.009), presence of surgical material (p = 0.01). In the multivariate analysis, the SAPS II score (OR 1.07 [1.014-1.182], p = 0.019) and the duration of surgery (OR 1.005 [1.000-1.012], p = 0.041) were the only risk factors identified. CONCLUSION We report an 11.5% rate of secondary wound infection following high-energy ammunition injuries. Risk factors were an immediately severe condition and a prolonged surgery.
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Affiliation(s)
- Ron Birnbaum
- Anaesthesia and Intensive Care Department, Paris-Est Créteil University, Henri Mondor Hospital, Assistance Publique-Hôpitaux de Paris, Créteil, France.
| | - Rudy Bitton
- Anaesthesia and Intensive Care Department, Paris-Est Créteil University, Henri Mondor Hospital, Assistance Publique-Hôpitaux de Paris, Créteil, France
| | - Romain Pirracchio
- Department of Anesthesia and Perioperative Medicine, University of California, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, USA
| | - Anne-Laure Féral-Pierssens
- Emergency Department, University Paris Descartes, European Georges Pompidou Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Anne-Laure Constant
- Anaesthesia and Intensive Care Department, University Paris Descartes, European Georges Pompidou Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Clément Dubost
- Intensive Care Unit, Begin Military Teaching Hospital, Saint-Mandé, France
| | - Benjamin Chousterman
- Anaesthesia and Intensive Care Department, Paris-Nord University, Lariboisière Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Thomas Lescot
- Anaesthesia and Intensive Care Department, Sorbonne University, Saint-Antoine Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Brice Lortat-Jacob
- Anaesthesia and Intensive Care Department, Paris-Nord University, Bichat Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Anatole Harrois
- Anaesthesia and Intensive Care Department, Paris-Saclay University, Bicêtre Hospital, Assistance Publique-Hôpitaux de Paris, Le Kremlin-Bicêtre, France
| | - Paer-Selim Abback
- Anaesthesia and Intensive Care Department, Paris-Nord University, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris, Clichy, France
| | - Anissa Belbachir
- Anaesthesia and Intensive Care Department, Paris-Centre University, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Emmanuel Basto
- Anaesthesia and Intensive Care Department, Paris-Nord University, Saint-Louis Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Yves Castier
- Thoracic and Vascular Surgery Department, Paris-Nord University, Bichat Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Philippe Laitselart
- Anaesthesia and Intensive Care Department, Percy Military Teaching Hospital, Clamart, France
| | - Pierre Carli
- SAMU de Paris, Anaesthesia and Intensive Care Unit Department, Paris-Centre University, Necker Hospital, Paris, France
| | - Frédéric Lapostolle
- SAMU 93, UF Research-Teaching-Quality, Paris-Nord University, Avicenne Hospital, Bobigny, France, INSERM U942, Sorbonne University, Paris, France
| | | | | | - Mathieu Raux
- Anaesthesia and Intensive Care Department, Paris-Sorbonne University, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; Sorbonne University, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France
| | - Roman Mounier
- Anaesthesia and Intensive Care Department, Paris-Est Créteil University, Henri Mondor Hospital, Assistance Publique-Hôpitaux de Paris, Créteil, France; Paris-Est Créteil University, INSERM U955, Team 15, Créteil, France
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12
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Soar J, Böttiger BW, Carli P, Couper K, Deakin CD, Djärv T, Lott C, Olasveengen T, Paal P, Pellis T, Perkins GD, Sandroni C, Nolan JP. [Adult advanced life support]. Notf Rett Med 2021; 24:406-446. [PMID: 34121923 PMCID: PMC8185697 DOI: 10.1007/s10049-021-00893-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/20/2021] [Indexed: 12/19/2022]
Abstract
These European Resuscitation Council Advanced Life Support guidelines are based on the 2020 International Consensus on Cardiopulmonary Resuscitation Science with Treatment Recommendations. This section provides guidelines on the prevention of and ALS treatments for both in-hospital cardiac arrest and out-of-hospital cardiac arrest.
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Affiliation(s)
- Jasmeet Soar
- Southmead Hospital, North Bristol NHS Trust, Bristol, Großbritannien
| | - Bernd W. Böttiger
- Department of Anaesthesiology and Intensive Care Medicine, Universitätsklinikum Köln, Köln, Deutschland
| | - Pierre Carli
- SAMU de Paris, Center Hospitalier Universitaire Necker Enfants Malades, Assistance Publique Hôpitaux de Paris, and Université Paris Descartes, Paris, Frankreich
| | - Keith Couper
- Critical Care Unit, University Hospitals Birmingham NHS Foundation Trust, Birmingham, Großbritannien
- Warwick Medical School, University of Warwick, Coventry, Großbritannien
| | - Charles D. Deakin
- University Hospital Southampton NHS Foundation Trust, Southampton, Großbritannien
- South Central Ambulance Service NHS Foundation Trust, Otterbourne, Großbritannien
| | - Therese Djärv
- Dept of Acute and Reparative Medicine, Karolinska University Hospital, Stockholm, Schweden
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Schweden
| | - Carsten Lott
- Department of Anesthesiology, University Medical Center, Johannes Gutenberg-Universität Mainz, Mainz, Deutschland
| | - Theresa Olasveengen
- Department of Anesthesiology, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norwegen
| | - Peter Paal
- Department of Anaesthesiology and Intensive Care Medicine, Hospitallers Brothers Hospital, Paracelsus Medical University, Salzburg, Österreich
| | - Tommaso Pellis
- Department of Anaesthesia and Intensive Care, Azienda Sanitaria Friuli Occidentale, Pordenone, Italien
| | - Gavin D. Perkins
- Warwick Medical School and University Hospitals Birmingham NHS Foundation Trust, University of Warwick, Coventry, Großbritannien
| | - Claudio Sandroni
- Department of Intensive Care, Emergency Medicine and Anaesthesiology, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Rom, Italien
- Institute of Anaesthesiology and Intensive Care Medicine, Università Cattolica del Sacro Cuore, Rom, Italien
| | - Jerry P. Nolan
- Warwick Medical School, Coventry, Großbritannien, Consultant in Anaesthesia and Intensive Care Medicine Royal United Hospital, University of Warwick, Bath, Großbritannien
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14
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Telion C, Marx JS, Dautreppe C, Carli P. Crise COVID-19 : les étudiants en médecine en renfort de la régulation médicale. Journal Européen des Urgences et de Réanimation 2021. [PMCID: PMC8098058 DOI: 10.1016/j.jeurea.2021.05.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
L’épidémie de COVID-19 a nécessité un renforcement en moyens techniques comme en personnel dans le cadre des activités de régulation médicale mais aussi pour les interventions préhospitalières non médicalisées ou des SMUR. Ce renforcement a été adapté à l’évolution de l’activité. Au SAMU de Paris, l’activité a imposé le doublement des postes de régulation dès la deuxième semaine de mars afin de répondre à la fois aux appels habituels mais aussi à la demande liée au COVID. Des étudiants en médecine de diplôme de formation approfondie en sciences médicales (DFASM) de 1re, 2e et 3e années volontaires ont été mobilisés pour venir renforcer la régulation médicale et assurer les réponses au sein d’une salle supplémentaire installée pour répondre aux appels COVID. Seuls, les étudiants en médecine du 2e cycle ont donc été intégrés à cette organisation, ils bénéficiaient à leur arrivée d’une formation adaptée à leur niveau d’étude et aux fonctions à accomplir au sein de la régulation médicale et aussi tout au long de leur activité d’un encadrement par un médecin sénior de l’aide médicale d’urgence et/ou de la permanence des soins ambulatoires. Cette activité était donc sécurisée par des médecins séniors comme dans tout stage hospitalier. Cette organisation a contribué notamment à Paris, à la réponse à l’afflux des appels au SAMU. Ce renfort a ensuite été maintenu, aussi bien dans le cadre de la crise que dans l’activité quotidienne et dans le déploiement du Service d’accès aux soins (SAS).
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15
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Hutin A, Levy Y, Lidouren F, Kohlhauer M, Carli P, Ghaleh B, Lamhaut L, Tissier R. Resuscitative endovascular balloon occlusion of the aorta vs epinephrine in the treatment of non-traumatic cardiac arrest in swine. Ann Intensive Care 2021; 11:81. [PMID: 34002305 PMCID: PMC8128970 DOI: 10.1186/s13613-021-00871-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 05/08/2021] [Indexed: 12/31/2022] Open
Abstract
Background The administration of epinephrine in the management of non-traumatic cardiac arrest remains recommended despite controversial effects on neurologic outcome. The use of resuscitative endovascular balloon occlusion of the aorta (REBOA) could be an interesting alternative. The aim of this study was to compare the effects of these 2 strategies on return of spontaneous circulation (ROSC) and cerebral hemodynamics during cardiopulmonary resuscitation (CPR) in a swine model of non-traumatic cardiac arrest. Results Anesthetized pigs were instrumented and submitted to ventricular fibrillation. After 4 min of no-flow and 18 min of basic life support (BLS) using a mechanical CPR device, animals were randomly submitted to either REBOA or epinephrine administration before defibrillation attempts. Six animals were included in each experimental group (Epinephrine or REBOA). Hemodynamic parameters were similar in both groups during BLS, i.e., before randomization. After epinephrine administration or REBOA, mean arterial pressure, coronary and cerebral perfusion pressures similarly increased in both groups. However, carotid blood flow (CBF) and cerebral regional oxygenation saturation were significantly higher with REBOA as compared to epinephrine administration (+ 125% and + 40%, respectively). ROSC was obtained in 5 animals in both groups. After resuscitation, CBF remained lower in the epinephrine group as compared to REBOA, but it did not achieve statistical significance. Conclusions During CPR, REBOA is as efficient as epinephrine to facilitate ROSC. Unlike epinephrine, REBOA transitorily increases cerebral blood flow and could avoid its cerebral detrimental effects during CPR. These experimental findings suggest that the use of REBOA could be beneficial in the treatment of non-traumatic cardiac arrest.
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Affiliation(s)
- Alice Hutin
- Univ Paris Est Créteil, INSERM, IMRB, 94010, Créteil, France.,Ecole Nationale Vétérinaire D'Alfort, IMRB, AfterROSC Network, 7 avenue du Général de Gaulle, 94700, Maisons-Alfort, France.,SAMU de Paris-ICU, Necker University Hospital, Assistance Publique-Hôpitaux de Paris, Université de Paris, 75015, Paris, France
| | - Yaël Levy
- Univ Paris Est Créteil, INSERM, IMRB, 94010, Créteil, France.,Ecole Nationale Vétérinaire D'Alfort, IMRB, AfterROSC Network, 7 avenue du Général de Gaulle, 94700, Maisons-Alfort, France
| | - Fanny Lidouren
- Univ Paris Est Créteil, INSERM, IMRB, 94010, Créteil, France.,Ecole Nationale Vétérinaire D'Alfort, IMRB, AfterROSC Network, 7 avenue du Général de Gaulle, 94700, Maisons-Alfort, France
| | - Matthias Kohlhauer
- Univ Paris Est Créteil, INSERM, IMRB, 94010, Créteil, France.,Ecole Nationale Vétérinaire D'Alfort, IMRB, AfterROSC Network, 7 avenue du Général de Gaulle, 94700, Maisons-Alfort, France
| | - Pierre Carli
- SAMU de Paris-ICU, Necker University Hospital, Assistance Publique-Hôpitaux de Paris, Université de Paris, 75015, Paris, France
| | - Bijan Ghaleh
- Univ Paris Est Créteil, INSERM, IMRB, 94010, Créteil, France.,Ecole Nationale Vétérinaire D'Alfort, IMRB, AfterROSC Network, 7 avenue du Général de Gaulle, 94700, Maisons-Alfort, France
| | - Lionel Lamhaut
- SAMU de Paris-ICU, Necker University Hospital, Assistance Publique-Hôpitaux de Paris, Université de Paris, 75015, Paris, France.,INSERM U970, PARCC, CEMS, Paris, France
| | - Renaud Tissier
- Univ Paris Est Créteil, INSERM, IMRB, 94010, Créteil, France. .,Ecole Nationale Vétérinaire D'Alfort, IMRB, AfterROSC Network, 7 avenue du Général de Gaulle, 94700, Maisons-Alfort, France.
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16
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James A, Yordanov Y, Ausset S, Langlois M, Tourtier JP, Carli P, Riou B, Raux M. Assessment of the mass casualty triage during the November 2015 Paris area terrorist attacks: towards a simple triage rule. Eur J Emerg Med 2021; 28:136-143. [PMID: 33252375 DOI: 10.1097/mej.0000000000000771] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKROUND Triage is key in the management of mass casualty incidents. OBJECTIVE The objective of this study was to assess the prehospital triage performed during the 2015 Paris area terrorist attack. DESIGN SETTING AND PARTICIPANT This was a retrospective cohort study that included all casualties of the attacks on 13 November 2015 in Paris area, France, that were admitted alive at the hospital within the first 24 h after the events. Patients were triaged as absolute emergency or relative emergency by a prehospital physician or nurse. This triage was then compared to the one of an expert panel that had retrospectively access to all prehospital and hospital files. OUTCOMES MEASURES AND ANALYSIS The primary endpoints were the rate of overtriage and undertriage, defined as number of patients misclassified in one triage category, divided by the total number of patients in this triage category. MAIN RESULT Among 337 casualties admitted to the hospital, 262 (78%) were triaged during prehospital care, with, respectively, 74 (28%) and 188 (72%) as absolute and relative emergencies. Among these casualties, the expert panel classified 96 (37%) patients as absolute emergencies and 166 (63%) as relative emergency. The rate of undertriage and overtriage was 36% [95% confidence interval (CI), 27-47%] and 8% (95% CI, 4-13%), respectively. Among undertriaged casualties, 8 (23%) were considered as being severely undertriaged. Among overtriaged casualties, 10 (77%) were considered as being severely overtriaged. CONCLUSION A simple prehospital triage for trauma casualties during the 13 November terrorist attack in Paris could have been performed triaged in 78% of casualties that were admitted to the hospital, with a 36% rate of undertriage and 8% of overtriage. Qualitative analysis of undertriage and overtriage indicate some possibilities for further improvement.
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Affiliation(s)
- Arthur James
- Sorbonne Université
- Department of Anaesthesiology and Critical Care Paris, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris (APHP)
| | - Youri Yordanov
- Sorbonne Université
- UMRS Inserm 1136
- Department of Emergency Medicine and Surgery, Hôpital Saint-Antoine
- Department of Emergency, APHP
| | - Sylvain Ausset
- Department of Anesthesiology and Critical Care, Hôpital d'Instruction des armées (HIA), Clamart
| | - Matthieu Langlois
- Department of Anaesthesiology and Critical Care Paris, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris (APHP)
- Service Médical du RAID, Bièvres
| | | | - Pierre Carli
- Service d'Aide Médicale Urgente 75, Hôpital Necker-Enfants Malades, APHP
- Université de Paris
| | - Bruno Riou
- Sorbonne Université
- Department of Emergency Medicine and Surgery, Hôpital Saint-Antoine
- UMRS Inserm 1166, IHU ICAN
- Department of Emergency Medicine and Surgery, Hôpital Pitié-Salpêtrière
| | - Mathieu Raux
- Sorbonne Université
- Department of Anaesthesiology and Critical Care Paris, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris (APHP)
- UMRS Inserm 1158, Paris, France
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17
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Soar J, Böttiger BW, Carli P, Couper K, Deakin CD, Djärv T, Lott C, Olasveengen T, Paal P, Pellis T, Perkins GD, Sandroni C, Nolan JP. European Resuscitation Council Guidelines 2021: Adult advanced life support. Resuscitation 2021; 161:115-151. [PMID: 33773825 DOI: 10.1016/j.resuscitation.2021.02.010] [Citation(s) in RCA: 407] [Impact Index Per Article: 135.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
These European Resuscitation Council Advanced Life Support guidelines, are based on the 2020 International Consensus on Cardiopulmonary Resuscitation Science with Treatment Recommendations. This section provides guidelines on the prevention of and ALS treatments for both in-hospital cardiac arrest and out-of-hospital cardiac arrest.
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Affiliation(s)
- Jasmeet Soar
- Southmead Hospital, North Bristol NHS Trust, Bristol, UK.
| | - Bernd W Böttiger
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Cologne, Cologne, Germany
| | - Pierre Carli
- SAMU de Paris, Centre Hospitalier Universitaire Necker Enfants Malades, Assistance Publique Hôpitaux de Paris, and Université Paris Descartes, Paris, France
| | - Keith Couper
- Critical Care Unit, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK; Warwick Medical School, University of Warwick, Coventry,UK
| | - Charles D Deakin
- University Hospital Southampton NHS Foundation Trust, Southampton, UK; South Central Ambulance Service NHS Foundation Trust, Otterbourne,UK
| | - Therese Djärv
- Dept of Acute and Reparative Medicine, Karolinska University Hospital, Stockholm, Sweden, Department of Medicine Solna, Karolinska Institutet,Stockholm, Sweden
| | - Carsten Lott
- Department of Anesthesiology, University Medical Center, Johannes Gutenberg-Universitaet Mainz, Germany
| | - Theresa Olasveengen
- Department of Anesthesiology, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Norway
| | - Peter Paal
- Department of Anaesthesiology and Intensive Care Medicine, Hospitallers Brothers Hospital, Paracelsus Medical University, Salzburg, Austria
| | - Tommaso Pellis
- Department of Anaesthesia and Intensive Care, Azienda Sanitaria Friuli Occidentale, Italy
| | - Gavin D Perkins
- University of Warwick, Warwick Medical School and University Hospitals Birmingham NHS Foundation Trust, Coventry, UK
| | - Claudio Sandroni
- Department of Intensive Care, Emergency Medicine and Anaesthesiology, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Rome, Italy; Institute of Anaesthesiology and Intensive Care Medicine, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Jerry P Nolan
- University of Warwick, Warwick Medical School, Coventry, CV4 7AL; Royal United Hospital, Bath, UK
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Hutin A, Ricard-Hibon A, Briole N, Dupin A, Dagron C, Raphalen JH, Mungur A, An K, Carli P, Lamhaut L. First Description of a Helicopter-Borne ECPR Team for Remote Refractory Out-of-Hospital Cardiac Arrest. PREHOSP EMERG CARE 2021:1-5. [PMID: 33275477 DOI: 10.1080/10903127.2020.1859026] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 11/10/2020] [Accepted: 11/28/2020] [Indexed: 10/22/2022]
Abstract
Introduction: Access time to extracorporeal cardiopulmonary resuscitation (ECPR) refractory out of hospital cardiac arrest (OHCA) is a crucial factor. In our region, some patients are not eligible to this treatment due to the impossibility to reach the hospital with reasonable delay (ideally 60 min). In order to increase accessibility for patients far from ECPR centers, we developed a helicopter-borne ECPR-team which is sent out to the patient for ECPR implementation on the scene of the OHCA.Methods: We conducted a retrospective monocentric study to evaluate this strategy. The team is triggered by the local emergency medical service and heliborne on the site of the OHCA. All consecutive patients implemented with ECPR by our heliborne ECPR team from January 2014 to December 2017 were included. We analyzed usual CA characteristics, different times (no-flow, low-flow, time between OHCA and dispatch…), and patient outcome.Results: During this 4-year study period, 33 patients were included. Mean age was 43.9 years. Mean distance from the ECPR-team base to OHCA location was 41 km. Mean low-flow time was 110 minutes. Five patients survived with good neurological outcome; 6 patients developed brain death and became organ donors.Conclusion: These results show the possibility to make ECPR accessible for patients far from ECPR centers. Survival rate is non negligible, especially in the absence of therapeutic alternative. An earlier trigger of the ECPR-team could reduce the low-flow time and probably increase survival. This strategy improves equity of access to ECPR and needs to be confirmed by further studies.
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Affiliation(s)
- A Hutin
- SAMU de Paris-ICU, Necker University Hospital, Assistance publique-Hopitaux de Paris, Paris, France (AH, CD, JHR, AM, KA, PC, LL); INSERM U955, Equipe 3, École Nationale Vétérinaire d'Alfort, Université Paris-Est Créteil, Paris, France (AH); SAMU-SMUR 95, Centre Hospitalier René Dubois, Pontoise, France (AR-H); SAMU-SMUR 77, Centre Hospitalier Marc Jaquet, Melun, France (NB); SAMU-SMUR 91, Centre Hospitalier Sud Francilien, Corbeil-Essones, France (AD); René Descartes University, Paris, France (PC, LL); INSERM U970, Unité 4 SDEC, Paris, France (LL)
| | - A Ricard-Hibon
- SAMU de Paris-ICU, Necker University Hospital, Assistance publique-Hopitaux de Paris, Paris, France (AH, CD, JHR, AM, KA, PC, LL); INSERM U955, Equipe 3, École Nationale Vétérinaire d'Alfort, Université Paris-Est Créteil, Paris, France (AH); SAMU-SMUR 95, Centre Hospitalier René Dubois, Pontoise, France (AR-H); SAMU-SMUR 77, Centre Hospitalier Marc Jaquet, Melun, France (NB); SAMU-SMUR 91, Centre Hospitalier Sud Francilien, Corbeil-Essones, France (AD); René Descartes University, Paris, France (PC, LL); INSERM U970, Unité 4 SDEC, Paris, France (LL)
| | - N Briole
- SAMU de Paris-ICU, Necker University Hospital, Assistance publique-Hopitaux de Paris, Paris, France (AH, CD, JHR, AM, KA, PC, LL); INSERM U955, Equipe 3, École Nationale Vétérinaire d'Alfort, Université Paris-Est Créteil, Paris, France (AH); SAMU-SMUR 95, Centre Hospitalier René Dubois, Pontoise, France (AR-H); SAMU-SMUR 77, Centre Hospitalier Marc Jaquet, Melun, France (NB); SAMU-SMUR 91, Centre Hospitalier Sud Francilien, Corbeil-Essones, France (AD); René Descartes University, Paris, France (PC, LL); INSERM U970, Unité 4 SDEC, Paris, France (LL)
| | - A Dupin
- SAMU de Paris-ICU, Necker University Hospital, Assistance publique-Hopitaux de Paris, Paris, France (AH, CD, JHR, AM, KA, PC, LL); INSERM U955, Equipe 3, École Nationale Vétérinaire d'Alfort, Université Paris-Est Créteil, Paris, France (AH); SAMU-SMUR 95, Centre Hospitalier René Dubois, Pontoise, France (AR-H); SAMU-SMUR 77, Centre Hospitalier Marc Jaquet, Melun, France (NB); SAMU-SMUR 91, Centre Hospitalier Sud Francilien, Corbeil-Essones, France (AD); René Descartes University, Paris, France (PC, LL); INSERM U970, Unité 4 SDEC, Paris, France (LL)
| | - C Dagron
- SAMU de Paris-ICU, Necker University Hospital, Assistance publique-Hopitaux de Paris, Paris, France (AH, CD, JHR, AM, KA, PC, LL); INSERM U955, Equipe 3, École Nationale Vétérinaire d'Alfort, Université Paris-Est Créteil, Paris, France (AH); SAMU-SMUR 95, Centre Hospitalier René Dubois, Pontoise, France (AR-H); SAMU-SMUR 77, Centre Hospitalier Marc Jaquet, Melun, France (NB); SAMU-SMUR 91, Centre Hospitalier Sud Francilien, Corbeil-Essones, France (AD); René Descartes University, Paris, France (PC, LL); INSERM U970, Unité 4 SDEC, Paris, France (LL)
| | - J H Raphalen
- SAMU de Paris-ICU, Necker University Hospital, Assistance publique-Hopitaux de Paris, Paris, France (AH, CD, JHR, AM, KA, PC, LL); INSERM U955, Equipe 3, École Nationale Vétérinaire d'Alfort, Université Paris-Est Créteil, Paris, France (AH); SAMU-SMUR 95, Centre Hospitalier René Dubois, Pontoise, France (AR-H); SAMU-SMUR 77, Centre Hospitalier Marc Jaquet, Melun, France (NB); SAMU-SMUR 91, Centre Hospitalier Sud Francilien, Corbeil-Essones, France (AD); René Descartes University, Paris, France (PC, LL); INSERM U970, Unité 4 SDEC, Paris, France (LL)
| | - A Mungur
- SAMU de Paris-ICU, Necker University Hospital, Assistance publique-Hopitaux de Paris, Paris, France (AH, CD, JHR, AM, KA, PC, LL); INSERM U955, Equipe 3, École Nationale Vétérinaire d'Alfort, Université Paris-Est Créteil, Paris, France (AH); SAMU-SMUR 95, Centre Hospitalier René Dubois, Pontoise, France (AR-H); SAMU-SMUR 77, Centre Hospitalier Marc Jaquet, Melun, France (NB); SAMU-SMUR 91, Centre Hospitalier Sud Francilien, Corbeil-Essones, France (AD); René Descartes University, Paris, France (PC, LL); INSERM U970, Unité 4 SDEC, Paris, France (LL)
| | - K An
- SAMU de Paris-ICU, Necker University Hospital, Assistance publique-Hopitaux de Paris, Paris, France (AH, CD, JHR, AM, KA, PC, LL); INSERM U955, Equipe 3, École Nationale Vétérinaire d'Alfort, Université Paris-Est Créteil, Paris, France (AH); SAMU-SMUR 95, Centre Hospitalier René Dubois, Pontoise, France (AR-H); SAMU-SMUR 77, Centre Hospitalier Marc Jaquet, Melun, France (NB); SAMU-SMUR 91, Centre Hospitalier Sud Francilien, Corbeil-Essones, France (AD); René Descartes University, Paris, France (PC, LL); INSERM U970, Unité 4 SDEC, Paris, France (LL)
| | - P Carli
- SAMU de Paris-ICU, Necker University Hospital, Assistance publique-Hopitaux de Paris, Paris, France (AH, CD, JHR, AM, KA, PC, LL); INSERM U955, Equipe 3, École Nationale Vétérinaire d'Alfort, Université Paris-Est Créteil, Paris, France (AH); SAMU-SMUR 95, Centre Hospitalier René Dubois, Pontoise, France (AR-H); SAMU-SMUR 77, Centre Hospitalier Marc Jaquet, Melun, France (NB); SAMU-SMUR 91, Centre Hospitalier Sud Francilien, Corbeil-Essones, France (AD); René Descartes University, Paris, France (PC, LL); INSERM U970, Unité 4 SDEC, Paris, France (LL)
| | - L Lamhaut
- SAMU de Paris-ICU, Necker University Hospital, Assistance publique-Hopitaux de Paris, Paris, France (AH, CD, JHR, AM, KA, PC, LL); INSERM U955, Equipe 3, École Nationale Vétérinaire d'Alfort, Université Paris-Est Créteil, Paris, France (AH); SAMU-SMUR 95, Centre Hospitalier René Dubois, Pontoise, France (AR-H); SAMU-SMUR 77, Centre Hospitalier Marc Jaquet, Melun, France (NB); SAMU-SMUR 91, Centre Hospitalier Sud Francilien, Corbeil-Essones, France (AD); René Descartes University, Paris, France (PC, LL); INSERM U970, Unité 4 SDEC, Paris, France (LL)
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Baud FJ, Jullien V, Abarou T, Pilmis B, Raphalen JH, Houzé P, Carli P, Lamhaut L. Elimination of fluconazole during continuous renal replacement therapy. An in vitro assessment. Int J Artif Organs 2020; 44:453-464. [DOI: 10.1177/0391398820976144] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Introduction: Continuous renal replacement therapy (CRRT) efficiently eliminates fluconazole. However, the routes of elimination were not clarified. Adsorption of fluconazole by filters is a pending question. We studied the elimination of fluconazole in a model mimicking a session of CRRT in humans using the NeckEpur® model. Two filters were studied. Methods: The AV1000®-polysulfone filter with the Multifiltrate Pro. Fresenius and the ST150®-polyacrylonitrile filter with the Prismaflex. Baxter-Gambro were studied. Continuous filtration used a flowrate of 2.5 L/h in post-dilution only. Session were made in duplicate. Routes of elimination were assessed using the NeckEpur® model. Results: The mean measured initial fluconazole concentration (mean ± SD) for the four sessions in the central compartment (CC) was 14.9 ± 0.2 mg/L. The amount eliminated from the CC at the end of 6 h-session at a 2.5 L/h filtration flowrate for the AV1000®-polysulfone and the ST150®-polyacrylonitrile filters were 90%–93% and 96%–94%, respectively; the clearances from the central compartment (CC) were 2.5–2.6 and 2.4–2.3 L/h, respectively. The means of the instantaneous sieving coefficient were 0.94%–0.91% and 0.99%–0.91%, respectively. The percentages of the amount eliminated from the CC by filtration/adsorption were 100/0%–95/5% and 100/0%–100/0%, respectively. Conclusion: Neither the ST150®-polyacrylonitrile nor the AV1000®-polysulfone filters result in any significant adsorption of fluconazole.
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Affiliation(s)
- Frédéric J Baud
- Department of Anesthesiology and Intensive Care Medicine, Adult Intensive Care Unit, Necker Hospital, Paris, France
- EA7323 Evaluation of Therapeutics and Pharmacology in Perinatality and Pediatrics, Hôpitaux Universitaires Cochin—Broca—Hôtel Dieu, Site Tarnier, Université Paris Descartes, Paris, France
- University Paris Diderot, Paris, France
| | - Vincent Jullien
- Assistance Publique—Hôpitaux de Paris, Groupe Hospitalier Paris Seine-Saint-Denis, Bobigny, France
- Molecular Mycology Unit-CNRS UMR 2000, Pasteur Institute, Paris, France
| | - Tarik Abarou
- Laboratoire de Chimie Analytique, Faculté de Pharmacie, Université Paris Descartes, Paris, France
| | - Benoît Pilmis
- Equipe Mobile de Microbiologie Clinique, Groupe Hospitalier Paris Saint-Joseph, Paris, France
- Service de Maladies Infectieuses et Tropicales, Hôpital Necker-Enfants Malades, Paris, France
- Institut Micalis, UMR 1319, Université Paris-Saclay, INRAe, AgroParisTech, Chatenay-Malabry, France
| | - Jean-Herlé Raphalen
- Department of Anesthesiology and Intensive Care Medicine, SAMU de Paris, Adult Intensive Care Unit, Necker Hospital, Paris, France
| | - Pascal Houzé
- Laboratoire de Biochimie, Hôpital Universitaire Necker-Enfants Malades, Assistance Publique—Hôpitaux de Paris, Paris, France
- Unité de Technologies Chimiques et Biologiques Pour la Santé, CNRS UMR8258 – U1022, Faculté de Pharmacie Paris Descartes, Paris, France
- Université Paris Descartes, Paris, France
| | - Pierre Carli
- Department of Anesthesiology and Intensive Care Medicine, SAMU de Paris, Adult Intensive Care Unit, Necker Hospital, Paris, France
- Université Paris Descartes, Paris, France
| | - Lionel Lamhaut
- Department of Anesthesiology and Intensive Care Medicine, SAMU de Paris, Adult Intensive Care Unit, Necker Hospital, Paris, France
- Université Paris Descartes, Paris, France
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Abstract
L’épidémie de Covid-19 représente une crise dont l’ampleur n’avait jusque-là jamais été imaginée. Des modifications des pratiques pour y faire face ne pouvaient reposer uniquement sur des doctrines ou des intuitions, mais nécessitaient adaptabilité, innovation et réactivité. Un renforcement en moyens techniques et humains a été débuté dès la fin du mois de février. L’organisation de la régulation médicale du Samu de Paris a été modifiée, renforcée en fonction des flux de patients à traiter et adaptée à la spécificité de la crise de Covid. L’ensemble des mesures avait comme objectif d’apporter la réponse la plus adaptée aux patients atteints de la Covid-19 et de préserver la réponse aux appels urgents du 15. Une collaboration fructueuse s’est rapidement établie entre tous les acteurs de la santé, hospitaliers et libéraux favorisant un maintien à domicile d’un certain nombre de patients et empêchant ainsi une saturation précoce des services d’urgence. Le développement et l’intégration de nouveaux outils informatiques ont facilité et diversifié les réponses apportées. Il est, dès à présent, indispensable de pérenniser et de renforcer ces acquis afin de développer le service d’accès aux soins (SAS) nécessaire pour apporter à la population une qualité de soins optimisée.
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Lamhaut L, Nivet CM, Dagron C, Nace L, Braun F, Carli P. Retour d’expérience des évacuations par train à grande vitesse de patients en syndrome de détresse respiratoire aiguë sur infection à Covid-19 : les missions Chardon. Ann Fr Med Urgence 2020. [DOI: 10.3166/afmu-2020-0275] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Lors de la crise Covid-19 en France, il a fallu transférer des patients de zones où les lits de réanimation étaient saturés vers d’autres régions. Tous les moyens ont été utilisés : terrestre, aérien, maritime… Pour la première fois, des trains à grande vitesse (TGV) ont été utilisés. Le transport ferroviaire avait été utilisé largement pendant la Première Guerre mondiale. Ces transferts ont nécessité une collaboration extrêmement importante interservices : ministère, agences régionales de santé, hôpitaux, Samu zonaux, Samu, Smur associations de sécurités civiles, sapeurs-pompiers… L’une des collaborations des plus importantes a été celle avec la SNCF qui a permis une adaptation des rames, sécurisations des itinéraires, adaptation de la conduite… Chaque voiture transporte quatre patients intubés en syndrome de détresse respiratoire aiguë avec un médecin senior, un junior, quatre infirmiers et un logisticien pour la réalisation de la surveillance et des soins. Dans chaque rame, une équipe de régulation médicale est présente pour la coordination. Il y a eu dix évacuations sanitaires, qui ont transporté 197 patients sur 6 600 km (350‒950 km/TGV). Le transport le plus long a été de 7 h 14 min. On n’a pas relevé de complications majeures pendant les transferts. Plusieurs questions restent en suspens comme les critères de sélections des patients, la mise en place d’un train sanitaire aménagé permanent, un stock de matériel. Afin de mieux connaître les conséquences sur les patients, une étude est en cours. Les urgentistes ont une nouvelle corde à leur arc avec la possibilité d’effectuer des évacuations sanitaires en TGV pour des patients médicaux graves sur de longues distances.
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Baud FJ, Houzé P, Carli P, Lamhaut L. Alteration of the pharmacokinetics of aminoglycosides by adsorption in a filter during continuous renal replacement therapy. An in vitro assessment. Therapie 2020; 76:415-424. [DOI: 10.1016/j.therap.2020.10.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 08/11/2020] [Accepted: 10/23/2020] [Indexed: 10/23/2022]
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Cariou A, Pottecher J, Adnet F, Whitaker D, Carli P, Pasquier P, Mercat A. Opération Code Bleu : mettons en place un numéro d’appel unique (2222) pour les urgences vitales intra-hospitalières ! Méd Intensive Réa 2020. [DOI: 10.37051/mir-00007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
La survenue d’un arrêt cardiaque intra-hospitalier, quiconstitue la forme la plus extrême de l’urgence vitaleintra-hospitalière (UVIH), constitue un évènementindésirable majeur qui concerne environ 1 à 5 patientspour 1000 admissions. Le pronostic de ces victimesest étroitement dépendant de la mise en œuvre d’unechaîne de survie intra-hospitalière efficace, dont l’élémentle plus important est le déclenchement immédiat dessecours. Chaque minute compte : tout retard engendrénotamment par une incertitude ou une hésitation surle système d’alerte diminue les chances de survie etaugmente les risques de séquelles.
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Jouffroy R, Saade A, Philippe P, Guyard A, Carli P, Vivien B. Pupil Reactivity in Refractory Out-ofHospital Cardiac Arrest Treated by ExtraCorporeal Cardiopulmonary Resuscitation. Turk J Anaesthesiol Reanim 2020; 48:294-299. [PMID: 32864644 PMCID: PMC7434341 DOI: 10.5152/tjar.2019.75418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 02/11/2019] [Indexed: 11/22/2022] Open
Affiliation(s)
- Romain Jouffroy
- Intensive Care Unit, Anaesthesiology department and SAMU of Paris, Hospital Necker, Assistance Publique Hôpitaux de Paris, Paris Descartes University, Paris, France
| | - Anastasia Saade
- Intensive Care Unit, Anaesthesiology department and SAMU of Paris, Hospital Necker, Assistance Publique Hôpitaux de Paris, Paris Descartes University, Paris, France
| | - Pascal Philippe
- Intensive Care Unit, Anaesthesiology department and SAMU of Paris, Hospital Necker, Assistance Publique Hôpitaux de Paris, Paris Descartes University, Paris, France
| | - Alexandra Guyard
- Intensive Care Unit, Anaesthesiology department and SAMU of Paris, Hospital Necker, Assistance Publique Hôpitaux de Paris, Paris Descartes University, Paris, France
| | - Pierre Carli
- Intensive Care Unit, Anaesthesiology department and SAMU of Paris, Hospital Necker, Assistance Publique Hôpitaux de Paris, Paris Descartes University, Paris, France
| | - Benoit Vivien
- Intensive Care Unit, Anaesthesiology department and SAMU of Paris, Hospital Necker, Assistance Publique Hôpitaux de Paris, Paris Descartes University, Paris, France
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Jouffroy R, Pierre Tourtier J, Gueye P, Bloch-Laine E, Bounes V, Debaty G, Boularan J, Carli P, Vivien B. Prehospital shock index to assess 28-day mortality for septic shock. Am J Emerg Med 2020; 38:1352-1356. [DOI: 10.1016/j.ajem.2019.11.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 10/17/2019] [Accepted: 11/02/2019] [Indexed: 11/26/2022] Open
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Guillemet L, Jamme M, Bougouin W, Geri G, Deye N, Vivien B, Varenne O, Pène F, Mira JP, Barat F, Treluyer JM, Hermine O, Carli P, Coste J, Cariou A. Effects of early high-dose erythropoietin on acute kidney injury following cardiac arrest: exploratory post hoc analyses from an open-label randomized trial. Clin Kidney J 2020; 13:413-420. [PMID: 32699621 PMCID: PMC7367106 DOI: 10.1093/ckj/sfz068] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 04/29/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Acute kidney injury (AKI) is frequent in patients resuscitated from cardiac arrest (CA) and may worsen outcome. Experimental data suggest a renoprotective effect by treating these patients with a high dose of erythropoietin (Epo) analogues. We aimed to evaluate the efficacy of epoetin alpha treatment on renal outcome after CA. METHODS We did a post hoc analysis of the Epo-ACR-02 trial, which randomized patients with a persistent coma after a witnessed out-of-hospital CA. Only patients admitted in one intensive care unit were analysed. In the intervention group, patients received five intravenous injections of Epo spaced 12 h apart during the first 48 h, started as soon as possible after resuscitation. In the control group, patients received standard care without Epo. The main endpoint was the proportion of patients with persistent AKI defined by Kidney Disease: Improving Global Outcomes criteria at Day 2. Secondary endpoints included the occurrence of AKI through Day 7, estimated glomerular filtration rate (eGFR) at Day 28, haematological indices and adverse events. RESULTS A total of 162 patients were included in the primary analysis (74 in the Epo group, 88 in the control group). Baseline characteristics were similar in the two groups. At Day 2, 52.8% of the patients (38/72) in the intervention group had an AKI, as compared with 54.4% of the patients (46/83) in the control group (P = 0.74). There was no significant difference between the two groups regarding the proportion of patients with AKI through Day 7. Among patients with persistent AKI at Day 2, 33% (4/12) in the intervention group had an eGFR <75 mL/min/1.73 m2 compared with 25% (3/12) in the control group at Day 28 (P = 0.99). We found no significant differences in haematological indices or adverse events. CONCLUSION After CA, early administration of Epo did not confer any renal protective effect as compared with standard therapy.
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Affiliation(s)
- Lucie Guillemet
- Medical Intensive Care Unit, Cochin Hospital (AP-HP), Paris, France
- Paris Descartes University, Paris, France
| | - Matthieu Jamme
- Medical Intensive Care Unit, Cochin Hospital (AP-HP), Paris, France
| | - Wulfran Bougouin
- Medical Intensive Care Unit, Cochin Hospital (AP-HP), Paris, France
- Paris Descartes University, Paris, France
- INSERM U970 (Team 4), Parisian Cardiovascular Research Center, Paris Descartes University, Paris, France
| | - Guillaume Geri
- Medical Intensive Care Unit, Cochin Hospital (AP-HP), Paris, France
- Paris Descartes University, Paris, France
- INSERM U970 (Team 4), Parisian Cardiovascular Research Center, Paris Descartes University, Paris, France
| | - Nicolas Deye
- Medical Intensive Care Unit, Lariboisière Hospital (AP-HP) and INSERM U942, Paris, France
| | - Benoît Vivien
- Paris Descartes University, Paris, France
- SAMU 75, Necker Hospital (AP-HP), Paris, France
| | - Olivier Varenne
- Paris Descartes University, Paris, France
- Cardiology Department, Cochin University Hospital (AP-HP), Paris, France
| | - Frédéric Pène
- Medical Intensive Care Unit, Cochin Hospital (AP-HP), Paris, France
- Paris Descartes University, Paris, France
| | - Jean-Paul Mira
- Medical Intensive Care Unit, Cochin Hospital (AP-HP), Paris, France
- Paris Descartes University, Paris, France
| | - Florence Barat
- Clinical Trial Unit, Central Pharmacy, AP-HP, Paris, France
| | - Jean-Marc Treluyer
- Paris Descartes University, Paris, France
- Clinical Research Unit, Paris Centre and Paris Descartes University, Paris, France
| | - Olivier Hermine
- Paris Descartes University, Paris, France
- Hematology Department, Necker Hospital (AP-HP)—Imagine institute—INSERM U1123 CNRS erl 8654 - Labex des Globules Rouges Grex, Paris, France
| | - Pierre Carli
- Paris Descartes University, Paris, France
- SAMU 75, Necker Hospital (AP-HP), Paris, France
| | - Joël Coste
- Paris Descartes University, Paris, France
- Biostatistics and Epidemiology Unit, Hôtel-Dieu Hospital (AP-HP), Paris, France
| | - Alain Cariou
- Medical Intensive Care Unit, Cochin Hospital (AP-HP), Paris, France
- Paris Descartes University, Paris, France
- INSERM U970 (Team 4), Parisian Cardiovascular Research Center, Paris Descartes University, Paris, France
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Soar J, Lott C, Böttiger BW, Carli P, Couper K, Deakin CD, Djärv T, Olasveengen T, Paal P, Pellis T, Perkins GD, Sandroni C, Nolan JP. Erweiterte lebensrettende Maßnahmen bei Erwachsenen. Notf Rett Med 2020; 23:248-250. [PMID: 32536800 PMCID: PMC7284666 DOI: 10.1007/s10049-020-00720-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Jouffroy R, Saade A, Philippe P, Buffo M, Carli P, Vivien B. Association between Blood Pressure after Haemodynamic Resuscitation in the Prehospital Setting and 28-Day Mortality in Septic Shock. Turk J Anaesthesiol Reanim 2020; 48:229-234. [PMID: 32551451 PMCID: PMC7279876 DOI: 10.5152/tjar.2019.45577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 07/20/2019] [Indexed: 11/22/2022] Open
Affiliation(s)
- Romain Jouffroy
- Department of Anaesthesia and Intensive Care Unit, SAMU, Paris, France
| | - Anastasia Saade
- Department of Anaesthesia and Intensive Care Unit, SAMU, Paris, France
| | - Pascal Philippe
- Department of Anaesthesia and Intensive Care Unit, SAMU, Paris, France
| | - Milene Buffo
- Department of Anaesthesia and Intensive Care Unit, SAMU, Paris, France
| | - Pierre Carli
- Department of Anaesthesia and Intensive Care Unit, SAMU, Paris, France
| | - Benoit Vivien
- Department of Anaesthesia and Intensive Care Unit, SAMU, Paris, France
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Affiliation(s)
- Benoît Vivien
- SAMU de Paris, Service d’Anesthésie Réanimation, Centre Hospitalier Universitaire Necker Enfants Malades, Assistance Publique Hôpitaux de Paris, and Université Paris Descartes, Paris, France
| | - Jean-Emmanuel de la Coussaye
- Service de Médecine d’Urgence, SAMU du Gard, Centre Hospitalier Universitaire de Nîmes and Université de Montpellier, Nîmes, France
| | - Pierre Carli
- SAMU de Paris, Service d’Anesthésie Réanimation, Centre Hospitalier Universitaire Necker Enfants Malades, Assistance Publique Hôpitaux de Paris, and Université Paris Descartes, Paris, France
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Baud FJ, Houzé P, Raphalen JH, Winchenne A, Philippe P, Carli P, Lamhaut L. Diafiltration flowrate is a determinant of the extent of adsorption of amikacin in renal replacement therapy using the ST150®-AN69 filter: An in vitro study. Int J Artif Organs 2020; 43:758-766. [DOI: 10.1177/0391398820911928] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Introduction: In continuous renal replacement therapy, conduction and convection are controlled allowing prescribing dosage regimen improving survival. In contrast, adsorption is an uncontrolled property altering drug disposition. Whether adsorption depends on flowrates is unknown. We hypothesized an in vitro model may provide information in conditions mimicking continuous renal replacement therapy in humans. Methods: ST150®-AN69 filter and Prismaflex dialyzer, Baxter-Gambro were used. Simulated blood flowrate was set at 200 mL/min. The flowrates in the filtration (continuous filtration), dialysis (continuous dialysis), and diafiltration (continuous diafiltration) were 1500, 2500, and 4000 mL/h, respectively. Routes of elimination were assessed using NeckEpur® analysis. Results: The percentages of the total amount eliminated by continuous filtration, continuous dialysis, and continuous diafiltration were 82%, 86%, and 94%, respectively. Elimination by effluents and adsorption accounted for 42% ± 7% and 58% ± 5%, 57% ± 7% and 43% ± 6%, and 84% ± 6% and 16% ± 6% of amikacin elimination, respectively. There was a linear regression between flowrates and amikacin clearance: Y = 0.6 X ± 1.7 (R2 = 0.9782). Conversely, there was a linear inverse correlation between the magnitude of amikacin adsorption and flowrate: Y = –16.9 X ± 84.1 (R2 = 0.9976). Conclusion: Low flowrates resulted in predominant elimination by adsorption, accounting for 58% of the elimination of amikacin from the central compartment in the continuous filtration mode at 1500 mL/h of flowrate. Thereafter, the greater the flowrate, the lower the adsorption of amikacin in a linear manner. Flowrate is a major determinant of adsorption of amikacin. There was an about 17% decrease in the rate of adsorption per increase in the flowrate of 1 L/min.
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Affiliation(s)
- Frédéric Joseph Baud
- Department of Anesthesiology an Intensive Care Medicine, Adult Intensive Care Unit, SAMU de Paris, Necker Hospital, Paris, France
- Université de Paris, Paris, France
- EA7323, Université de Paris, Paris, France
| | - Pascal Houzé
- Laboratoire de Biochimie, Necker Hospital, Paris, France
- UMR8258 – U1022, Paris, France
| | - Jean-Herlé Raphalen
- Department of Anesthesiology an Intensive Care Medicine, Adult Intensive Care Unit, SAMU de Paris, Necker Hospital, Paris, France
| | - Anaïs Winchenne
- Department of Anesthesiology an Intensive Care Medicine, Adult Intensive Care Unit, SAMU de Paris, Necker Hospital, Paris, France
| | - Pascal Philippe
- Department of Anesthesiology an Intensive Care Medicine, Adult Intensive Care Unit, SAMU de Paris, Necker Hospital, Paris, France
| | - Pierre Carli
- Department of Anesthesiology an Intensive Care Medicine, Adult Intensive Care Unit, SAMU de Paris, Necker Hospital, Paris, France
- Université de Paris, Paris, France
| | - Lionel Lamhaut
- Department of Anesthesiology an Intensive Care Medicine, Adult Intensive Care Unit, SAMU de Paris, Necker Hospital, Paris, France
- Université de Paris, Paris, France
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Rudd AG, Bladin C, Carli P, De Silva DA, Field TS, Jauch EC, Kudenchuk P, Kurz MW, Lærdal T, Ong M, Panagos P, Ranta A, Rutan C, Sayre MR, Schonau L, Shin SD, Waters D, Lippert F. Utstein recommendation for emergency stroke care. Int J Stroke 2020; 15:555-564. [PMID: 32223543 PMCID: PMC7672780 DOI: 10.1177/1747493020915135] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Background Recent advances in treatment for stroke give new possibilities for optimizing
outcomes. To deliver these prehospital care needs to become more
efficient. Aim To develop a framework to support improved delivery of prehospital care. The
recommendations are aimed at clinicians involved in prehospital and
emergency health systems who will often not be stroke specialists but need
clear guidance as to how to develop and deliver safe and effective care for
acute stroke patients. Methods Building on the successful implementation program from the Global
Resuscitation Alliance and the Resuscitation Academy, the Utstein
methodology was used to define a generic chain of survival for Emergency
Stroke Care by assembling international expertise in Stroke and Emergency
Medical Services (EMS). Ten programs were identified for Acute Stroke Care
to improve survival and outcomes, with recommendations for implementation of
best practice. Conclusions Efficient prehospital systems for acute stroke will be improved through
public awareness, optimized prehospital triage and timely diagnostics, and
quick and equitable access to acute treatments. Documentation, use of
metrics and transparency will help to build a culture of excellence and
accountability.
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Affiliation(s)
- A G Rudd
- NHS England and King's College, London, England
| | - C Bladin
- Eastern Health Monash University, Melbourne, Australia
| | - P Carli
- Emergency Medical Services, Paris, France
| | - D A De Silva
- National Neuroscience Institute, Singapore General Hospital, Singapore
| | - T S Field
- University of British Columbia, Vancouver, Canada
| | - E C Jauch
- Mission Health System, Asheville, USA
| | - P Kudenchuk
- University of Washington School of Medicine, Seattle, WA, USA
| | - M W Kurz
- Stavanger University Hospital, Stavanger, Norway
| | - T Lærdal
- The Laerdal Foundation, Stavanger, Norway
| | - Meh Ong
- Singapore General Hospital and Duke-NUS Medical School, Singapore, Singapore
| | - P Panagos
- Washington University School of Medicine, St. Louis, MO, USA
| | - A Ranta
- University of Otago, Dunedin, New Zealand
| | - C Rutan
- American Heart Association, Dallas, TX, USA
| | | | - L Schonau
- Danish Resuscitation Council, Copenhagen, Denmark
| | - S D Shin
- Seoul National University College of Medicine, Seoul, South Korea
| | - D Waters
- Ambulance New Zealand, Wellington, New Zealand
| | - F Lippert
- Copenhagen Emergency Medical Services, Copenhagen, Denmark
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Rossinot H, Lapandry C, Adnet F, Carli P, Lecarpentier E, Baer M, Veber F. Is the French Emergency Medical Service System duplicable in developing countries? Eur J Public Health 2019. [DOI: 10.1093/eurpub/ckz186.097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Issue
The management of pre-hospital emergencies is a growing issue in developing countries, particularly because of the increase of both road accidents and cardio-vascular diseases.
Description of the problem
Numerous countries have tried or are currently trying to develop emergency response systems like the French SAMU but the outcome of those actions show a lot of difficulties. It is however proved that efficient care of serious pre-hospital medical emergencies significantly improves both patients’ mortality and morbidity.
Results
AP-HP, Greater Paris University Hospitals, has a strong experience of supporting the development of this model of care in countries with limited resources. Most of last 30 years’ experiments have been reviewed to understand what the essential prerequisites to succeed in setting up an emergency response system such as SAMU are. The analysis (5 criteria evaluation: efficiency, sustainability, effectiveness, impact, relevance) of past and present experiments in 28 countries showed that main issues are political (what are the priorities?), financial and societal (what does the population expect?). The question of medical resources is also crucial as the French model introduces medical regulation at all levels. Moreover, in France, such a system is built as a health care pathway with a predetermined orientation towards the appropriate and operational structure, which unfortunately is not the case in a lot of countries. Aside from those realized in China or in some Southern American countries, most of the projects so far don’t match all the evaluation criteria, particularly sustainability, as it is based both on stable funding and a strong reactivity of local hospitals.
Lessons
Future projects will have to fit with the local context. Strong commitments from partner countries must be made on the long term to have a real impact.
Key messages
There is no universal system easily duplicable. Some major prerequisites must be identified and implemented to succeed in the set-up of an efficient and sustainable EMSS.
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Affiliation(s)
- H Rossinot
- Délégation aux Relations Internationales, AP-HP, Paris, France
| | - C Lapandry
- Délégation aux Relations Internationales, AP-HP, Paris, France
| | - F Adnet
- SAMU AP-HP Avicenne, AP-HP, Bobigny, France
| | - P Carli
- SAMU AP-HP Necker, AP-HP, Paris, France
| | | | - M Baer
- SAMU AP-HP Raymond poincaré, AP-HP, Garches, France
| | - F Veber
- Délégation aux Relations Internationales, AP-HP, Paris, France
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Bougouin W, Dumas F, Lamhaut L, Marijon E, Carli P, Combes A, Pirracchio R, Aissaoui N, Karam N, Deye N, Sideris G, Beganton F, Jost D, Cariou A, Jouven X, Adnet F, Agostinucci JM, Aissaoui-Balanant N, Algalarrondo V, Alla F, Alonso C, Amara W, Annane D, Antoine C, Aubry P, Azoulay E, Beganton F, Benhamou D, Billon C, Bougouin W, Boutet J, Bruel C, Bruneval P, Cariou A, Carli P, Casalino E, Cerf C, Chaib A, Cholley B, Cohen Y, Combes A, Crahes M, Da Silva D, Das V, Demoule A, Denjoy I, Deye N, Dhonneur G, Diehl JL, Dinanian S, Domanski L, Dreyfuss D, Duboc D, Dubois-Rande JL, Dumas F, Empana JP, Extramiana F, Fartoukh M, Fieux F, Gabbas M, Gandjbakhch E, Geri G, Guidet B, Halimi F, Henry P, Hidden Lucet F, Jabre P, Jacob L, Joseph L, Jost D, Jouven X, Karam N, Kassim H, Lacotte J, Lahlou-Laforet K, Lamhaut L, Lanceleur A, Langeron O, Lavergne T, Lecarpentier E, Leenhardt A, Lellouche N, Lemiale V, Lemoine F, Linval F, Loeb T, Ludes B, Luyt CE, Maltret A, Mansencal N, Mansouri N, Marijon E, Marty J, Maury E, Maxime V, Megarbane B, Mekontso-Dessap A, Mentec H, Mira JP, Monnet X, Narayanan K, Ngoyi N, Perier MC, Piot O, Pirracchio R, Plaisance P, Plu I, Raux M, Revaux F, Ricard JD, Richard C, Riou B, Roussin F, Santoli F, Schortgen F, Sharifzadehgan A, Sideris G, Spaulding C, Teboul JL, Timsit JF, Tourtier JP, Tuppin P, Ursat C, Varenne O, Vieillard-Baron A, Voicu S, Wahbi K, Waldmann V. Extracorporeal cardiopulmonary resuscitation in out-of-hospital cardiac arrest: a registry study. Eur Heart J 2019; 41:1961-1971. [DOI: 10.1093/eurheartj/ehz753] [Citation(s) in RCA: 98] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 03/26/2019] [Accepted: 10/01/2019] [Indexed: 11/13/2022] Open
Abstract
Abstract
Aims
Out-of-hospital cardiac arrest (OHCA) without return of spontaneous circulation (ROSC) despite conventional resuscitation is common and has poor outcomes. Adding extracorporeal membrane oxygenation (ECMO) to cardiopulmonary resuscitation (extracorporeal-CPR) is increasingly used in an attempt to improve outcomes.
Methods and results
We analysed a prospective registry of 13 191 OHCAs in the Paris region from May 2011 to January 2018. We compared survival at hospital discharge with and without extracorporeal-CPR and identified factors associated with survival in patients given extracorporeal-CPR. Survival was 8% in 525 patients given extracorporeal-CPR and 9% in 12 666 patients given conventional-CPR (P = 0.91). By adjusted multivariate analysis, extracorporeal-CPR was not associated with hospital survival [odds ratio (OR), 1.3; 95% confidence interval (95% CI), 0.8–2.1; P = 0.24]. By conditional logistic regression with matching on a propensity score (including age, sex, occurrence at home, bystander CPR, initial rhythm, collapse-to-CPR time, duration of resuscitation, and ROSC), similar results were found (OR, 0.8; 95% CI, 0.5–1.3; P = 0.41). In the extracorporeal-CPR group, factors associated with hospital survival were initial shockable rhythm (OR, 3.9; 95% CI, 1.5–10.3; P = 0.005), transient ROSC before ECMO (OR, 2.3; 95% CI, 1.1–4.7; P = 0.03), and prehospital ECMO implantation (OR, 2.9; 95% CI, 1.5–5.9; P = 0.002).
Conclusions
In a population-based registry, 4% of OHCAs were treated with extracorporeal-CPR, which was not associated with increased hospital survival. Early ECMO implantation may improve outcomes. The initial rhythm and ROSC may help select patients for extracorporeal-CPR.
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Affiliation(s)
- Wulfran Bougouin
- Paris Cardiovascular Research Center (PARCC), INSERM Unit 970, 56 rue Leblanc, 75787 Paris, France
- Medical-Surgical Intensive Care Unit, Ramsay Générale de Santé, Hôpital Privé Jacques Cartier, 6 Avenue du Noyer Lambert, 91300 Massy, France
- Paris Sudden Death Expertise Center, 56 rue Leblanc, 75787 Paris, France
- AfterROSC network, 27 Rue du Faubourg Saint-Jacques, 75014 Paris, France
| | - Florence Dumas
- Paris Cardiovascular Research Center (PARCC), INSERM Unit 970, 56 rue Leblanc, 75787 Paris, France
- Paris Sudden Death Expertise Center, 56 rue Leblanc, 75787 Paris, France
- Université Paris Descartes-Sorbonne Paris Cité, 12 Rue de l'École de Médecine, 75006 Paris, France
- Emergency Department, Cochin-Hotel-Dieu Hospital, APHP, 27 Rue du Faubourg Saint-Jacques, 75014 Paris, France
| | - Lionel Lamhaut
- Paris Cardiovascular Research Center (PARCC), INSERM Unit 970, 56 rue Leblanc, 75787 Paris, France
- Paris Sudden Death Expertise Center, 56 rue Leblanc, 75787 Paris, France
- AfterROSC network, 27 Rue du Faubourg Saint-Jacques, 75014 Paris, France
- Université Paris Descartes-Sorbonne Paris Cité, 12 Rue de l'École de Médecine, 75006 Paris, France
- Intensive Care Unit - SAMU 75, Necker-Enfants-Malades Hospital, APHP, 149 Rue de Sèvres, 75015 Paris, France
| | - Eloi Marijon
- Paris Cardiovascular Research Center (PARCC), INSERM Unit 970, 56 rue Leblanc, 75787 Paris, France
- Paris Sudden Death Expertise Center, 56 rue Leblanc, 75787 Paris, France
- Université Paris Descartes-Sorbonne Paris Cité, 12 Rue de l'École de Médecine, 75006 Paris, France
- Cardiology Department, Georges Pompidou European Hospital, AP-HP, 20 Rue Leblanc, 75015 Paris, France
| | - Pierre Carli
- Université Paris Descartes-Sorbonne Paris Cité, 12 Rue de l'École de Médecine, 75006 Paris, France
- Intensive Care Unit - SAMU 75, Necker-Enfants-Malades Hospital, APHP, 149 Rue de Sèvres, 75015 Paris, France
| | - Alain Combes
- Medical-Surgical Intensive Care Unit, iCAN, Institute of Cardiometabolism and Nutrition, Pitié-Salpétrière Hospital, APHP, 47-83 Boulevard de l'Hôpital, 75013 Paris, France
| | - Romain Pirracchio
- Université Paris Descartes-Sorbonne Paris Cité, 12 Rue de l'École de Médecine, 75006 Paris, France
- Surgical ICU, Georges Pompidou European Hospital, AP-HP, 20 Rue Leblanc, 75015 Paris, France
| | - Nadia Aissaoui
- Paris Cardiovascular Research Center (PARCC), INSERM Unit 970, 56 rue Leblanc, 75787 Paris, France
- Paris Sudden Death Expertise Center, 56 rue Leblanc, 75787 Paris, France
- AfterROSC network, 27 Rue du Faubourg Saint-Jacques, 75014 Paris, France
- Université Paris Descartes-Sorbonne Paris Cité, 12 Rue de l'École de Médecine, 75006 Paris, France
- Medical ICU, Georges Pompidou European Hospital, AP-HP, 20 Rue Leblanc, 75015 Paris, France
| | - Nicole Karam
- Paris Cardiovascular Research Center (PARCC), INSERM Unit 970, 56 rue Leblanc, 75787 Paris, France
- Paris Sudden Death Expertise Center, 56 rue Leblanc, 75787 Paris, France
- Université Paris Descartes-Sorbonne Paris Cité, 12 Rue de l'École de Médecine, 75006 Paris, France
- Cardiology Department, Georges Pompidou European Hospital, AP-HP, 20 Rue Leblanc, 75015 Paris, France
| | - Nicolas Deye
- AfterROSC network, 27 Rue du Faubourg Saint-Jacques, 75014 Paris, France
- Medical ICU, Lariboisière Hospital, AP-HP, 2 Rue Ambroise Paré, 75010 Paris, France
| | - Georgios Sideris
- Cardiology Department, Lariboisière Hospital, AP-HP, 2 Rue Ambroise Paré, 75010 Paris, France
| | - Frankie Beganton
- Paris Cardiovascular Research Center (PARCC), INSERM Unit 970, 56 rue Leblanc, 75787 Paris, France
- Paris Sudden Death Expertise Center, 56 rue Leblanc, 75787 Paris, France
| | - Daniel Jost
- Paris Cardiovascular Research Center (PARCC), INSERM Unit 970, 56 rue Leblanc, 75787 Paris, France
- Paris Sudden Death Expertise Center, 56 rue Leblanc, 75787 Paris, France
- Brigade de Sapeurs Pompiers de Paris (BSPP), 1 Place Jules Renard, 75017 Paris, France
| | - Alain Cariou
- Paris Cardiovascular Research Center (PARCC), INSERM Unit 970, 56 rue Leblanc, 75787 Paris, France
- Paris Sudden Death Expertise Center, 56 rue Leblanc, 75787 Paris, France
- AfterROSC network, 27 Rue du Faubourg Saint-Jacques, 75014 Paris, France
- Université Paris Descartes-Sorbonne Paris Cité, 12 Rue de l'École de Médecine, 75006 Paris, France
- Medical Intensive Care Unit, Cochin Hospital, APHP, 27 Rue du Faubourg Saint-Jacques, 75014 Paris, France
| | - Xavier Jouven
- Paris Cardiovascular Research Center (PARCC), INSERM Unit 970, 56 rue Leblanc, 75787 Paris, France
- Paris Sudden Death Expertise Center, 56 rue Leblanc, 75787 Paris, France
- Université Paris Descartes-Sorbonne Paris Cité, 12 Rue de l'École de Médecine, 75006 Paris, France
- Cardiology Department, Georges Pompidou European Hospital, AP-HP, 20 Rue Leblanc, 75015 Paris, France
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Houzé P, Baud FJ, Raphalen JH, Winchenne A, Moreira S, Gault P, Carli P, Lamhaut L. Continuous renal replacement therapy in the treatment of severe hyperkalemia: An in vitro study. Int J Artif Organs 2019; 43:87-93. [DOI: 10.1177/0391398819865748] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction: Continuous renal replacement therapy is not presently recommended in the treatment of life-threatening hyperkalemia. There are no specific recommendations in hemodialysis to treat hyperkalemia. We hypothesized an in vitro model may provide valuable information on the usefulness of continuous renal replacement therapy to treat severe hyperkalemia. Methods: A potassium-free solute was used instead of diluted blood for continuous renal replacement therapy with a simulated blood flowrate set at 200 mL/min. The mode of elimination included continuous filtration, continuous dialysis, and continuous diafiltration using a flowrate of 4000 mL/min for continuous filtration and continuous dialysis modes, and a ratio of 2500/1500 in the continuous diafiltration mode. Results: The mean initial potassium in the central compartment was 10.1 ± 0.4 mmol/L. The clearances in the continuous diafiltration, continuous filtration, and continuous dialysis were 3.4 ± 0.5, 3.6 ± 0.1, and 3.7 ± 0.1 L/h, respectively, not significantly different. Continuous dialysis resulted in the lowest workload for staff. Increasing the continuous dialysis flowrates from 2000 to 8000 mL/h increased clearance from 2.3 ± 0.3 to 6.2 ± 0.8 L/h. The delays in decreasing the potassium concentration to 5.5 mmol/L dropped from 120 to 45 min, respectively. Potassium eliminated in the first hour increased from 18 to 38 mmol that compared favorably with hemodialysis. Decrease in simulated blood flowrate from 200 to 50 mL/min moderately but significantly decreased the clearance from 3.7 to 3.0 L/h. Conclusion: Hyperkalemia is efficiently treated by continuous renal replacement therapy using the dialysis mode. Caution is needed to prevent the onset of severe hypokalemia within 40 min after initiation of the session.
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Affiliation(s)
- Pascal Houzé
- Laboratoire de Biochimie, Hôpital Universitaire Necker–Enfants Malades, Assistance Publique–Hôpitaux de Paris (AP-HP), Paris, France
- Unité de Technologies Chimiques et Biologiques pour la Santé (UTCBS), CNRS UMR8258, Inserm U1022, Faculté de Pharmacie Paris Descartes, Université Paris Descartes, Paris, France
| | - Frédéric Joseph Baud
- Département d’Anesthésie et de Réanimation, Adult Intensive Care Unit, Hôpital Universitaire Necker–Enfants Malades, Assistance Publique–Hôpitaux de Paris (AP-HP), Paris, France
- EA7323 Evaluation of Therapeutics and Pharmacology in Perinatality and Pediatrics, Hôpitaux Universitaires Cochin—Broca—Hôtel Dieu, Site Tarnier, Université Paris Descartes, Paris, France
- Paris Diderot University, Paris, France
| | - Jean-Herlé Raphalen
- Département d’Anesthésie et de Réanimation, Adult Intensive Care Unit, Hôpital Universitaire Necker–Enfants Malades, Assistance Publique–Hôpitaux de Paris (AP-HP), Paris, France
| | - Anaïs Winchenne
- Département d’Anesthésie et de Réanimation, Adult Intensive Care Unit, Hôpital Universitaire Necker–Enfants Malades, Assistance Publique–Hôpitaux de Paris (AP-HP), Paris, France
| | - Sonia Moreira
- Département d’Anesthésie et de Réanimation, Adult Intensive Care Unit, Hôpital Universitaire Necker–Enfants Malades, Assistance Publique–Hôpitaux de Paris (AP-HP), Paris, France
| | - Philippe Gault
- Département d’Anesthésie et de Réanimation, Adult Intensive Care Unit, Hôpital Universitaire Necker–Enfants Malades, Assistance Publique–Hôpitaux de Paris (AP-HP), Paris, France
| | - Pierre Carli
- Département d’Anesthésie et de Réanimation, Adult Intensive Care Unit, Hôpital Universitaire Necker–Enfants Malades, Assistance Publique–Hôpitaux de Paris (AP-HP), Paris, France
- Université Paris Descartes, Paris, France
| | - Lionel Lamhaut
- Département d’Anesthésie et de Réanimation, Adult Intensive Care Unit, Hôpital Universitaire Necker–Enfants Malades, Assistance Publique–Hôpitaux de Paris (AP-HP), Paris, France
- Université Paris Descartes, Paris, France
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Jouffroy R, Saade A, Philippe P, Carli P, Vivien B. Impact of Prehospital Mobile Intensive Care Unit Intervention on Mortality of Patients with Sepsis. Turk J Anaesthesiol Reanim 2019; 47:334-341. [DOI: 10.5152/tjar.2019.26576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 09/18/2018] [Indexed: 11/22/2022] Open
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Jouffroy R, Guyard A, Philippe P, Carli P, Vivien B. Effect of Mean Blood Pressure During Extracorporeal Life Support on Outcome After Out-of-Hospital Cardiac Arrest. Turk J Anaesthesiol Reanim 2019; 47:134-141. [PMID: 31080955 DOI: 10.5152/tjar.2019.73558] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Accepted: 09/06/2018] [Indexed: 12/29/2022] Open
Abstract
Objective Extracorporeal Life Support (ECLS) can help to improve the outcome of refractory cardiac arrest (CA). ECLS allows to maintain blood pressure and tissue perfusion until the cause of CA is treated. The aim of the present study was to describe the mean blood pressure (MBP) during the first 24 h of ECLS for out-of-hospital CA (OHCA). Methods We performed a retrospective analysis of consecutive refractory OHCA requiring ECLS admitted to the intensive care unit. MBP was examined after starting ECLS (H0) and every 6 h during the first 24 h (H6, H12, H18 and H24). Results Forty patients were analysed. MBP significantly differs between survivors and non-survivors since 6 h: 77 vs 44 mm Hg (p=0.002), 51 vs 87 mm Hg at H12 (p=0.008), 57 vs 75 mm Hg at H18 (p=0.015) and 79 vs 53 mm Hg at H24 (p=0.004), whereas no difference was observed at H0: 69 vs 55 mm Hg (p=0.06). An MBP lower than 65 mm Hg since 6 h is associated with a poor outcome (sensitivity and specificity of death of 87% and 66% at H6, 80% and 75% at H12, 100% and 75% at H18 and 70% and 80% at H24, respectively). Conclusion Despite high levels of catecholamine, the inability to maintain MBP higher than 60 mm Hg after starting ECLS for OHCA is associated with a poor outcome.
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Affiliation(s)
- Romain Jouffroy
- Intensive Care Unit, Anaesthesiology Department and SAMU of Paris, Hôpital Universitaire Necker - Enfants Malades, Assistance Publique - Hôpitaux de Paris, Université Paris Descartes, Paris, France
| | - Alexandra Guyard
- Intensive Care Unit, Anaesthesiology Department and SAMU of Paris, Hôpital Universitaire Necker - Enfants Malades, Assistance Publique - Hôpitaux de Paris, Université Paris Descartes, Paris, France
| | - Pascal Philippe
- Intensive Care Unit, Anaesthesiology Department and SAMU of Paris, Hôpital Universitaire Necker - Enfants Malades, Assistance Publique - Hôpitaux de Paris, Université Paris Descartes, Paris, France
| | - Pierre Carli
- Intensive Care Unit, Anaesthesiology Department and SAMU of Paris, Hôpital Universitaire Necker - Enfants Malades, Assistance Publique - Hôpitaux de Paris, Université Paris Descartes, Paris, France
| | - Benoit Vivien
- Intensive Care Unit, Anaesthesiology Department and SAMU of Paris, Hôpital Universitaire Necker - Enfants Malades, Assistance Publique - Hôpitaux de Paris, Université Paris Descartes, Paris, France
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Jouffroy R, Philippe P, Saade A, Carli P, Vivien B. Prognostic Value of Blood Lactate and Base Deficit in Refractory Cardiac Arrest Cases Undergoing Extracorporeal Life Support. Turk J Anaesthesiol Reanim 2019; 47:407-413. [PMID: 31572993 DOI: 10.5152/tjar.2019.65391] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2018] [Accepted: 09/26/2018] [Indexed: 12/23/2022] Open
Abstract
Objective Cardiac arrest (CA) resuscitation is associated with an 'ischaemia-reperfusion' syndrome characterised by lactic acidosis as assessed by lactate and base deficit (BD). Both biomarkers are usually measured in patients suffering from refractory CA (RCA) subjected to extracorporeal life support (ECLS) to evaluate tissue reperfusion. However, their prognostic value has never been compared. The aim of the present study was to compare the prognostic value of both biomarkers measured at 0 and 3 h after the initiation of ECLS in patients with RCA on mortality. Methods Patients who were admitted to the intensive care unit with RCA were consecutively included in the study. Results Sixty-six patients were included. Lactate correlated with BD (R2=0.44, p<0.001). An area under the curve of 0.72 (95% confidence interval (CI) 0.59-0.84) was found for lactate and of 0.60 (95% CI 0.46-0.73) for BD. Using multivariable logistic regression, lactate (odds ratio (OR) 1.22, 95% CI 1.03-1.48) remained associated with mortality on day 28, but not BD (OR 0.99, 95% CI 0.86-1.14). Conclusion We report a difference in the prognostic value of lactate and BD on mortality. Three hours from the initiation of ECLS in patients with RCA, lactate should be preferred to BD to predict the efficiency of ECLS.
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Affiliation(s)
- Romain Jouffroy
- Departments of Anaesthesia and Intensive Care Unit, SAMU, Hôpital Universitaire Necker - Enfants Malades, Université Paris Descartes, Paris, France
| | - Pascal Philippe
- Departments of Anaesthesia and Intensive Care Unit, SAMU, Hôpital Universitaire Necker - Enfants Malades, Université Paris Descartes, Paris, France
| | - Anastasia Saade
- Departments of Anaesthesia and Intensive Care Unit, SAMU, Hôpital Universitaire Necker - Enfants Malades, Université Paris Descartes, Paris, France
| | - Pierre Carli
- Departments of Anaesthesia and Intensive Care Unit, SAMU, Hôpital Universitaire Necker - Enfants Malades, Université Paris Descartes, Paris, France
| | - Benoit Vivien
- Departments of Anaesthesia and Intensive Care Unit, SAMU, Hôpital Universitaire Necker - Enfants Malades, Université Paris Descartes, Paris, France
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Tissier R, Hocini H, Tchitchek N, Deye N, Legriel S, Pichon N, Daubin C, Hermine O, Carli P, Vivien B, Tréluyer JM, Lefebvre C, Tisserand P, Dubois-Randé JL, Berdeaux A, Ghaleh B, Lelièvre JD, Levy Y, Cariou A. Early blood transcriptomic signature predicts patients' outcome after out-of-hospital cardiac arrest. Resuscitation 2019; 138:222-232. [PMID: 30885824 DOI: 10.1016/j.resuscitation.2019.03.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 02/27/2019] [Accepted: 03/10/2019] [Indexed: 12/24/2022]
Abstract
BACKGROUND Early prognostication is a major challenge after out-of-hospital cardiac arrest (OHCA). AIMS We hypothesized that a genome-wide analysis of blood gene expression could offer new prognostic tools and lines of research. METHODS Sixty-nine patients were enrolled from an ancillary study of the clinical trial NCT00999583 that tested the effect of erythropoietin (EPO) after OHCA. Blood samples were collected in comatose survivors of OHCA at hospital admission and 1 and 3 days after resuscitation. Gene expression profiles were analyzed (Illumina HumanHT-12 V4 BeadChip; >34,000 genes). Patients were classified into two categories representing neurological favorable outcome (cerebral performance category [CPC] = 1-2) vs unfavorable outcome (CPC > 2) at Day 60 after OHCA. Differential and functional enrichment analyses were performed to compare transcriptomic profiles between these two categories. RESULTS Among the 69 enrolled patients, 33 and 36 patients were treated or not by EPO, respectively. Among them, 42% had a favorable neurological outcome in both groups. EPO did not affect the transcriptomic response at Day-0 and 1 after OHCA. In contrast, 76 transcripts differed at Day-0 between patients with unfavorable vs favorable neurological outcome. This signature persisted at Day-1 after OHCA. Functional enrichment analysis revealed a down-regulation of adaptive immunity with concomitant up-regulation of innate immunity and inflammation in patients with unfavorable vs favorable neurological outcome. The transcription of many genes of the HLA family was decreased in patients with unfavorable vs favorable neurological outcome. Concomitantly, neutrophil activation and inflammation were observed. Up-stream regulators analysis showed the implication of numerous factors involved in cell cycle and damages. A logistic regression including a set of genes allowed a reliable prediction of the clinical outcomes (specificity = 88%; Hit Rate = 83%). CONCLUSIONS A transcriptomic signature involving a counterbalance between adaptive and innate immune responses is able to predict neurological outcome very early after hospital admission after OHCA. This deserves confirmation in a larger population.
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Affiliation(s)
- Renaud Tissier
- Inserm, U955, F94000, Créteil, France; Université Paris Est, UMR_S955, UPEC, Ecole Nationale Vétérinaire d'Alfort, F-94000, Créteil, France.
| | - Hakim Hocini
- Inserm, U955, F94000, Créteil, France; Vaccine Research Institute, Université Paris Est-Créteil, F-94000, Créteil, France
| | - Nicolas Tchitchek
- Vaccine Research Institute, Université Paris Est-Créteil, F-94000, Créteil, France; CEA - Université Paris Sud 11 - INSERM U1184, Immunology of Viral Infections and Autoimmune Diseases, IDMIT Infrastructure, F-92265 Fontenay-aux-Roses, France
| | - Nicolas Deye
- Medical ICU, Inserm U942, Lariboisiere Hospital, APHP, F-75010, Paris, France
| | - Stéphane Legriel
- Intensive Care Unit, Versailles Hospital, Le Chesnay, F-78150, France
| | - Nicolas Pichon
- Intensive Care Unit, University Hospital Dupuytren, Limoges, F-87042, France
| | - Cédric Daubin
- CHU de Caen, Department of Medical Intensive Care, Caen, F-14000, France
| | - Olivier Hermine
- Department of Hematology and INSERM U1163 CNRS ERL 8654, Imagine Institute and Necker Hospital, Paris, F-75015, France
| | - Pierre Carli
- SAMU de Paris, Service d'Anesthésie-Réanimation, Hôpital Universitaire Necker- Enfants Malades, Université Paris Descartes, F-75015, Paris, France
| | - Benoît Vivien
- SAMU de Paris, Service d'Anesthésie-Réanimation, Hôpital Universitaire Necker- Enfants Malades, Université Paris Descartes, F-75015, Paris, France
| | - Jean-Marc Tréluyer
- Clinical Research Unit, Paris Centre and Paris Descartes University, Paris, France
| | - Cécile Lefebvre
- Inserm, U955, F94000, Créteil, France; Vaccine Research Institute, Université Paris Est-Créteil, F-94000, Créteil, France
| | - Pascaline Tisserand
- Inserm, U955, F94000, Créteil, France; Vaccine Research Institute, Université Paris Est-Créteil, F-94000, Créteil, France
| | - Jean-Luc Dubois-Randé
- Inserm, U955, F94000, Créteil, France; Université Paris Est, UMR_S955, UPEC, Ecole Nationale Vétérinaire d'Alfort, F-94000, Créteil, France
| | - Alain Berdeaux
- Inserm, U955, F94000, Créteil, France; Université Paris Est, UMR_S955, UPEC, Ecole Nationale Vétérinaire d'Alfort, F-94000, Créteil, France
| | - Bijan Ghaleh
- Inserm, U955, F94000, Créteil, France; Université Paris Est, UMR_S955, UPEC, Ecole Nationale Vétérinaire d'Alfort, F-94000, Créteil, France; APHP, Hôpitaux Universitaires Henri Mondor, Plateforme de Ressources Biologiques, F-94000, Créteil, France
| | - Jean-Daniel Lelièvre
- Inserm, U955, F94000, Créteil, France; Vaccine Research Institute, Université Paris Est-Créteil, F-94000, Créteil, France
| | - Yves Levy
- Inserm, U955, F94000, Créteil, France; Vaccine Research Institute, Université Paris Est-Créteil, F-94000, Créteil, France.
| | - Alain Cariou
- Service de Réanimation Médicale, Hôpitaux Universitaires Paris Centre, Hôpital Cochin, Paris, France
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Jouffroy R, Saade A, Castres Saint Martin L, Philippe P, Carli P, Vivien B. Reply to Karim et al.: “Pre-hospital invasive ventilation in patients with septic shock: Is hyperoxemia an unwanted company?”. Am J Emerg Med 2019; 37:532-533. [DOI: 10.1016/j.ajem.2018.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Accepted: 07/06/2018] [Indexed: 10/28/2022] Open
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Jouffroy R, Saade A, Philippe P, Carli P, Vivien B. Prognostic Value of Blood Lactate and Lactate Clearance in Refractory Cardiac Arrest Treated by Extracorporeal Life Support. Turk J Anaesthesiol Reanim 2019; 47:48-54. [PMID: 31276111 PMCID: PMC6598657 DOI: 10.5152/tjar.2018.96992] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Accepted: 07/08/2018] [Indexed: 06/09/2023] Open
Abstract
OBJECTIVE During cardiac arrest (CA) resuscitation, an 'ischaemia-reperfusion' syndrome occurs leading to multiorgan failure reflected by an increase in blood lactate. Blood lactate is a diagnosis and prognosis biomarker in extracorporeal life support (ECLS), but its kinetic appears more informative to assess a patient's outcome. The aim of the present study was to describe the prognostic value of blood lactate and lactate clearance (LC) 3 (H3) and 6 h (H6) after the initiation of ECLS in the treatment of refractory CA. METHODS Patients admitted to the intensive care unit for refractory CA were included. Lactate measurements were performed at the initiation of ECLS (H0) and at H3 and H6 upon the initiation of ECLS. LC was measured from 0 to 3 h (LC03), 0 to 6 h (LC06) and 3 to 6 h (LC36). The primary endpoint was in-hospital mortality within 28 days. RESULTS Sixty-six patients were enrolled in the study. Lactate levels were higher in deceased patients. Increased mortality was observed with increasing levels of lactate at H3 and H6 and with decreasing LC03. Using logistic regression, an association was observed between mortality and lactate at H3 with an odds ratio (OR) of 1.21 (95% confidence interval (CI) 1.05-1.42); LC03, OR of 0.93 (95% CI 0.87-0.99) and LC06, OR of 0.96 (95% CI 0.92-0.99). CONCLUSION Blood lactate and LC within the first 3 h of ECLS in refractory CA are associated with mortality. LC is a more relevant parameter than blood lactate, taking into account both the production and elimination of lactate. We suggest to preferentially use LC to assess the patient's outcome.
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Affiliation(s)
- Romain Jouffroy
- Departments of Anaesthesia and Intensive Care Unit, SAMU, Hôpital Universitaire Necker - Enfants Malades, Université Paris Descartes, Paris, France
| | - Anastasia Saade
- Departments of Anaesthesia and Intensive Care Unit, SAMU, Hôpital Universitaire Necker - Enfants Malades, Université Paris Descartes, Paris, France
| | - Pascal Philippe
- Departments of Anaesthesia and Intensive Care Unit, SAMU, Hôpital Universitaire Necker - Enfants Malades, Université Paris Descartes, Paris, France
| | - Pierre Carli
- Departments of Anaesthesia and Intensive Care Unit, SAMU, Hôpital Universitaire Necker - Enfants Malades, Université Paris Descartes, Paris, France
| | - Benoit Vivien
- Departments of Anaesthesia and Intensive Care Unit, SAMU, Hôpital Universitaire Necker - Enfants Malades, Université Paris Descartes, Paris, France
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Jouffroy R, Saade A, Pegat-Toquet A, Philippe P, Carli P, Vivien B. Pre-hospital mechanical ventilation in septic shock patients. Am J Emerg Med 2019; 37:1860-1863. [PMID: 30638630 DOI: 10.1016/j.ajem.2018.12.047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 12/12/2018] [Accepted: 12/24/2018] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND Mechanical ventilation can cause deleterious effects on the lung and thus alter patient's prognosis. The aim of this study was to describe the characteristics of prehospital mechanical ventilation in patients with septic shock requiring mechanical ventilation in the prehospital setting. METHODS Patients with septic shock subjected to pre-hospital intubation and mechanical ventilation by a mobile intensive care unit were consecutively included and retrospectively analysed. Septic shock was defined according to the international sepsis-3 consensus conference. Patient's characteristics, interventions, prehospital ventilatory parameters and outcome were retrieved from medical records. The association between the tidal volume indexed on ideal body weight (VTIBW) and mortality at day 28 was evaluated. RESULTS Fifty-nine patients were included. Septic shock was mainly associated with pulmonary (64%) infection. Mean pre-hospital VTIBW was 7 ± 1 ml.kg-1 in the overall population. Mortality reached 42%. The AUC of VTIBW was 0.83 [0.72-0.94]. Using logistic regression model including: age, prehospital mean blood pressure, volume infused in the prehospital setting, FiO2 and length of stay in the intensive care unit, the association with mortality remained significant for VTIBW (OR adjusted [CI95] = 4.11 [1.89-10.98]), VTIBW >8 ml·kg-1 (OR adjusted [CI95] = 8.29 [2.35-34.98]) and VTIBW <8 ml·kg-1 (OR adjusted [CI95] = 0.12 [0.03-0.43]). CONCLUSION In this retrospective study, we observed an association between mortality at day 28 and prehospital VTIBW in pre-hospital mechanically ventilated patients with septic shock. A VTIBW <8 ml·kg-1 was associated with a decrease and a VTIBW >8 ml·kg-1 with an increase in mortality.
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Affiliation(s)
- Romain Jouffroy
- Department of Anesthesia & Intensive Care Unit, SAMU, Hôpital Necker - Enfants Malades, 149 rue de Sèvres, University Paris Descartes, 75015 Paris, France; Department of Anesthesia & Clinical Epidemiology and Biostatistics, Michael DeGroote, School of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada; Population Health Research Institute, David Braley Cardiac, Vascular and Stroke Research Institute, Perioperative Medicine and Surgical Research Unit, Hamilton, Ontario, Canada.
| | - Anastasia Saade
- Department of Anesthesia & Intensive Care Unit, SAMU, Hôpital Necker - Enfants Malades, 149 rue de Sèvres, University Paris Descartes, 75015 Paris, France
| | - Antoine Pegat-Toquet
- Department of Anesthesia & Intensive Care Unit, SAMU, Hôpital Necker - Enfants Malades, 149 rue de Sèvres, University Paris Descartes, 75015 Paris, France
| | - Pascal Philippe
- Department of Anesthesia & Intensive Care Unit, SAMU, Hôpital Necker - Enfants Malades, 149 rue de Sèvres, University Paris Descartes, 75015 Paris, France
| | - Pierre Carli
- Department of Anesthesia & Intensive Care Unit, SAMU, Hôpital Necker - Enfants Malades, 149 rue de Sèvres, University Paris Descartes, 75015 Paris, France
| | - Benoît Vivien
- Department of Anesthesia & Intensive Care Unit, SAMU, Hôpital Necker - Enfants Malades, 149 rue de Sèvres, University Paris Descartes, 75015 Paris, France
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Jouffroy R, Saade A, Durand S, Philippe P, Carli P, Vivien B. Predicting value of prehospital body temperature for ICU admission of septic shock patients. Acute Med 2019; 18:56-58. [PMID: 32608397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
To specify whether an association exists between pre-hospital body temperature collected by the emergency medical services (EMS) call centre, and intensive care unit (ICU) admission of patients with septic shock. An observational study based on data collected by the EMS of Paris. All septic shocks were included. Among, the 140 calls concerning septic shock, 22 patients (16%) were admitted to ICU. The mean core temperature was 37.4±1.6°C for ICU and 38.6±1.1°C (p<4.10^-5) for non-ICU patients. Using propensity score analysis, the relative risk for ICU admission of patients with pre-hospital fever or hypothermia was 0.31 and 2 respectively. The study highlights the potential usefulness of early temperature measurement in septic shock patients to allow early proper orientation.
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Affiliation(s)
- R Jouffroy
- Department of Anesthesia & Intensive Care Unit, SAMU, Hôpital Necker - Enfants Malades 149 rue de Sèvres 75015 Paris, University Paris Descartes, France
| | - A Saade
- Department of Anesthesia & Intensive Care Unit, SAMU, Hôpital Necker - Enfants Malades 149 rue de Sèvres 75015 Paris, University Paris Descartes, France
| | - S Durand
- Department of Anesthesia & Intensive Care Unit, SAMU, Hôpital Necker - Enfants Malades 149 rue de Sèvres 75015 Paris, University Paris Descartes, France
| | - P Philippe
- Department of Anesthesia & Intensive Care Unit, SAMU, Hôpital Necker - Enfants Malades 149 rue de Sèvres 75015 Paris, University Paris Descartes, France
| | - P Carli
- Department of Anesthesia & Intensive Care Unit, SAMU, Hôpital Necker - Enfants Malades 149 rue de Sèvres 75015 Paris, University Paris Descartes, France
| | - B Vivien
- Department of Anesthesia & Intensive Care Unit, SAMU, Hôpital Necker - Enfants Malades 149 rue de Sèvres 75015 Paris, University Paris Descartes, France
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Hutin A, Abu-Habsa M, Burns B, Bernard S, Bellezzo J, Shinar Z, Torres EC, Gueugniaud PY, Carli P, Lamhaut L. Early ECPR for out-of-hospital cardiac arrest: Best practice in 2018. Resuscitation 2018; 130:44-48. [DOI: 10.1016/j.resuscitation.2018.05.004] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Revised: 03/26/2018] [Accepted: 05/04/2018] [Indexed: 12/20/2022]
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Karam N, Pechmajou L, Dumas F, Bougouin W, Beganton F, Jost D, Carli P, Cariou A, Spaulding C, Marijon E, Jouven X. P1009Sports-related sudden cardiac arrest in young adults: Insight from the Paris SDEC Registry. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy564.p1009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- N Karam
- Inserm U970 - Paris Cardiovascular Research Center (PARCC), Cardiovascular Epidemiology-Sudden Death, Paris, France
| | - L Pechmajou
- Inserm U970 - Paris Cardiovascular Research Center (PARCC), Cardiovascular Epidemiology-Sudden Death, Paris, France
| | - F Dumas
- Inserm U970 - Paris Cardiovascular Research Center (PARCC), Cardiovascular Epidemiology-Sudden Death, Paris, France
| | - W Bougouin
- Inserm U970 - Paris Cardiovascular Research Center (PARCC), Cardiovascular Epidemiology-Sudden Death, Paris, France
| | - F Beganton
- Inserm U970 - Paris Cardiovascular Research Center (PARCC), Cardiovascular Epidemiology-Sudden Death, Paris, France
| | - D Jost
- Inserm U970 - Paris Cardiovascular Research Center (PARCC), Cardiovascular Epidemiology-Sudden Death, Paris, France
| | - P Carli
- Inserm U970 - Paris Cardiovascular Research Center (PARCC), Cardiovascular Epidemiology-Sudden Death, Paris, France
| | - A Cariou
- Inserm U970 - Paris Cardiovascular Research Center (PARCC), Cardiovascular Epidemiology-Sudden Death, Paris, France
| | - C Spaulding
- Inserm U970 - Paris Cardiovascular Research Center (PARCC), Cardiovascular Epidemiology-Sudden Death, Paris, France
| | - E Marijon
- Inserm U970 - Paris Cardiovascular Research Center (PARCC), Cardiovascular Epidemiology-Sudden Death, Paris, France
| | - X Jouven
- Inserm U970 - Paris Cardiovascular Research Center (PARCC), Cardiovascular Epidemiology-Sudden Death, Paris, France
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Jouffroy R, Saade A, Muret A, Philippe P, Michaloux M, Carli P, Vivien B. Reply to Zhou et al.: "fluid resuscitation in pre-hospital patients with septic shock: one size does not fit all". Am J Emerg Med 2018; 37:169-171. [PMID: 29861370 DOI: 10.1016/j.ajem.2018.05.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 05/25/2018] [Indexed: 10/16/2022] Open
Affiliation(s)
- Romain Jouffroy
- Intensive Care Unit, Anesthesiology Department and SAMU of Paris, Hôpital Necker - Enfants Malades, Assistance Publique - Hôpitaux de Paris, Paris Descartes University, Paris, France.
| | - Anastasia Saade
- Intensive Care Unit, Anesthesiology Department and SAMU of Paris, Hôpital Necker - Enfants Malades, Assistance Publique - Hôpitaux de Paris, Paris Descartes University, Paris, France
| | - Alexandre Muret
- Intensive Care Unit, Anesthesiology Department and SAMU of Paris, Hôpital Necker - Enfants Malades, Assistance Publique - Hôpitaux de Paris, Paris Descartes University, Paris, France
| | - Pascal Philippe
- Intensive Care Unit, Anesthesiology Department and SAMU of Paris, Hôpital Necker - Enfants Malades, Assistance Publique - Hôpitaux de Paris, Paris Descartes University, Paris, France
| | - Maud Michaloux
- Intensive Care Unit, Anesthesiology Department and SAMU of Paris, Hôpital Necker - Enfants Malades, Assistance Publique - Hôpitaux de Paris, Paris Descartes University, Paris, France
| | - Pierre Carli
- Intensive Care Unit, Anesthesiology Department and SAMU of Paris, Hôpital Necker - Enfants Malades, Assistance Publique - Hôpitaux de Paris, Paris Descartes University, Paris, France
| | - Benoit Vivien
- Intensive Care Unit, Anesthesiology Department and SAMU of Paris, Hôpital Necker - Enfants Malades, Assistance Publique - Hôpitaux de Paris, Paris Descartes University, Paris, France
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Jouffroy R, Saade A, Alexandre P, Philippe P, Carli P, Vivien B. Epinephrine administration in non-shockable out-of-hospital cardiac arrest. Am J Emerg Med 2018; 37:387-390. [PMID: 29857945 DOI: 10.1016/j.ajem.2018.05.055] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 05/20/2018] [Accepted: 05/24/2018] [Indexed: 10/16/2022] Open
Abstract
BACKGROUND Epinephrine is recommended for the treatment of non-shockable out of hospital cardiac arrest (OHCA) to obtain return of spontaneous circulation (ROSC). Epinephrine efficiency and safety remain under debate. OBJECTIVE We propose to describe the association between the cumulative dose of epinephrine and the failure of ROSC during the first 30 min of advanced life support (ALS). METHODOLOGY A retrospective observational cohort study using the Paris SAMU 75 registry including all non-traumatic OHCA. All OHCA receiving epinephrine during the first 30 min of ALS were enrolled. Cumulative epinephrine dose given during ALS to ROSC was retrieved from medical reports. RESULTS Among 1532 patients with OHCA, 776 (51%) had initial non-shockable rhythm. Fifty-four patients were excluded for missing data. The mean value of cumulative dose of epinephrine was 10 ± 4 mg in patients who failed to achieve ROSC (ROSC-) and 4 ± 3 mg (p = 0.04) for those who achieved ROSC. ROC curve analysis indicated a cut-off point of 7 mg total cumulative epinephrine associated with ROSC- (AUC = 0.89 [0.86-0.92]). Using propensity score analysis including age, sex and no-flow duration, association with ROSC- only remained significant for epinephrine > 7 mg (p ≤10-3, OR [CI95] = 1.53 [1.42-1.65]). CONCLUSION An association between total cumulative epinephrine dose administered during OHCA resuscitation and ROSC- was reported with a threshold of 7 mg, best identifying patients with refractory OHCA. We suggest using this threshold in this context to guide the termination of ALS and early decide on the implementation of extracorporeal life support or organ harvesting in the first 30 min of ALS.
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Affiliation(s)
- R Jouffroy
- Department of Anesthesia & Critical Care - SAMU, Assistance Publique - Hôpitaux de Paris, Hôpital Necker - Enfants Malades, Université Paris Descartes, 149 rue de Sèvres, 75015 Paris, France.
| | - A Saade
- Department of Anesthesia & Critical Care - SAMU, Assistance Publique - Hôpitaux de Paris, Hôpital Necker - Enfants Malades, Université Paris Descartes, 149 rue de Sèvres, 75015 Paris, France
| | - P Alexandre
- Department of Anesthesia & Critical Care - SAMU, Assistance Publique - Hôpitaux de Paris, Hôpital Necker - Enfants Malades, Université Paris Descartes, 149 rue de Sèvres, 75015 Paris, France
| | - P Philippe
- Department of Anesthesia & Critical Care - SAMU, Assistance Publique - Hôpitaux de Paris, Hôpital Necker - Enfants Malades, Université Paris Descartes, 149 rue de Sèvres, 75015 Paris, France
| | - P Carli
- Department of Anesthesia & Critical Care - SAMU, Assistance Publique - Hôpitaux de Paris, Hôpital Necker - Enfants Malades, Université Paris Descartes, 149 rue de Sèvres, 75015 Paris, France
| | - B Vivien
- Department of Anesthesia & Critical Care - SAMU, Assistance Publique - Hôpitaux de Paris, Hôpital Necker - Enfants Malades, Université Paris Descartes, 149 rue de Sèvres, 75015 Paris, France
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Jouffroy R, Saade A, Ellouze S, Carpentier A, Michaloux M, Carli P, Vivien B. Prehospital triage of septic patients at the SAMU regulation: Comparison of qSOFA, MRST, MEWS and PRESEP scores. Am J Emerg Med 2018; 36:820-824. [DOI: 10.1016/j.ajem.2017.10.030] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Revised: 10/10/2017] [Accepted: 10/10/2017] [Indexed: 01/04/2023] Open
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Jouffroy R, Saade A, Saint Martin LC, Philippe P, Carli P, Vivien B. Prognosis value of partial arterial oxygen pressure in patients with septic shock subjected to pre-hospital invasive ventilation. Am J Emerg Med 2018; 37:56-60. [PMID: 29709397 DOI: 10.1016/j.ajem.2018.04.050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 04/18/2018] [Accepted: 04/22/2018] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVE Mechanical ventilation can help improve the prognosis of septic shock. While adequate delivery of oxygen to the tissue is crucial, hyperoxemia may be deleterious. Invasive out-of-hospital ventilation is often promptly performed in life-threatening emergencies. We propose to determine whether the arterial oxygen pressure (PaO2) at the intensive care unit (ICU) admission is associated with mortality in patients with septic shock subjected to pre-hospital mechanical ventilation. METHODS We performed a monocentric retrospective observational study on 77 patients. PaO2 was measured at ICU admission. The primary outcome was mortality at day 28 (D28). RESULTS Forty-nine (64%) patients were included. The mean PaO2 at ICU admission was 153 ± 77 and 202 ± 82 mm Hg for alive and deceased patients respectively. Mortality concerned 18% of patients for PaO2 < 100, 25% for 100 < PaO2 < 150 and 57% for a PaO2 > 150 mm Hg. PaO2 was significantly associated with mortality at D28 (p = 0.04). Using propensity score analysis including SOFA score, pre-hospital duration, lactate, and prehospital fluid volume expansion, association with mortality at D28 only remained for PaO2 > 150 mm Hg (p = 0.02, OR [CI95] = 1.59 [1.20-2.10]). CONCLUSIONS In this study, we report a significant association between hyperoxemia at ICU admission and mortality in patients with septic shock subjected to pre-hospital invasive mechanical ventilation. The early adjustment of the PaO2 should be considered for these patients to avoid the toxic effects of hyperoxemia. However, blood gas analysis is hard to get in a prehospital setting. Consequently, alternative and feasible measures are needed, such as pulse oximetry, to improve the management of pre-hospital invasive ventilation.
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Affiliation(s)
- Romain Jouffroy
- Department of Anesthesia & Intensive Care Unit, SAMU, Hôpital Necker Enfants Malades, 149 rue de Sèvres, 75015 Paris, France.
| | - Anastasia Saade
- Department of Anesthesia & Intensive Care Unit, SAMU, Hôpital Necker Enfants Malades, 149 rue de Sèvres, 75015 Paris, France
| | - Laure Castres Saint Martin
- Department of Anesthesia & Intensive Care Unit, SAMU, Hôpital Necker Enfants Malades, 149 rue de Sèvres, 75015 Paris, France
| | - Pascal Philippe
- Department of Anesthesia & Intensive Care Unit, SAMU, Hôpital Necker Enfants Malades, 149 rue de Sèvres, 75015 Paris, France
| | - Pierre Carli
- Department of Anesthesia & Intensive Care Unit, SAMU, Hôpital Necker Enfants Malades, 149 rue de Sèvres, 75015 Paris, France
| | - Benoit Vivien
- Department of Anesthesia & Intensive Care Unit, SAMU, Hôpital Necker Enfants Malades, 149 rue de Sèvres, 75015 Paris, France
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Ferrara G, Argenziano G, Soyer HP, D'Argenio P, Carli P, Cerroni L, Chimenti S, De Giorgi V, Delfino M, De Rosa G, El Shabrawi-Caelen L, Ferrari A, Massi D, Mazzocchetti G, Peris K, Piccolo D, Santucci M, Scalvenzi M, Staibano S. Histopathologic Interobserver Agreement on the Diagnosis of Melanocytic Skin Lesions with Equivocal Dermoscopic Features: A Pilot Study. Tumori 2018; 86:445-9. [PMID: 11218183 DOI: 10.1177/030089160008600602] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aims and background Dermoscopy (dermatoscopy, skin surface microscopy, epiluminescence microscopy) has been increasingly employed in recent years for the preoperative detection of cutaneous melanoma, and dermatoscopic features of pigmented skin lesions have been previously defined using histopathology (HP) as the “key to the code”. The aim of the present study was to evaluate the interobserver agreement on the HP diagnosis in a series of epiluminescence microscopy equivocal melanocytic skin lesions. Study design Ten melanocytic skin lesions were selected on the basis of diagnostic disagreement of at least 2 out of 9 epiluminescence microscopy observers. The histologic specimens from the 10 lesions were examined by 9 HP observers. The agreement of the HP diagnoses was calculated by means of Fleiss' k statistics. Results The overall HP agreement was less than excellent (k = 0.5). When considering the prevailing epiluminescence microscopic and HP diagnoses, 2 cases were shown to be epiluminescence microscopy false-negative melanomas. Virtually no agreement was found among epiluminescence microscopy observers in 4 cases (40%) or among HP observers in 3 cases (30%). However, only one pigmented skin lesion remained un-classifiable on epiluminescence microscopy as well as HP. Conclusions When at least 2 epiluminescence microscopy experts disagree in the evaluation of a given melanocytic skin lesion, even HP consultations may give equivocal results. The need to establish more reliable epiluminescence microscopic and HP criteria by performing an improved and meticulous clinicopathologic correlation, e.g. by using telecommunication via Internet, is emphasized.
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Affiliation(s)
- G Ferrara
- UO Anatomia Patologica, Azienda Ospedaliera G. Rummo, Benevento, Italy
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Brogelli L, Carli P, Reali UM, Pimpinelli N, Moretti S. Antigenic Phenotype of Radial Growth Phase Melanomas with or without a Vertical Growth Phase Portion. Tumori 2018; 74:157-62. [PMID: 3285554 DOI: 10.1177/030089168807400206] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The expression of 4 melanoma-associated antigens and of class I and II HLA antigens was investigated in 12 superficial spreading melanomas (SSM) and in 8 SSM with a vertical growth pattern portion (SS + NM) by the use of monoclonal antibodies and an indirect immunoperoxidase procedure. Monoclonal antibodies 225.28, 763.74, CL. 203, VF19-LL217, Q5-13, W6-32 and anti-HLA-DR, were used. Each antigen was more frequently expressed by SS +NM on the whole than by SSM and also by the radial growth pattern portions of SS + NM than by SSM. Vertical growth pattern portions of SS + NM were not antigenically similar to radial growth pattern portions in the same tumors. The high frequency of antigen expression in radial growth pattern melanomas seems to be associated with the appearance of a more invasive cell population.
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Affiliation(s)
- L Brogelli
- Clinica Dermatologica II dell'Università degli Studi di Firenze
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