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1. Temporal Trends of Out-of-Hospital Cardiac Arrests Without Resuscitation Attempt by Emergency Medical Services

Author

Ardalan Sharifzadehgan, Patricia Jabre, Alain Cariou, Thomas Loeb, Wulfran Bougouin, Frankie Beganton, Nicole Karam, François Revaux, Daniel Jost, Bertrand Ludes, Jean-Marc Agostinucci, Lionel Lamhaut, Bamba Gaye, Florence Dumas, Kumar Narayanan, Bruno Mégarbane, Frédéric Adnet, on behalf Paris-SDEC investigators, Xavier Jouven, Eloi Marijon, Victor Waldmann, Haoiinda Kassim, Sandrine Deltour, Sebastian Voicu, Hôpital Européen Georges Pompidou [APHP] (HEGP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO), Paris-Centre de Recherche Cardiovasculaire (PARCC (UMR_S 970/ U970)), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité), Hôpital Cochin [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Medicover Hospitals, Hyderabad, India, SAMU 75 [Paris], SAMU 92 [Garches], Hôpital Raymond Poincaré [AP-HP], SAMU 93 [Bobigny], Hôpital Avicenne [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Hôpital Lariboisière-Fernand-Widal [APHP], and Mégarbane, Bruno

Subjects
Male, Emergency Medical Services, medicine.medical_specialty, Resuscitation, resuscitation, Population, population, 030204 cardiovascular system & hematology, survival, [SDV.MHEP.PSR]Life Sciences [q-bio]/Human health and pathology/Pulmonology and respiratory tract, Out of hospital cardiac arrest, 03 medical and health sciences, 0302 clinical medicine, [SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, [SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases, Emergency medical services, Humans, Medicine, Prospective Studies, 030212 general & internal medicine, education, Aged, [SDV.MHEP.ME] Life Sciences [q-bio]/Human health and pathology/Emerging diseases, Aged, 80 and over, Out of hospital, [SDV.MHEP.ME]Life Sciences [q-bio]/Human health and pathology/Emerging diseases, education.field_of_study, business.industry, Editorials, Original Articles, Middle Aged, ventricular fibrillation, Cardiopulmonary Resuscitation, [SDV.MHEP.CSC] Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, [SDV.TOX] Life Sciences [q-bio]/Toxicology, Survival Rate, Editorial, [SDV.TOX]Life Sciences [q-bio]/Toxicology, Emergency medicine, [SDV.MHEP.MI] Life Sciences [q-bio]/Human health and pathology/Infectious diseases, [SDV.MHEP.PSR] Life Sciences [q-bio]/Human health and pathology/Pulmonology and respiratory tract, Female, Cardiology and Cardiovascular Medicine, business, Out-of-Hospital Cardiac Arrest
Abstract

Background: Significant improvements in survival from out-of-hospital cardiac arrest (OHCA) have been reported; however, these are based only on data from OHCA in whom resuscitation is initiated by emergency medical services (EMS). We aimed to assess the characteristics and temporal trends of OHCA without resuscitation attempt by EMS. Methods: Prospective population-based study between 2011 and 2016 in the Greater Paris area (6.7 million inhabitants). All cases of OHCA were included in collaboration with EMS units, 48 different hospitals, and forensic units. Results: Among 15 207 OHCA (mean age 70.7±16.9 years, 61.6% male), 5486 (36.1%) had no resuscitation attempt by EMS. Factors that were independently associated with increase in likelihood of no resuscitation attempt included: age of patients (odds ratio, 1.06 per year [95% CI, 1.05–1.06], P P =0.002), OHCA at home location (odds ratio, 3.38 [95%CI, 2.86–4.01], P P P =0.028). This increase was related to an increase of the annual number of OHCA without resuscitation attempt by EMS by 26.3% (from 993 to 1253, P =0.012), while the annual number of OHCA with resuscitation attempt by EMS did not significantly change (from 1930 to 1936, P =0.416). Considering only cases with resuscitation attempt, survival rate at hospital discharge increased (from 7.3% to 9.5%, P =0.02). However, when considering all OHCA, survival improvement did not reach statistical significance (from 4.8% to 5.7%, P =0.17). Conclusions: We demonstrated an increase of the total number of OHCA related to an increase of the number of OHCA without resuscitation attempt by EMS. This increasing proportion of OHCA without resuscitation attempt attenuates improvement in survival rates achieved in EMS-treated patients.

Published
2021

2. Temporal trends in the use of targeted temperature management after cardiac arrest and association with outcome: insights from the Paris Sudden Death Expertise Centre

Author

Nicolas Deye, Daniel Jost, Eloi Marijon, Florence Dumas, Lionel Lamhaut, Richard Chocron, Alain Cariou, Stéphane Legriel, Frankie Beganton, Nadia Aissaoui, Wulfran Bougouin, Jean-Baptiste Lascarrou, Antoine Vieillard-Baron, Xavier Jouven, Bodescot, Myriam, Service de Médecine Intensive et Réanimation [Nantes], Centre hospitalier universitaire de Nantes (CHU Nantes), Paris-Centre de Recherche Cardiovasculaire (PARCC - UMR-S U970), Hôpital Européen Georges Pompidou [APHP] (HEGP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM), Paris Sudden Death Expertise Center [Paris] (Paris-SDEC), AfterROSC Network Group [Paris], Emergency Department [Paris], Hôpital Cochin [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Medical-Surgical Intensive Care Unit [Le Chesnay], Centre Hospitalier de Versailles André Mignot (CHV), Medical Intensive Care Unit [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO), Hôpitaux Universitaires Saint-Louis, Lariboisière, Fernand-Widal, SAMU 75 [Paris], Département d'Anesthésie-Réanimation [Paris] (DAR), CHU Necker - Enfants Malades [AP-HP], Brigade de sapeurs pompiers de Paris (BSPP), Medical Intensive Care Unit [Boulogne-Billancourt], Hôpital Ambroise Paré [AP-HP], AP-HP - Hôpital Cochin Broca Hôtel Dieu [Paris], This study was funded solely by institutional and departmental sources., and SDEC

Subjects
SDEC, Male, Resuscitation, Time Factors, Outcome Assessment, medicine.medical_treatment, Hypothermia, 030204 cardiovascular system & hematology, Targeted temperature management, Cardiovascular, Critical Care and Intensive Care Medicine, Medical and Health Sciences, 0302 clinical medicine, Hypothermia, Induced, Outcome Assessment, Health Care, Odds Ratio, 80 and over, Medicine, Registries, Aged, 80 and over, Confounding, lcsh:Medical emergencies. Critical care. Intensive care. First aid, Middle Aged, Cardiac arrest, 3. Good health, [SDV.MHEP.CSC] Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, Neurological outcome, Heart Disease, Treatment Outcome, Female, Induced hypothermia, medicine.medical_specialty, Paris, and over, Return of spontaneous circulation, Sudden death, 03 medical and health sciences, [SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, Clinical Research, Internal medicine, Humans, Aged, business.industry, Research, Induced, Neurosciences, 030208 emergency & critical care medicine, lcsh:RC86-88.9, Emergency & Critical Care Medicine, Brain Disorders, Health Care, Logistic Models, [SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie, Bystander cpr, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, business, Out-of-Hospital Cardiac Arrest
Abstract

Purpose Recent doubts regarding the efficacy may have resulted in a loss of interest for targeted temperature management (TTM) in comatose cardiac arrest (CA) patients, with uncertain consequences on outcome. We aimed to identify a change in TTM use and to assess the relationship between this change and neurological outcome. Methods We used Utstein data prospectively collected in the Sudden Death Expertise Center (SDEC) registry (capturing CA data from all secondary and tertiary hospitals located in the Great Paris area, France) between May 2011 and December 2017. All cases of non-traumatic OHCA patients with stable return of spontaneous circulation (ROSC) were included. After adjustment for potential confounders, we assessed the relationship between changes over time in the use of TTM and neurological recovery at discharge using the Cerebral Performance Categories (CPC) scale. Results Between May 2011 and December 2017, 3925 patients were retained in the analysis, of whom 1847 (47%) received TTM. The rate of good neurological outcome at discharge (CPC 1 or 2) was higher in TTM patients as compared with no TTM (33% vs 15%, P P P P P = 0.76). After adjustment, year of CA occurrence was not associated with outcome. Conclusions We report a progressive decrease in the use of TTM in post-cardiac arrest patients over the recent years. During this period, neurological outcome remained stable, despite an increase in bystander-initiated resuscitation and a decrease in “no flow” duration.

Published
2019

3. French Registry on Acute ST-elevation and non-ST-elevation Myocardial Infarction 2015 (FAST-MI 2015). Design and baseline data

Author

Martine Gilard, Patrick Goldstein, Nicolas Naccache, Pierre Coste, Jean Ferrières, Jacques Gauthier, Jean-Noël Labèque, Yves Cottin, Khalife Khalife, Thibaut Perret, Francois Schiele, Loic Belle, François Braun, Vincent Bataille, Bruno Farah, Elodie Drouet, Pierre-Yves Gueugniaud, Guillaume Cayla, Nicolas Danchin, Jean-Yves Le Heuzey, Etienne Puymirat, Tabassome Simon, Service de Cardiologie [Centre hospitalier Annecy-Genevois, Annecy], Centre Hospitalier Annecy-Genevois [Saint-Julien-en-Genevois], Centre Hospitalier Universitaire de Nîmes (CHU Nîmes), Service de Cardiologie [CHU de Dijon], Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon), Service de Cardiologie [CHU Bordeaux], CHU Bordeaux [Bordeaux], Service de cardiologie - Soins intensifs [CHR Metz-Thionville], Centre hospitalier régional Metz-Thionville (CHR Metz-Thionville), Service de cardiologie [Centre Hospitalier de la Côte Basque, Bayonne], Centre Hospitalier de la Côte Basque, Service de cardiologie [Clinique Pasteur - Toulouse], Clinique Pasteur [Toulouse], Service de cardiologie [centre hospitalier St-Joseph-et-St-Luc, Lyon], Centre hospitalier Saint Joseph - Saint Luc [Lyon], SAMU 59 et Pôle de l'Urgence, Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Société Française de Médecine d'Urgence [Paris, France], SAMU 75 [Paris], Collège national des cardiologues français, Société française de cardiologie, CHU Saint-Antoine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Epidémiologie et analyses en santé publique : risques, maladies chroniques et handicaps (LEASP), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées, Service de cardiologie [Toulouse], Hôpital de Rangueil, CHU Toulouse [Toulouse]-CHU Toulouse [Toulouse], Dpt Cardiologie [CHU Georges Pompidou], Hôpital Européen Georges Pompidou [APHP] (HEGP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO), Université Paris Descartes - Faculté de Médecine (UPD5 Médecine), Université Paris Descartes - Paris 5 (UPD5), Service de cardiologie [CHRU de Besançon], Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon), Service de pharmacologie - Dosage de médicaments [CHU Saint-Antoine], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Centre Hospitalier Régional Universitaire de Nîmes (CHRU Nîmes), CHU Saint-Antoine [APHP], Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Institut National de la Santé et de la Recherche Médicale (INSERM), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-CHU Toulouse [Toulouse]-Hôpital de Rangueil, CHU Toulouse [Toulouse], Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO), Centre Hospitalier Régional Universitaire [Besançon] (CHRU Besançon), and CHU Saint-Antoine [APHP]-Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)

Subjects
Male, Pediatrics, Complications, Time Factors, health care facilities, manpower, and services, Comorbidity, 030204 cardiovascular system & hematology, 0302 clinical medicine, Risk Factors, Medicine, Thrombolytic Therapy, 030212 general & internal medicine, Myocardial infarction, Hospital Mortality, Prospective Studies, Registries, Non-ST Elevated Myocardial Infarction, health care economics and organizations, Aged, 80 and over, ST elevation, General Medicine, Middle Aged, 3. Good health, Management, Data Accuracy, Hospitalization, Treatment Outcome, Research Design, Registre, Female, France, Cardiology and Cardiovascular Medicine, medicine.medical_specialty, Registry, Prise en charge, Infarctus du myocarde, Outcomes, 03 medical and health sciences, Percutaneous Coronary Intervention, [SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, St elevation myocardial infarction, Humans, cardiovascular diseases, Aged, business.industry, Patient Selection, Cardiovascular Agents, Baseline data, medicine.disease, Emergency medicine, ST Elevation Myocardial Infarction, business
Abstract

The FAST-MI programme, consisting of 1-month surveys of patients admitted to hospital for acute myocardial infarction (AMI) in France, has run since 2005.To gather data on the characteristics, management and outcomes of patients hospitalized for AMI at the end of 2015 in France and to provide comparisons with the previous surveys.Consecutive adults with ST-segment elevation myocardial infarction (STEMI) or non-ST-segment-elevation myocardial infarction (NSTEMI) with symptom onset≤48hours were included over a 1-month period, with a possible extension of recruitment for 1 additional month. Patients with AMI following cardiovascular procedures were excluded. In all, 204 centres participated in the survey (114 community hospitals, 40 academic, 48 private clinics, 2 army hospitals), representing 78% of French centres managing AMI patients. Inclusion started from 5 October 2015. Data were collected on-site from source files by external research technicians, using an electronic case record form with automatic quality checks. Centralized biology was organized in voluntary centres to collect RNA and DNA samples, serum and stools. Long-term follow-up was organized centrally with interrogation of municipal registry offices, physicians and by direct contact with the patients or their families.A total of 5291 patients were included over the entire recruitment period, with 3813 included during the first month (STEMI: 49%, NSTEMI: 51%). Mean age was 66±14 years, 29% were≥75 years of age, 28% were women; 80% presented with typical chest pain. In STEMI patients, 6% received intravenous fibrinolysis and 71% underwent primary PCI. The hospital death rate was 2.7% (STEMI: 2.8%, NSTEMI: 2.5%).Recruitment was in line with expectations and the first data show that management has continued to evolve since the 2010 survey, with continued improvement in hospital outcomes.

Published
2017

4. A cluster of acute diarrhea suspected to be cholera in French travelers in Haiti, December 2010

Author

Franck de Laval, Migliani R, Rafaëlle Theodose, Gérard Chevallier, Marie Laure Quilici, Bernard Liautaud, Joseph Garcia, Fathi Ktari, R. Haus-Cheymol, Centre d'épidémiologie et de santé publique des armées, Service de Santé des Armées, Laboratoire de microbiologie, Centre Hospitalier Universitaire de Martinique [Fort-de-France, Martinique], Centre National de Référence des Vibrions et du Choléra - National Reference Center Vibrios and Cholera (CNR), Institut Pasteur [Paris] (IP), Embassy of France, Service des Maladies Infectieuses, SAMU, SAMU 75 [Paris], Medical Service of French Police Force, and Institut Pasteur [Paris]

Subjects
Diarrhea, Volunteers, medicine.medical_specialty, Veterinary medicine, 030231 tropical medicine, Attack rate, Context (language use), Disease cluster, Disease Outbreaks, Cohort Studies, Foodborne Diseases, 03 medical and health sciences, Antimalarials, Young Adult, 0302 clinical medicine, Cholera, Internal medicine, Epidemiology, Medicine, Humans, 030212 general & internal medicine, Retrospective Studies, Travel, business.industry, Malaria prophylaxis, Outbreak, General Medicine, medicine.disease, Relief Work, [SDV.MP.BAC]Life Sciences [q-bio]/Microbiology and Parasitology/Bacteriology, Haiti, Police, 3. Good health, Anti-Bacterial Agents, Relative risk, Doxycycline, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, France, business
Abstract

International audience; A cluster of 21 cases of watery diarrhea suspected to be cholera that involved French military policemen and young volunteers occurring in the context of the Haiti cholera outbreak is described. The attack rate (AR) was higher among young volunteers (71.4%) than among policemen (15.3%) (p < 0.0001). There was a significant association between raw vegetables consumption and watery diarrhea in the young volunteer group. If we consider the raw vegetables consumers only, AR was lower among doxycycline-exposed subjects (relative risk: 0.2; 95% confidence interval: 0.1–0.4). The main aspect that is of scientific interest is the potential prophylactic effect of doxycycline used for malaria prophylaxis on the watery diarrhea AR.

Published
2012

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