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Selecting patients most likely to benefit from venoarterial extracorporeal membrane oxygenation (V-A ECMO) to treat refractory drug-induced cardiovascular shock remains a difficult challenge for physicians. This study reported short-term survival outcomes and factors associated with mortality in V-A ECMO-treated patients for poisoning. Twenty-two patients placed on V-A ECMO after drug intoxication from January 2014 to December 2020 were retrospectively analyzed. he primary endpoint of this study was survival at hospital discharge. Univariate descriptive analysis was performed to compare survivors and nonsurvivors during hospitalization. The overall survival at hospital discharge was 45.4% (n = 10/22). Survival rate tended to be higher in patients treated for refractory shock (n = 7/10) compared with those treated for refractory cardiac arrest (n = 3/12, p = 0.08). Low-flow duration and time from admission to ECMO cannulation were shorter in survivors (p = 0.02 and p = 0.03, respectively). Baseline characteristics before ECMO, including the class of drugs involved in the poisoning, between survivors and nonsurvivors were not statistically different except pH, bicarbonate, serum lactate, Sequential Organ Failure Assessment, and Survival After Veno-arterial-ECMO (SAVE) score. All patients with SAVE-score risk classes II/III survived whereas 85.7% (n = 12/14) of those with SAVE-score risk classes IV/V died. A lactic acid >9 mmol/L predicts mortality with a sensitivity/specificity ratio of 83.3%/100%. V-A ECMO for severe drug intoxication should be reserved for highly selected poisoned patients who do not respond to conventional therapies. Shortening the timing of V-A ECMO initiation should be a key priority in improving outcomes. Low-flow time >60min, lactic acid >9mmol/L, and SAVE-score may be good indicators of a worse prognosis.

Background: Randomized trials have shown that trans-nasal evaporative cooling initiated during CPR (i.e. intra-arrest) effectively lower core body temperature in out-of-hospital cardiac arrest patients. However, these trials may have been underpowered to detect significant differences in neurologic outcome, especially in patients with initial shockable rhythm. Methods: We conducted a pooled analysis of individual data from two randomised trials including 843 patients who eventually received the allocated intervention and with available outcome. Primary outcome was survival with favourable neurological outcome at hospital discharge (Cerebral Performance Category [CPC] of 1-2) according to the initial rhythm (shockable vs. non-shockable). Secondary outcomes included complete neurological recovery (CPC 1) at hospital discharge. Findings: Among the 325 patients with initial shockable rhythms, favourable neurological outcome was observed in 54/158 (34.2%) patients in the intervention and 40/167 (24.0%) in the control group (RR 1.43 [confidence intervals, CIs 1.01-2.02]). Complete neurological recovery was observed in 40/158 (25.3%) in the intervention and 27/167 (16.2%) in the control group (RR 1.57 [CIs 1.01-2.42]. Among the 518 patients with initial non-shockable rhythms, favourable neurological outcome was observed in 10/250 (4.0%) patients in the intervention and 13/267 (4.9%) in the control group (RR 0.82 [CIs 0.37-1.84]; complete neurological recovery was observed in 4/250 (1.6%) and 5/267 (1.9%) patients, respectively (RR 0.85 [CIs 0.23-3.15]. Interpretation: In this pooled analysis of individual data, intra-arrest cooling was associated with a significant increase in favourable neurological outcome in out-of-hospital cardiac arrest patients with initial shockable rhythms. No effects were observed in patients with initial non-shockable rhythms. Funding Statement: No funding has been received for this study. Declaration of Interests: The authors declare that they have no competing interests. Ethics Approval Statement: Ethics and institutional committees in each participating country approved the study protocols and written consent was obtained from closest relative or a legal representative of each patient after hospital admission and, at a later stage, from each patient who showed neurological recovery. Both studies were conducted according to the requirements of the Declaration of Helsinki.

Resume La leptospirose est une anthropozoonose c’est-a-dire une maladie animale transmissible a l’homme, provoquee par un spirochete, du genre Leptospira qui vit essentiellement parmi les rongeurs, mais aussi dans les zones humides. Elle sevit dans le monde entier particulierement en Asie, en Amerique latine et en Afrique. En Europe, son incidence est modeste (sauf en France et en Grande-Bretagne ou sa frequence s’est accrue ces dernieres annees) mais la frequence peut etre sous-estimee. Certaines regions d’outre-mer sont particulierement touchees. En France, le potentiel epidemique de la leptospirose est soumis aux variations climatiques, justifiant d’une surveillance constante de la maladie assuree par le Centre national de reference (CNR) des leptospires. La transmission a l’homme se fait surtout par contact avec les milieux souilles par les urines d’animaux infectes. La maladie peut atteindre le foie et les reins (hepatonephrite) sous forme de cytolyse, cholestase et d’insuffisance renale associee a la fievre. Une coagulopathie accompagne generalement le tableau. Son diagnostic est difficile en raison du polymorphisme clinique. Un diagnostic precoce de la leptospirose permet une prise en charge medicale efficace, ameliorant le pronostic du patient. Ce dernier repose actuellement sur amplification genique (PCR) ou par une serologie positive par le microscopic agglutination test (MAT) qui est la methode de reference. Son evolution est generalement favorable sous traitement antibiotique adapte (aminopenicilline). Mais 5 a 10 % des patients symptomatiques presentent une forme severe multiviscerale. Pres d’un siecle apres la decouverte de l’agent causal, cette zoonose reste un probleme de sante publique, zoonose prioritaire, sur le plan de la virulence, sa declaration est obligatoire dans notre pays. Nous rapportons le cas d’une forme d’hepatonephrite severe par contamination d’eau contaminee par leptospire observee dans le Nord de la France.

Respiratory failure in COPD patients is a frequent call in French emergency dispatching centers. We have evaluated the prehospital management of COPD patients and severity signs, and analyse outcome in the emergency department or ICU.

Benefits of the use of NIV in emergency departments are well established. Training and available staff, and choice of respiratory machines are essential criteria for success.

Following patients referred by the French emergency dispatching centre (SAMU 15) in different hospital services (emergency or ICU) is not always easy. The purpose of this study was to analyze each call arriving in the emergency dispatching centre, define resources for transportation, the host hospital department, and analyze the short-term outcome of these patients.

In emergency medicine, noninvasive ventilation (NIV) has grown up for COPD and acute pulmonary edema through the use of continuous positive airway pressure (CPAP). Recently, several studies have reported the use of NIV coupled with nebulized bronchodilators to optimize the management of acute asthma patients in emergency departments and ICUs. This has indicated an improvement in gas exchanges, decreased lung resistances and decreased work of breathing. The purpose of this study is to assess prehospital practices in CPAP for these patients, to target patients for its use, and to compare clinical data before and after achievement of CPAP with nebulization.