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1. A novel capnogram analysis to guide ventilation during cardiopulmonary resuscitation: clinical and experimental observations

Author

Lesimple, Arnaud, Fritz, Caroline, Hutin, Alice, Charbonney, Emmanuel, Savary, Dominique, Delisle, Stéphane, Ouellet, Paul, Bronchti, Gilles, Lidouren, Fanny, Piraino, Thomas, Beloncle, François, Prouvez, Nathan, Broc, A, Mercat, Alain, Brochard, Laurent, Tissier, Renaud, Richard, Jean-Christophe, MitoVasc - Physiopathologie Cardiovasculaire et Mitochondriale (MITOVASC), Université d'Angers (UA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM), 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), SAMU 75 [Paris], Institut Mondor de Recherche Biomédicale (IMRB), Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR10-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Université du Québec à Trois-Rivières (UQTR), École des Hautes Études en Santé Publique [EHESP] (EHESP), Institut de recherche en santé, environnement et travail (Irset), Université d'Angers (UA)-Université de Rennes (UR)-École des Hautes Études en Santé Publique [EHESP] (EHESP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), Université de Montréal (UdeM), St. Michael's Hospital, University of Toronto, French society of intensive care medicine (SRLF), Physiopathologie Cardiovasculaire et Mitochondriale (MITOVASC), Université d'Angers (UA)-Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-École des Hautes Études en Santé Publique [EHESP] (EHESP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), and Chard-Hutchinson, Xavier

Subjects
Cardiopulmonary resuscitation, MESH: Out-of-Hospital Cardiac Arrest, MESH: Humans, Swine, MESH: Cardiopulmonary Resuscitation, [SDV]Life Sciences [q-bio], Carbon Dioxide, Critical Care and Intensive Care Medicine, Cardiac arrest, MESH: Carbon Dioxide, [SDV] Life Sciences [q-bio], Intrathoracic airway closure, Cadaver, Animals, Humans, Thoracic distension, MESH: Cadaver, MESH: Lung, CO2 pattern, Lung, MESH: Swine, Out-of-Hospital Cardiac Arrest
Abstract

Background Cardiopulmonary resuscitation (CPR) decreases lung volume below the functional residual capacity and can generate intrathoracic airway closure. Conversely, large insufflations can induce thoracic distension and jeopardize circulation. The capnogram (CO2 signal) obtained during continuous chest compressions can reflect intrathoracic airway closure, and we hypothesized here that it can also indicate thoracic distension. Objectives To test whether a specific capnogram may identify thoracic distension during CPR and to assess the impact of thoracic distension on gas exchange and hemodynamics. Methods (1) In out-of-hospital cardiac arrest patients, we identified on capnograms three patterns: intrathoracic airway closure, thoracic distension or regular pattern. An algorithm was designed to identify them automatically. (2) To link CO2 patterns with ventilation, we conducted three experiments: (i) reproducing the CO2 patterns in human cadavers, (ii) assessing the influence of tidal volume and respiratory mechanics on thoracic distension using a mechanical lung model and (iii) exploring the impact of thoracic distension patterns on different circulation parameters during CPR on a pig model. Measurements and main results (1) Clinical data: 202 capnograms were collected. Intrathoracic airway closure was present in 35%, thoracic distension in 22% and regular pattern in 43%. (2) Experiments: (i) Higher insufflated volumes reproduced thoracic distension CO2 patterns in 5 cadavers. (ii) In the mechanical lung model, thoracic distension patterns were associated with higher volumes and longer time constants. (iii) In six pigs during CPR with various tidal volumes, a CO2 pattern of thoracic distension, but not tidal volume per se, was associated with a significant decrease in blood pressure and cerebral perfusion. Conclusions During CPR, capnograms reflecting intrathoracic airway closure, thoracic distension or regular pattern can be identified. In the animal experiment, a thoracic distension pattern on the capnogram is associated with a negative impact of ventilation on blood pressure and cerebral perfusion during CPR, not predicted by tidal volume per se.

Published
2022

2. 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

3. Understanding and monitoring the evolution of the Covid-19 epidemic from medical emergency calls: the example of the Paris area

Author

Gaubert, Stéphane, Akian, Marianne, Allamigeon, Xavier, Boyet, Marin, Colin, Baptiste, Grohens, Théotime, Massoulié, Laurent, Parsons, David, Adnet, Frederic, Chanzy, Érick, Goix, Laurent, Lapostolle, Frédéric, Lecarpentier, Éric, Leroy, Christophe, Loeb, Thomas, Marx, Jean-Sébastien, Télion, Caroline, Treluyer, Laurent, Carli, Pierre, TROPICAL (TROPICAL), Centre de Mathématiques Appliquées - Ecole Polytechnique (CMAP), École polytechnique (X)-Centre National de la Recherche Scientifique (CNRS)-École polytechnique (X)-Centre National de la Recherche Scientifique (CNRS)-Inria Saclay - Ile de France, Institut National de Recherche en Informatique et en Automatique (Inria)-Institut National de Recherche en Informatique et en Automatique (Inria), École polytechnique (X)-Centre National de la Recherche Scientifique (CNRS), Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Institut National des Sciences Appliquées (INSA), Laboratoire d'InfoRmatique en Image et Systèmes d'information (LIRIS), Université Lumière - Lyon 2 (UL2)-École Centrale de Lyon (ECL), Université de Lyon-Université de Lyon-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Centre National de la Recherche Scientifique (CNRS), Artificial Evolution and Computational Biology (BEAGLE), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Centre National de la Recherche Scientifique (CNRS)-Université Lumière - Lyon 2 (UL2)-École Centrale de Lyon (ECL), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Centre National de la Recherche Scientifique (CNRS)-Inria Grenoble - Rhône-Alpes, Institut National de Recherche en Informatique et en Automatique (Inria)-Institut National de Recherche en Informatique et en Automatique (Inria)-Laboratoire de Biométrie et Biologie Evolutive - UMR 5558 (LBBE), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National de Recherche en Informatique et en Automatique (Inria)-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS)-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS), Microsoft Research - Inria Joint Centre (MSR - INRIA), Institut National de Recherche en Informatique et en Automatique (Inria)-Microsoft Research Laboratory Cambridge-Microsoft Corporation [Redmond, Wash.], Dynamics of Geometric Networks (DYOGENE), Département d'informatique - ENS Paris (DI-ENS), École normale supérieure - Paris (ENS-PSL), Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL)-Institut National de Recherche en Informatique et en Automatique (Inria)-Centre National de la Recherche Scientifique (CNRS)-École normale supérieure - Paris (ENS-PSL), Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL)-Institut National de Recherche en Informatique et en Automatique (Inria)-Centre National de la Recherche Scientifique (CNRS)-Centre National de la Recherche Scientifique (CNRS)-Inria de Paris, Institut National de Recherche en Informatique et en Automatique (Inria), SED [Grenoble], Inria Grenoble - Rhône-Alpes, 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), Université Paris 13 (UP13), Service d'anesthésie-réanimation SAMU94-SMUR94 [Mondor], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Henri Mondor-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), SAMU 92 [Garches], Hôpital Raymond Poincaré [AP-HP], SAMU 75 [Paris], Université Paris Cité (UPCité), Service Expérimentation et Développement (SED [Grenoble]), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Université de Lyon-Institut National des Sciences Appliquées (INSA)-Centre National de la Recherche Scientifique (CNRS)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-École Centrale de Lyon (ECL), Université de Lyon-Université Lumière - Lyon 2 (UL2), Université de Lyon-Université Lumière - Lyon 2 (UL2)-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Université Lumière - Lyon 2 (UL2)-Inria Grenoble - Rhône-Alpes, Inria de Paris, Institut National de Recherche en Informatique et en Automatique (Inria)-Institut National de Recherche en Informatique et en Automatique (Inria)-Centre National de la Recherche Scientifique (CNRS)-Département d'informatique - ENS Paris (DI-ENS), Centre National de la Recherche Scientifique (CNRS)-Institut National de Recherche en Informatique et en Automatique (Inria)-École normale supérieure - Paris (ENS Paris), Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL)-Centre National de la Recherche Scientifique (CNRS)-École normale supérieure - Paris (ENS Paris), Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL), Université de Paris (UP), Université Paris Cité (UPC), Institut National des Sciences Appliquées (INSA)-Université de Lyon, Institut National des Sciences Appliquées (INSA)-Université de Lyon-Institut National des Sciences Appliquées (INSA)-Université de Lyon-Centre National de la Recherche Scientifique (CNRS)-Université Claude Bernard Lyon 1 (UCBL), Laboratoire de Biométrie et Biologie Evolutive - UMR 5558 (LBBE), Université de Lyon-Université de Lyon-Institut National de Recherche en Informatique et en Automatique (Inria)-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National de Recherche en Informatique et en Automatique (Inria)-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS)-Inria Grenoble - Rhône-Alpes, Institut National de Recherche en Informatique et en Automatique (Inria)-Laboratoire d'InfoRmatique en Image et Systèmes d'information (LIRIS), Institut National des Sciences Appliquées (INSA)-Université de Lyon-Institut National des Sciences Appliquées (INSA)-Centre National de la Recherche Scientifique (CNRS)-École Centrale de Lyon (ECL), Département d'informatique de l'École normale supérieure (DI-ENS), École normale supérieure - Paris (ENS Paris), and Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL)-Institut National de Recherche en Informatique et en Automatique (Inria)-Centre National de la Recherche Scientifique (CNRS)-École normale supérieure - Paris (ENS Paris)

Subjects
[MATH.MATH-ST]Mathematics [math]/Statistics [math.ST], [MATH.MATH-DS]Mathematics [math]/Dynamical Systems [math.DS], [MATH.MATH-AP]Mathematics [math]/Analysis of PDEs [math.AP], [MATH.MATH-OC]Mathematics [math]/Optimization and Control [math.OC]
Abstract

International audience; We portray the evolution of the Covid-19 epidemic during the crisis ofMarch-April 2020 in the Paris area, by analyzing the medical emergencycalls received by the EMS of the four central departments of this area(Centre 15 of SAMU 75, 92, 93 and 94). Our study reveals strongdissimilarities between these departments. We show that the logarithmof each epidemic observable can be approximated by a piecewise linearfunction of time. This allows us to distinguish the different phasesof the epidemic, and to identify the delay between sanitary measuresand their influence on the load of EMS. This also leads to analgorithm, allowing one to detect epidemic resurgences. We rely on atransport PDE epidemiological model, and we use methods fromPerron-Frobenius theory and tropical geometry.; Nous décrivons l'évolution de l'épidémie de Covid-19 dans l'agglomération parisienne, pendant la crise de Mars-Avril 2020, en analysant les appels d'urgence au numéro 15 traités par les SAMU des quatre départements centraux de l'agglomération (75, 92, 93 et 94). Notre étude révèle de fortes disparités entres ces départements. Nous montrons que le logarithme de toute observable épidémique peut être approché par une fonction du temps linéaire par morceaux. Cela nous permet d'identifier les différentes phases d'évolution de l'épidémie, et aussi d'évaluer le délai entre la prise de mesures sanitaires et leur effet sur la sollicitation de l'aide médicale urgente. Nous en déduisons un algorithme permettant de détecter une resurgence éventuelle de l'épidémie. Notre approche s'appuie sur un modèle d'EDP de transport de l'évolution épidémique, ainsi que sur des méthodes de théorie de Perron-Frobenius et de géométrie tropicale.

Published
2020

4. Life-threatening and major cardiac events during long-distance races: updates from the prospective RACE PARIS registry with a systematic review and meta-analysis

Author

Hazrije Mustafic, Jacques Monsegu, Anne Bellemain-Appaix, Thomas Levasseur, Jean-Philippe Collet, Lionel Lamhaut, Paul Guedeney, Benoît Gerardin, Hakim Benamer, Gilles Montalescot, Pierre Aubry, Centre Chirurgical Marie Lannelongue (CCML), Centre chirurgical Marie Lannelongue, Unité de Recherche sur les Maladies Cardiovasculaires, du Métabolisme et de la Nutrition = Institute of cardiometabolism and nutrition (ICAN), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Pitié-Salpêtrière [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Institut de cardiologie [CHU Pitié-Salpêtrière], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Pitié-Salpêtrière [AP-HP], Centre Hospitalier Universitaire de Reims (CHU Reims), Service de cardiologie et maladies vasculaires [CHU Ambroise Paré], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Ambroise Paré [AP-HP], Hôpital Foch [Suresnes], Groupe Hospitalier Mutualiste [Grenoble] (GHM), SAMU 75 [Paris], CIC - CHU Bichat, and Institut National de la Santé et de la Recherche Médicale (INSERM)

Subjects
medicine.medical_specialty, Epidemiology, [SDV]Life Sciences [q-bio], air pollution, Long distance running, 030204 cardiovascular system & hematology, Sudden cardiac death, Running, 03 medical and health sciences, Race (biology), 0302 clinical medicine, sudden cardiac arrest, Case fatality rate, medicine, Humans, 030212 general & internal medicine, Prospective Studies, Registries, Intensive care medicine, Stroke, business.industry, Medical record, Incidence (epidemiology), Sudden cardiac arrest, medicine.disease, 3. Good health, Heart Arrest, Death, Sudden, Cardiac, Meta-analysis, medicine.symptom, Cardiology and Cardiovascular Medicine, business, sport
Abstract

Aims Limited data exist regarding the incidence and aetiology of life-threatening events such as major cardiac events or exertional heat stroke during long-distance races. We aimed to provide an updated incidence, etiology and prognosis of life-threatening events during long-distance races. Methods The prospective RACE PARIS registry recorded all life-threatening events/fatal events occurring during 46 marathons, half-marathons and other long-distance races in the Paris area between 2006 and 2016, comprising 1,073,722 runners. Event characteristics were determined by review of medical records and interviews with survivors. Results The incidence of life-threatening events, exertional heat stroke and major cardiac events was 3.35 per 100,000, 1.02 per 100,000 and 2.33 per 100,000, respectively, including 18 sudden cardiac arrests (1.67 per 100,000). The main aetiology of sudden cardiac arrest was myocardial ischaemia (11/18), due to acute coronary thrombosis (6/11), stable atherosclerotic coronary artery disease (2/11), coronary dissection (1/11), anomalous connection (1/11) or myocardial bridging (1/11). A third of participants with ischaemia-related major cardiac events presented with pre-race clinical symptoms. Major cardiac events were more frequent in the case of a high pollution index (6.78 per 100,000 vs. 2.07 per 100,000, odds ratio 3.27, 95% confidence interval 1.12–9.54). Case fatality was low (0.19 per 100,000). Similarly, we report in a meta-analysis of eight long-distance race registries comprising 16,223,866 runners a low incidence of long-distance race-related sudden cardiac arrest (0.82 per 100,000) and fatality (0.39 per 100,000). Death following sudden cardiac arrest was strongly associated with initial asystole or pulseless rhythm. Conclusion Long-distance race-related life-threatening events remain rare although serious events. Better information for runners on the risk of pre-race clinical symptoms, outside air pollution and temperature may reduce their incidence.

Published
2020

5. Prévoir la progression locale de l'épidémie de Covid-19 à partir des appels au numéro d'urgence 15: l'exemple de l'agglomération parisienne

Author

Gaubert, Stéphane, Akian, Marianne, Allamigeon, Xavier, BOYET, Marin, Colin, Baptiste, Grohens, Théotime, Massoulié, Laurent, Parsons, David, Adnet, Frederic, Chanzy, Érick, Goix, Laurent, Lapostolle, Frédéric, Lecarpentier, Éric, Leroy, Christophe, Loeb, Thomas, Marx, Jean-Sébastien, Télion, Caroline, Treluyer, Laurent, Carli, Pierre, TROPICAL (TROPICAL), Centre de Mathématiques Appliquées - Ecole Polytechnique (CMAP), Centre National de la Recherche Scientifique (CNRS)-École polytechnique (X)-Centre National de la Recherche Scientifique (CNRS)-École polytechnique (X)-Inria Saclay - Ile de France, Institut National de Recherche en Informatique et en Automatique (Inria)-Institut National de Recherche en Informatique et en Automatique (Inria), Centre National de la Recherche Scientifique (CNRS)-École polytechnique (X), Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Institut National des Sciences Appliquées (INSA), Laboratoire d'InfoRmatique en Image et Systèmes d'information (LIRIS), Université Lumière - Lyon 2 (UL2)-École Centrale de Lyon (ECL), Université de Lyon-Université de Lyon-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Centre National de la Recherche Scientifique (CNRS)-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA), Artificial Evolution and Computational Biology (BEAGLE), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Université Lumière - Lyon 2 (UL2)-École Centrale de Lyon (ECL), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Inria Grenoble - Rhône-Alpes, Institut National de Recherche en Informatique et en Automatique (Inria)-Institut National de Recherche en Informatique et en Automatique (Inria)-Laboratoire de Biométrie et Biologie Evolutive - UMR 5558 (LBBE), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National de Recherche en Informatique et en Automatique (Inria)-Centre National de la Recherche Scientifique (CNRS)-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS)-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS), Microsoft Research - Inria Joint Centre (MSR - INRIA), Institut National de Recherche en Informatique et en Automatique (Inria)-Microsoft Research Laboratory Cambridge-Microsoft Corporation [Redmond, Wash.], Dynamics of Geometric Networks (DYOGENE), Inria de Paris, Institut National de Recherche en Informatique et en Automatique (Inria)-Institut National de Recherche en Informatique et en Automatique (Inria)-Centre National de la Recherche Scientifique (CNRS)-Département d'informatique de l'École normale supérieure (DI-ENS), Centre National de la Recherche Scientifique (CNRS)-Institut National de Recherche en Informatique et en Automatique (Inria)-École normale supérieure - Paris (ENS Paris)-Centre National de la Recherche Scientifique (CNRS)-École normale supérieure - Paris (ENS Paris), SED [Grenoble], Inria Grenoble - Rhône-Alpes, SAMU 93 [Bobigny], Hôpital Avicenne [Bobigny], Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Assistance publique - Hôpitaux de Paris (AP-HP) (APHP), Université Paris 13 (UP13), Service d'anesthésie-réanimation SAMU94-SMUR94 [Mondor], Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Hôpital Henri Mondor-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Assistance publique - Hôpitaux de Paris (AP-HP) (APHP), SAMU 92 [Garches], Hôpital Raymond Poincaré [AP-HP], SAMU 75 [Paris], Université de Paris, École polytechnique (X)-Centre National de la Recherche Scientifique (CNRS)-École polytechnique (X)-Centre National de la Recherche Scientifique (CNRS)-Inria Saclay - Ile de France, and École polytechnique (X)-Centre National de la Recherche Scientifique (CNRS)

Subjects
[MATH.MATH-ST]Mathematics [math]/Statistics [math.ST], [MATH.MATH-DS]Mathematics [math]/Dynamical Systems [math.DS], [MATH.MATH-AP]Mathematics [math]/Analysis of PDEs [math.AP], [MATH.MATH-OC]Mathematics [math]/Optimization and Control [math.OC]
Abstract

We portray the evolution of the Covid-19 epidemic during the crisis of March-April 2020 in the Paris area, by analyzing the medical emergency calls received by the EMS of the four central departments of this area (Centre 15 of SAMU 75, 92, 93 and 94). Our study reveals strong dissimilarities between these departments. We provide an algorithm, based on a piecewise linear approximation of the logarithm of epidemic observables, allowing one to monitor the epidemic. Our methods combine ideas from several elds of mathematics: tropical geometry, PerronFrobenius theory, probability and optimization, transport PDE in population dynamics.; Nous décrivons l'évolution de l'épidémie de Covid-19 dans l'agglomération parisienne, pendant la crise de Mars-Avril 2020, en analysant les appels d'urgence au numéro 15 traités par les SAMU des quatre départements centraux de l'agglomération (75, 92, 93 et 94).Notre étude révèle de fortes disparités entres ces départements. Nous donnons un algorithme, utilisant une approximation linéaire par morceaux du logarithme des observables épidémiques, qui permet de surveiller l'évolution. Nos méthodes sont inspirées par plusieurs domaines des mathématiques: géométrie tropicale, théorie de Perron--Frobenius, probabilités et optimisation, modèles d'EDP de transport en dynamique de population.

Published
2020

6. Low rates of immediate coronary angiography among young adults resuscitated from sudden cardiac arrest

Author

Eloi Marijon, Daniel Jost, Florence Dumas, Lionel Lamhaut, Nicolas Lellouche, Christian Spaulding, Frankie Beganton, Sebastian Voicu, Bruno Mégarbane, Nicole Karam, David S. Celermajer, Olivier Varenne, Bertrand Ludes, Alain Cariou, Fabrice Extramiana, Antoine Lafont, Estelle Gandjbakhch, Kumar Narayanan, Julien Rischard, Vincent Algalarrondo, Karim Wahbi, Georgios Sideris, Isabelle Plu, on behalf Paris-SDEC investigators, Wulfran Bougouin, Xavier Jouven, Victor Waldmann, Ardalan Sharifzadehgan, Paris-Centre de Recherche Cardiovasculaire (PARCC (UMR_S 970/ 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)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Paris (UP), Hôpital Privé Jacques Cartier [Massy], Service de médecine d'urgence [CHU Cochin], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Cochin [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Hôpital Lariboisière-Fernand-Widal [APHP], Service de Cardiologie [CHU Pitié-Salpêtrière], CHU Pitié-Salpêtrière [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Brigade de sapeurs pompiers de Paris (BSPP), SAMU 75 [Paris], CHU Necker - Enfants Malades [AP-HP], Service d'Anatomie et cytologie pathologiques [CHU Pitié-Salpêtrière] (ACP), Service de Cardiologie [CHU Cochin], CIC - CHU Bichat, Institut National de la Santé et de la Recherche Médicale (INSERM), Unité de Recherche sur les Maladies Cardiovasculaires, du Métabolisme et de la Nutrition = Institute of cardiometabolism and nutrition (ICAN), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Pitié-Salpêtrière [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), CHU Henri Mondor, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO), Unité de Soins Intensifs [CHU Cochin], Hôpital Cochin [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), CCSD, Accord Elsevier, 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), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Service d'Anatomie et cytologie pathologiques = Service de Pathologie [CHU Pitié-Salpêtrière] (ACP), Unité de Recherche sur les Maladies Cardiovasculaires, du Métabolisme et de la Nutrition = Research Unit on Cardiovascular and Metabolic Diseases (ICAN), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU)-Institut de Cardiométabolisme et Nutrition = Institute of Cardiometabolism and Nutrition [CHU Pitié Salpêtrière] (IHU ICAN), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-CHU Pitié-Salpêtrière [AP-HP], and Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)

Subjects
Coronary angiography, Adult, Male, medicine.medical_specialty, Acute coronary syndrome, Paris, Adolescent, Epidemiology, medicine.medical_treatment, [SDV]Life Sciences [q-bio], 030204 cardiovascular system & hematology, Emergency Nursing, Coronary Angiography, Coronary artery disease, Sudden cardiac death, Percutaneous coronary intervention, 03 medical and health sciences, Young Adult, 0302 clinical medicine, Internal medicine, medicine, Humans, Young adult, business.industry, 030208 emergency & critical care medicine, Sudden cardiac arrest, medicine.disease, Cardiac arrest, 3. Good health, [SDV] Life Sciences [q-bio], Death, Sudden, Cardiac, Emergency Medicine, Cardiology, Female, medicine.symptom, Cardiology and Cardiovascular Medicine, business, Out-of-Hospital Cardiac Arrest
Abstract

International audience; Aim: Coronary artery disease (CAD) has recently been emphasized as a major cause of sudden cardiac arrest (SCA) in young adults. We aim to assess the rate of immediate coronary angiography performance in young patients resuscitated from SCA.Methods: From May 2011 to May 2017, all cases of out-of-hospital SCA aged 18-40 years alive at hospital admission were prospectively included in 48 hospitals of the Great Paris area. Cardiovascular causes of SCA were centrally adjudicated, and management including immediate coronary angiography performance was assessed.Results: Out of 3579 SCA admitted alive, 409 (11.4%) patients were under 40 years of age (32.3 ± 6.2 years, 69.7% males), with 244 patients having a definite cause identified. Among those, CAD accounted for 72 (29.5%) cases, of which 64 (88.9%) were acute coronary syndromes. The rate of immediate coronary angiography was only 41.7% compared to 65.1% among those ≥40-years (P < 0.001). During the study period, while the rate of immediate coronary angiography increased from 60.5% to 70.3% (P < 0.001) in patients aged ≥40 years, the rate in patients aged less than 40 years remained stable (43.5% to 45.3%, P = 0.795). Patients younger than 40 years were significantly less likely to undergo immediate coronary angiography (OR = 0.34, 95% CI: 0.25-0.47), although early angiography was associated with survival at hospital discharge (OR = 2.68, 95% CI: 1.21-6.00).Conclusion: CAD is the first cause of SCA in young adults aged less than 40 years. The observed low rates of immediate coronary angiography suggest a missed opportunity for early intervention.

Published
2020

7. 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

8. Premedication practices for tracheal intubation in neonates transported by French medical transport teams: a prospective observational study

Author

Patricia Cimerman, Audrey Normand, Azzedine Ayachi, Jessica Rousseau, Noella Lode, Jean-Louis Chabernaud, Véronique Henry-Larzul, Ourida Chouakri, Emilie Courtois, Ricardo Carbajal, Katia Kessous, CHU Trousseau [APHP], Sorbonne Université (SU), Centre de Recherche Épidémiologie et Statistique Sorbonne Paris Cité (CRESS (U1153 / UMR_A_1125 / UMR_S_1153)), Université Paris Diderot - Paris 7 (UPD7)-Université Paris Descartes - Paris 5 (UPD5)-Université Sorbonne Paris Cité (USPC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), Equipe 1 : EPOPé - Épidémiologie Obstétricale, Périnatale et Pédiatrique (CRESS - U1153), Université Paris Descartes - Paris 5 (UPD5)-Centre de Recherche Épidémiologie et Statistique Sorbonne Paris Cité (CRESS (U1153 / UMR_A_1125 / UMR_S_1153)), Université Paris Diderot - Paris 7 (UPD7)-Université Paris Descartes - Paris 5 (UPD5)-Université Sorbonne Paris Cité (USPC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE)-Université Paris Diderot - Paris 7 (UPD7)-Université Sorbonne Paris Cité (USPC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), Hôpital Robert Debré Paris, Hôpital Robert Debré, SAMU 75 [Paris], CHU Necker - Enfants Malades [AP-HP], Centre national de ressources de lutte contre la douleur, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Institut National de la Recherche Agronomique (INRA)-Université Paris Diderot - Paris 7 (UPD7)-Université Paris Descartes - Paris 5 (UPD5)-Université Sorbonne Paris Cité (USPC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de la Recherche Agronomique (INRA)-Université Paris Diderot - Paris 7 (UPD7)-Université Sorbonne Paris Cité (USPC)-Institut National de la Santé et de la Recherche Médicale (INSERM), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Université Sorbonne Paris Cité (USPC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Paris-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), and Université Sorbonne Paris Cité (USPC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Paris-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE)-Université Sorbonne Paris Cité (USPC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Paris-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE)-Université de Paris

Subjects
Atropine, Male, Paris, Sufentanil, medicine.medical_treatment, Sedation, [SDV]Life Sciences [q-bio], Midazolam, Premedication, Pain, neonatology, intubation, 03 medical and health sciences, 0302 clinical medicine, Intensive Care Units, Neonatal, medicine, neonatal intensive & critical care, Intubation, Intratracheal, Intubation, Humans, 030212 general & internal medicine, Prospective Studies, Adverse effect, Nose, Original Research, business.industry, Tracheal intubation, Intensive Care, Infant, Newborn, General Medicine, 3. Good health, Analgesics, Opioid, medicine.anatomical_structure, pain management, Anesthesia, epidemiology, Female, medicine.symptom, business, 030217 neurology & neurosurgery, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology, medicine.drug
Abstract

ObjectivesPremedication practices for neonatal tracheal intubations have not yet been described for neonatal transport teams. Our objective is to describe the use of sedation/analgesia (SA) for tracheal intubations and to assess its tolerance in neonates transported by medical transport teams in France.SettingThis prospective observational study was part of the EPIPPAIN 2 project and collected around-the-clock data on SA practices in neonates intubated by all five paediatric medical transport teams of the Paris region during a 2-month period. Intubations were classified as emergent, semiemergent and non-emergent. Sedation level and conditions of intubation were assessed with the Tonus, Reactivity, Awareness and Conditions of intubation to Help in Endotracheal intubation Assessment (TRACHEA score). The scores range from 0 to 10 representing an increasing ladder from adequate to inadequate sedation, and from excellent to very poor conditions of intubation.Participants40 neonates intubated in 28 different centres.ResultsThe mean (SD) age was 34.9 (3.9) weeks, and 62.5% were intubated in the delivery room. 30/40 (75%) of intubations were performed with the use of SA. In 18/30 (60.0%) intubations performed with SA, the drug regimen was the association of sufentanil and midazolam. Atropine was given in 19/40 intubations. From the 16, 21 and 3 intubations classified as emergent, semiemergent and non-emergent, respectively, 8 (50%), 19 (90.5%) and 3 (100%) were performed with SA premedication. 79.3% of intubations performed with SA had TRACHEA scores of 3 or less. 22/40 (55%) infants had at least one of the following adverse events: muscle rigidity, bradycardia below 100/min, desaturation below 80% and nose or pharynx–larynx bleeding. 7/24 (29.2%) of those who had only one attempt presented at least one of these adverse events compared with 15/16 (93.8%) of those who needed two or more attempts (pConclusionSA premedication is largely feasible for tracheal intubations performed in neonates transported by medical transport teams including intubations judged as emergent or semiemergent.Trial registration numberNCT01346813; Results.

Published
2019

9. Acute kidney injury during an ultra-distance race

Author

Dany Anglicheau, Romain Jouffroy, Nicolas Mansencal, Xavier Lebreton, Anesthesiology and Intensive Care Unit [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-SAMU 75 [Paris]-CHU Necker - Enfants Malades [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Department of Anesthesia, Clinical Epidemiology and Biostatistics [Hamilton, ON, Canada], Michael DeGroote School of Medicine [Hamilton, ON, Canada], Faculty of Health Sciences [Hamilton, ON, Canada], McMaster University [Hamilton, Ontario]-McMaster University [Hamilton, Ontario]-Faculty of Health Sciences [Hamilton, ON, Canada], McMaster University [Hamilton, Ontario]-McMaster University [Hamilton, Ontario], Perioperative Medicine and Surgical Research Unit [Hamilton, ON, Canada], David Braley Cardiac, Vascular and Stroke Research Institute [Hamilton, ON, Canada], Population Health Research Institute [Hamilton, ON, Canada]-Population Health Research Institute [Hamilton, ON, Canada], Laboratory of molecular mechanisms of hematologic disorders and therapeutic implications (ERL 8254 - Equipe Inserm U1163), Imagine - Institut des maladies génétiques (IMAGINE - U1163), Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM), Institut de recherche biomédicale et d’épidémiologie du sport (IRMES - EA 7329), Université Paris Descartes - Paris 5 (UPD5)-Institut national du sport, de l'expertise et de la performance (INSEP), Institut Necker Enfants-Malades (INEM - UM 111 (UMR 8253 / U1151)), Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Service Néphrologie et transplantation rénale Adultes [CHU Necker], CHU Necker - Enfants Malades [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Service de cardiologie et maladies vasculaires [CHU Ambroise Paré], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Ambroise Paré [AP-HP], Centre de Référence des Cardiomyopathies et des Troubles du Rythme Cardiaque Héréditaires ou Rares [Boulogne-Billancourt], Hôpital Ambroise Paré [AP-HP], Épidémiologie et recherches translationnelles sur les maladies rénales et cardiovasculaires (EPREC) (U1018 (Équipe 5)), Centre de recherche en épidémiologie et santé des populations (CESP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris-Sud - Paris 11 (UP11)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris-Sud - Paris 11 (UP11)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Versailles Saint-Quentin-en-Yvelines (UVSQ), Bodescot, Myriam, Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris-Saclay, Institut de recherche biomédicale et d’épidémiologie du sport (IRMES - URP_7329), Institut national du sport, de l'expertise et de la performance (INSEP)-Université Paris Cité (UPCité), and Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Université Paris-Sud - Paris 11 (UP11)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Université Paris-Sud - Paris 11 (UP11)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM)

Subjects
Adult, Male, Physiology, Science, 030232 urology & nephrology, Renal function, Urine, 030204 cardiovascular system & hematology, Biochemistry, [SDV.MHEP.UN]Life Sciences [q-bio]/Human health and pathology/Urology and Nephrology, Running, 03 medical and health sciences, Race (biology), chemistry.chemical_compound, 0302 clinical medicine, Complete regression, Chronic Kidney Disease, medicine, Medicine and Health Sciences, Humans, Creatinine, Multidisciplinary, business.industry, Significant difference, Acute kidney injury, Biology and Life Sciences, Kidneys, Renal System, Acute Kidney Injury, medicine.disease, [SDV.MHEP.UN] Life Sciences [q-bio]/Human health and pathology/Urology and Nephrology, Body Fluids, Urinary Biomarkers, Blood, chemistry, Nephrology, Creatinine increased, Medicine, Anatomy, business, Biomarkers, Research Article
Abstract

International audience; PURPOSE:Previous studies have noted consequences of ultra-distance trail running on health, but few studies are available regarding the temporal variations of renal biomarker injury during the running. The aim of this study was to assess the of kidney function parameters temporal variation during and on short-term after an ultra-distance race.METHODS:We performed an observational study with 47 subjects participating in an ultra-distance race (80 km). Urine (47 subjects) and blood (21 subjects) samples were serially collected before (baseline-km 0), during (21 and 53 km), on arrival (80 km), and 9 days after the race (d9).RESULTS:Mean serum creatinine increased during the race from 90±14 μmol/L (km0) to 136±32 μmol/L (km 80-p0.05). On day 9, no significant difference remains in blood and urine biomarkers compared to their respective baseline levels.CONCLUSIONS:During an ultra-distance race, despite an acute and transient increase in the serum creatinine levels, urinary biomarkers of AKI displayed only limited changes with a complete regression on day 9. These results suggest the absence of the short-term impact of an ultra-distance race kidney function.

Published
2019

10. No evidence for major adverse events related to suspicion of Ebola in France, 2014-2015

Author

Manuel Etienne, X. Duval, Michel Nahon, Marie Lachâtre, Denis Malvy, Matthieu Mechain, Pierre Tattevin, Hélène Coignard-Biehler, Sophie Matheron, Philippe Gautret, AP-HP - Hôpital Bichat - Claude Bernard [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), CHU Bordeaux [Bordeaux], Bordeaux population health (BPH), Université de Bordeaux (UB)-Institut de Santé Publique, d'Épidémiologie et de Développement (ISPED)-Institut National de la Santé et de la Recherche Médicale (INSERM), Laboratoire des Adaptations Métaboliques à l'Exercice en Conditions Physiologiques et Pathologiques (AME2P), Université Clermont Auvergne [2017-2020] (UCA [2017-2020])-UFR Sciences et Techniques des Activités Physiques et Sportives - Clermont-Auvergne (UFR STAPS - UCA), Université Clermont Auvergne [2017-2020] (UCA [2017-2020])-Université Clermont Auvergne [2017-2020] (UCA [2017-2020]), Vecteurs - Infections tropicales et méditerranéennes (VITROME), Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Institut de Recherche Biomédicale des Armées [Brétigny-sur-Orge] (IRBA), SAMU 75 [Paris], Centre d'infectiologie Necker-Pasteur [CHU Necker], Institut Pasteur [Paris] (IP)-CHU Necker - Enfants Malades [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), CIC1425 - Bichat [AP-HP Hôpital Bichat - Claude Bernard], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Diderot - Paris 7 (UPD7), Service de microbiologie [CHU Bichat], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-AP-HP - Hôpital Bichat - Claude Bernard [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Nord Val de Seine, Infection, Anti-microbiens, Modélisation, Evolution (IAME (UMR_S_1137 / U1137)), Université Paris 13 (UP13)-Université Paris Diderot - Paris 7 (UPD7)-Université Sorbonne Paris Cité (USPC)-Institut National de la Santé et de la Recherche Médicale (INSERM), Service des maladies infectieuses et réanimation médicale [Rennes] = Infectious Disease and Intensive Care [Rennes], CHU Pontchaillou [Rennes], Centre d'Investigation Clinique [Rennes] (CIC), Université de Rennes (UR)-Hôpital Pontchaillou-Institut National de la Santé et de la Recherche Médicale (INSERM), Institut National de la Santé Et de la Recherche Médicale, SPILF, Institut de Recherche Biomédicale des Armées (IRBA)-Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU), Institut Pasteur [Paris]-CHU Necker - Enfants Malades [AP-HP], Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris 13 (UP13)-Université Paris Diderot - Paris 7 (UPD7)-Université Sorbonne Paris Cité (USPC), Université de Rennes 1 (UR1), and Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Hôpital Pontchaillou-Institut National de la Santé et de la Recherche Médicale (INSERM)

Subjects
Adult, Male, Microbiology (medical), medicine.medical_specialty, Pediatrics, MEDLINE, 030204 cardiovascular system & hematology, medicine.disease_cause, Disease Outbreaks, Diagnosis, Differential, 03 medical and health sciences, 0302 clinical medicine, [SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases, medicine, Humans, 030212 general & internal medicine, Intensive care medicine, Adverse effect, ComputingMilieux_MISCELLANEOUS, Retrospective Studies, Ebolavirus, business.industry, Retrospective cohort study, General Medicine, Hemorrhagic Fever, Ebola, 3. Good health, Infectious Diseases, Multicenter study, Africa, Female, France, Differential diagnosis, Travel-Related Illness, business
Abstract

International audience

Published
2018

11. 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

12. French ministry of health's response to paris attacks of 13 november 2015

Author

Jean-Marc Philippe, Jean-Pierre Tourtier, Olivier Brahic, Pierre Carli, Bruno Riou, Benoit Vallet, Ministère de la Santé, SAMU 75 [Paris], Brigade de sapeurs pompiers de Paris (BSPP), CHU Pitié-Salpêtrière [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Evaluation des technologies de santé et des pratiques médicales - ULR 2694 (METRICS), Université de Lille-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), CHU Lille, Université de Lille, Brigade de sapeurs pompiers de Paris [BSPP], Evaluation des technologies de santé et des pratiques médicales - ULR 2694 [METRICS], and Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)

Subjects
Emergency Medical Services, [SDV]Life Sciences [q-bio], Public administration, Critical Care and Intensive Care Medicine, Civil servants, MESH: Delivery of Health Care/organization & administration, MESH: Terrorism/statistics & numerical data, 0302 clinical medicine, Emergency medical services, Medicine, 030212 general & internal medicine, MESH: Terrorism/psychology, MESH: Disaster Planning/organization & administration, MESH: Emergency Medical Services/methods, MESH: Explosions/statistics & numerical data, MESH: Paris, 16. Peace & justice, Christian ministry, MESH: Emergency Medical Services/statistics & numerical data, Administration (government), Paris, Resource (biology), MESH: Terrorism/trends, Explosions, Disaster Planning, Stadium, 03 medical and health sciences, MESH: Disaster Planning/standards, Humans, MESH: Humans, business.industry, 030208 emergency & critical care medicine, MESH: Emergency Medical Services/organization & administration, Terrorism, Commentary, Element (criminal law), MESH: Delivery of Health Care/methods, business, Delivery of Health Care
Abstract

International audience; On Friday November 13th at 9:20 pm, three kamikaze bombs went off around the Stade de France a stadium in Saint-Denis just outside Paris, 4 different shootings took place and bombings in Paris and hundreds of people were held hostage in a theater.This multi-site terrorist attack was the first of this magnitude in France. Drawing the lessons of these attacks and those which occurred in other countries from a health perspective is essential to continuously adapt and improve the French response to possible future attacks. Several issues would need to be further explored: Management of uncertainties: When to trigger the plans: after the 1st attack, the 2nd? When do attacks end and when to release mobilized resources? Management of victims: How to ensure that all victims are secured or taken care of? How to provide assistance when attacks are ongoing? Management of teams: Proper follow-up of persons involved in the response: health professionals, police and firemen, emergency call centers but also civil servants within administration that contributed to the response. Communication: Reactivity of all is a key element to secure appropriate resource is mobilized for the response. All actors have to be able to communicate quickly in a secured way.

Published
2016

13. Total liquid ventilation offers ultra-fast and whole-body cooling in large animals in physiological conditions and during cardiac arrest

Author

Alice Hutin, Pierre Carli, Aurélien Seemann, Nicolas Mongardon, Jean-Damien Ricard, Bijan Ghaleh, Thierry Hauet, Alain Berdeaux, Renaud Tissier, Daniel Isabey, Fanny Lidouren, Richard E. Kerber, Bertrand Renaud, Matthias Kohlhauer, Benoît Vivien, Luc Lotteau, Institut Mondor de Recherche Biomédicale (IMRB), Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR10-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Hôpital Cochin [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Université Paris Descartes - Paris 5 (UPD5), Institut Mondor de recherche biomédicale (IMRB), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), INSERM U955, équipe 3, Pharmacie-Toxicologie, École nationale vétérinaire d'Alfort (ENVA)-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12)-École nationale vétérinaire d'Alfort (ENVA)-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12)-Institut Mondor de Recherche Biomédicale (IMRB), Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR10-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12)-Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR10-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Unité Médicale de Soins Intensifs, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Cochin [AP-HP], INSERM U955, équipe 13, Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR10-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12)-Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR10-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12)-Biomécanique cellulaire et respiratoire (BCR), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12)-Centre National de la Recherche Scientifique (CNRS)-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12)-Centre National de la Recherche Scientifique (CNRS), Service d'Anesthésie Réanimation [CHU Necker], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Necker - Enfants Malades [AP-HP], CHU Necker - Enfants Malades [AP-HP], SAMU 75 [Paris], Ecologie et Evolution des Microorganismes (EEM), Université Paris Diderot - Paris 7 (UPD7)-Université Paris 13 (UP13)-Université Sorbonne Paris Cité (USPC)-Institut National de la Santé et de la Recherche Médicale (INSERM), Ischémie Reperfusion en Transplantation d’Organes Mécanismes et Innovations Thérapeutiques ( IRTOMIT), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Poitiers, Institut des Maladies Métaboliques et Cardiovasculaires (I2MC), 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), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Université de Poitiers-Institut National de la Santé et de la Recherche Médicale (INSERM), CHU Cochin [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-CHU Cochin [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-CHU Necker - Enfants Malades [AP-HP], École nationale vétérinaire - Alfort (ENVA)-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12)-École nationale vétérinaire - Alfort (ENVA)-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12)-Institut Mondor de Recherche Biomédicale (IMRB), and Université Paris 13 (UP13)-Université Paris Diderot - Paris 7 (UPD7)-Université Sorbonne Paris Cité (USPC)-Institut National de la Santé et de la Recherche Médicale (INSERM)

Subjects
Comparative Effectiveness Research, Time Factors, Swine, medicine.medical_treatment, Resuscitation, Hypothermia, 030204 cardiovascular system & hematology, Emergency Nursing, Body weight, Liquid ventilator, Body Temperature, 03 medical and health sciences, 0302 clinical medicine, Blood Substitutes, Hypothermia, Induced, Medicine, Animals, Ultra fast, Animal model, Monitoring, Physiologic, Mechanical ventilation, Fluorocarbons, Ventilators, Mechanical, business.industry, Body Weight, 030208 emergency & critical care medicine, medicine.disease, Cardiac arrest, Cardiopulmonary Resuscitation, Heart Arrest, Disease Models, Animal, Liquid ventilation, Anesthesia, Ventricular fibrillation, Emergency Medicine, Total Liquid Ventilation, Cardiology and Cardiovascular Medicine, business, Whole body, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology, Conventional ventilation
Abstract

Introduction Total liquid ventilation (TLV) can cool down the entire body within 10–15 min in small animals. Our goal was to determine whether it could also induce ultra-fast and whole-body cooling in large animals using a specifically dedicated liquid ventilator. Cooling efficiency was evaluated under physiological conditions (beating-heart) and during cardiac arrest with automated chest compressions (CC, intra-arrest). Methods In a first set of experiments, beating-heart pigs were randomly submitted to conventional mechanical ventilation or hypothermic TLV with perfluoro-N-octane (between 15 and 32 °C). In a second set of experiments, pigs were submitted to ventricular fibrillation and CC. One group underwent continuous CC with asynchronous conventional ventilation (Control group). The other group was switched to TLV while pursuing CC for the investigation of cooling capacities and potential effects on cardiac massage efficiency. Results Under physiological conditions, TLV significantly decreased the entire body temperatures below 34 °C within only 10 min. As examples, cooling rates averaged 0.54 and 0.94 °C/min in rectum and esophageous, respectively. During cardiac arrest, TLV did not alter CC efficiency and cooled the entire body below 34 °C within 20 min, the low-flow period slowing cooling during CC. Conclusion Using a specifically designed liquid ventilator, TLV induced a very rapid cooling of the entire body in large animals. This was confirmed in both physiological conditions and during cardiac arrest with CC. TLV could be relevant for ultra-rapid cooling independently of body weight.

Published
2015

14. 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

15. Evolution of Incidence, Management, and Outcomes Over Time in Sports-Related Sudden Cardiac Arrest.

Author

Karam N, Pechmajou L, Narayanan K, Bougouin W, Sharifzadehgan A, Anys S, Weizman O, Perrot D, Waldmann V, Beganton F, Perier MC, Rischard J, Loeb T, Agostinucci JM, Lecarpentier E, Jabre P, Jost D, Dumas F, Cariou A, Jouven X, and Marijon E

Subjects
Age Distribution, Athletes, Cardiopulmonary Resuscitation statistics & numerical data, Datasets as Topic, Defibrillators supply & distribution, Female, France epidemiology, Humans, Incidence, Male, Middle Aged, Sex Distribution, Survival Analysis, Death, Sudden, Cardiac epidemiology
Abstract

Background: Major efforts have been made to reduce the burden of sports-related sudden cardiac arrest (SrSCA). The extent to which the incidence, management, and outcomes changed over time has not been investigated., Objectives: The purpose of this study was to assess temporal trends in SrSCA incidence, management, and survival., Methods: Using data from the French National Institute of Health and Medical Research, we evaluated the evolution of incidence, prehospital management, and survival at hospital discharge of SrSCA among subjects aged 18 to 75 years, over 6 successive 2-year periods between 2005 and 2018., Results: Among the 377 SrSCA, 20 occurred in young competitive athletes (5.3%), whereas 94.7% occurred in middle-aged recreational sports participants. Comparing the last 2-year to the first 2-year period, SrSCA incidence remained stable (6.24 vs 7.00 per million inhabitants/y; P = 0.51), with no significant differences in patients' mean age (46.6 ± 13.8 years vs 51.0 ± 16.4 years; P = 0.42), sex (men 94.7% vs 95.2%; P = 0.99), and history of heart disease (12.5% vs 15.9%; P = 0.85). However, frequency of bystander cardiopulmonary resuscitation and public automated external defibrillator use increased significantly (34.9% vs 94.7%; P < 0.001 and 1.6% vs 28.8%; P = 0.006, respectively). Survival to hospital discharge improved steadily, reaching 66.7% in the last study period compared with 23.8% in the first (P < 0.001)., Conclusions: Incidence of SrSCA remained relatively stable over time, suggesting a need for improvement in screening strategies. However, major improvements in on-field resuscitation led to a 3-fold increase in survival, underlining the value of public education in basic life support that should serve as an example for SCA in general., Competing Interests: Funding Support and Author Disclosures Funding was provided by the French National Institute of Health and Medical Research (INSERM), University of Paris, French Federation of Cardiology. The Paris-SDEC activities are supported by the Institut National de la Santé et de la Recherche Médicale (INSERM), University of Paris, Assistance Publique–Hôpitaux de Paris, Fondation Coeur et Artères, Global Heart Watch, Fédération Française de Cardiologie, Société Française de Cardiologie, Fondation Recherche Medicale, as well as unrestricted grants from industrial partners (Medtronic, St. Jude Medical, Boston Scientific, MicroPort, Biotronik, Zoll, and Schiller). The SDEC Executive Committee is part of the ESCAPE-NET project, a €10 million funding from the European Commission (Horizon2020 program) to develop research on sudden cardiac death in Europe. The authors have reported that they have no relationships relevant to the contents of this paper to disclose., (Copyright © 2022 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)

Published
2022
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16. Major regional differences in Automated External Defibrillator placement and Basic Life Support training in France: Further needs for coordinated implementation.

Author

Karam N, Narayanan K, Bougouin W, Benameur N, Beganton F, Jost D, Lamhaut L, Perier MC, Cariou A, Celermajer DS, Marijon E, and Jouven X

Subjects
Adolescent, Adult, Cardiopulmonary Resuscitation methods, Cardiopulmonary Resuscitation statistics & numerical data, Child, Electric Countershock statistics & numerical data, Female, France epidemiology, Humans, Male, Middle Aged, Out-of-Hospital Cardiac Arrest mortality, Prospective Studies, Registries, Time-to-Treatment, Young Adult, Cardiopulmonary Resuscitation education, Defibrillators supply & distribution, Emergency Medical Services organization & administration, Out-of-Hospital Cardiac Arrest therapy
Abstract

Background: Public Access Defibrillation (PAD) programs have emerged since mid-1990s with the aim of improving survival from Out-of-Hospital Cardiac Arrest (OHCA). The extent to which their implementation in the community differs among different areas has not been evaluated., Methods: We carried out a 5-year prospective national evaluation of PAD programs in 51 French districts (29.3 million inhabitants), through the cumulative density of Automated External Defibrillator (AEDs) and the proportion of persons educated in Basic Life Support (BLS)., Results: Major regional discrepancies were observed with AED density from 5 to 3399 per 100,000 inhabitants per 1000km 2 , and BLS-educated inhabitants varying from 6955 to 36,636 per 100,000 inhabitants. Only 18 districts (35.3%) achieved both AED density and educational rate above median (>13,988 and >22, respectively). Extrapolating the data from the French national registry on sports OHCA, mean survival rate was two-folds higher with AED density above the median (7.9% vs. 17.8%, P<0.001) and four-fold higher with BLS-education above the median (5.0% vs. 20.9%, P<0.001). In the group with both AED density and BLS-education level above the median, the survival rate reached up to 22.5%. Only the rate of population BLS education remained independently associated with survival (OR 1.64, 95% Confidence Interval 1.17-2.31; P=0.0045)., Conclusions: Major heterogeneities in PAD programs exist, with significant room for better coordination in implementation. Population education in BLS provides an important benefit, regardless of the density of AEDs deployed, which should be taken into account in planning public health policies for improving OHCA survival., (Copyright © 2017 Elsevier B.V. All rights reserved.)

Published
2017
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17. Are characteristics of hospitals associated with outcome after cardiac arrest? Insights from the Great Paris registry.

Author

Chocron R, Bougouin W, Beganton F, Juvin P, Loeb T, Adnet F, Lecarpentier E, Lamhaut L, Jost D, Marijon E, Cariou A, Jouven X, and Dumas F

Subjects
Age Factors, Aged, Female, Hospital Mortality, Humans, Intensive Care Units statistics & numerical data, Logistic Models, Male, Middle Aged, Out-of-Hospital Cardiac Arrest therapy, Paris epidemiology, Registries, Retrospective Studies, Statistics, Nonparametric, Survival Rate, Treatment Outcome, Cardiopulmonary Resuscitation statistics & numerical data, Emergency Medical Services statistics & numerical data, Hospitalization statistics & numerical data, Hospitals classification, Out-of-Hospital Cardiac Arrest mortality
Abstract

Purpose: As post-cardiac arrest care may influence patients' outcome, characteristics of receiving hospitals should be integrated in the evaluation of survival. We aimed at assessing the influence of care level center on patients' survival at hospital discharge using a regional registry of out-of-hospital cardiac arrest patients (OHCA)., Methods: We retrospectively analysed a Utstein and in-hospital data prospectively collected for all non-traumatic OHCA patients, in whom a successful return of spontaneous circulation (ROSC) had been obtained, from a large metropolitan area (Great Paris). Receiving hospitals were categorized in 3 groups as follows: A centers (High-case volume with cath-lab 24/7), B centers (Intermediate-case volume with cath-lab partly available) and C centers (Low-case volume and no cath-lab) We compared patients' characteristics and outcome in the 3 groups and performed a multivariate logistic regression using survival to discharge as primary endpoint., Results: Between May 2011 and December 2013, 1476 patients were admitted in 48 hospitals (group A: n=917; group B: n=428; group C: n=91). Overall survival rate at discharge was 433/1436 (30%). Patients' baseline characteristics significantly differed, as hospitals from group A received younger patients with a higher rate of shockable cardiac rhythms (p<0.001). Unadjusted survival rate differed significantly among the 3 groups of hospitals (respectively 34%, 25% and 15.4% for A-C, p<0.01). In multivariate analysis, the category of receiving hospital was no longer associated with survival, even in the subgroup of witnessed arrest and shockable patients., Conclusion: In this population-based study, characteristics of receiving hospitals are not associated with survival rate at discharge. This might be partially explained by the prehospital triage organization used in France., (Copyright © 2017. Published by Elsevier B.V.)

Published
2017
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18. Stent thrombosis after primary percutaneous coronary intervention in comatose survivors of out-of-hospital cardiac arrest: Are the new P2Y12 inhibitors really more effective than clopidogrel?

Author

Gouffran G, Rosencher J, Bougouin W, Jakamy R, Joffre J, Lamhaut L, Dumas F, Cariou A, and Varenne O

Subjects
Adenosine analogs & derivatives, Adenosine therapeutic use, Aspirin therapeutic use, Clopidogrel, Coma, Coronary Angiography, Drug Therapy, Combination, Female, Humans, Male, Middle Aged, Prasugrel Hydrochloride therapeutic use, Retrospective Studies, Risk Factors, Ticagrelor, Ticlopidine therapeutic use, Treatment Outcome, Coronary Thrombosis etiology, Coronary Thrombosis prevention & control, Out-of-Hospital Cardiac Arrest therapy, Percutaneous Coronary Intervention, Platelet Aggregation Inhibitors therapeutic use, Stents, Ticlopidine analogs & derivatives
Abstract

Aim: High rates of stent thrombosis (ST) have been reported in patients with out-of-hospital cardiac arrest (OHCA) who require a primary percutaneous coronary intervention (PCI). The aim of this study was to assess risk factors of ST in this population with a special focus on antiplatelet therapy administered during the acute phase., Materials and Methods: We conducted a retrospective observational study in patients treated with primary PCI after OHCA between 2011 and 2013 in our center. All consecutive patients were treated with mild therapeutic hypothermia and dual antiplatelet therapy after primary angioplasty., Results: A total of 101 consecutive patients were included in the present analysis. Mean age was 61.3 ± 12.7 years and 75% of patients had an initial ventricular fibrillation. All patients received aspirin before PCI. P2Y12 inhibitors were administered after PCI and included clopidogrel (47.5%), prasugrel (21.8%) or ticagrelor (29.7%). The survival rate at discharge was 44.5%. We identified 11 cases (10.9%) of definite or probable ST (clopidogrel (n=2), prasugrel (n=4) and ticagrelor (n=5)) occurring at a median of 2 days after PCI. No specific predictors were found to be significantly associated with ST. New P2Y12 inhibitors were associated with more ST compared to clopidogrel (17.3% vs. 4.2%; respectively, p=0.05). ST was associated with a decreased left ventricular ejection fraction (p=0.007) and with a trend toward a higher mortality compared to patients without ST (82% vs. 52%, p=0.06)., Conclusion: The incidence of ST in OHCA survivors is high and associated with poor clinical outcome. The use of new oral P2Y12 inhibitors does not appear to be associated with a reduction in ST compared to clopidogrel., (Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.)

Published
2016
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19. Outcomes of primary percutaneous coronary interventions in nonagenarians with acute myocardial infarction.

Author

Helft G, Georges JL, Mouranche X, Loyeau A, Spaulding C, Caussin C, Benamer H, Garot P, Livarek B, Teiger E, Varenne O, Monségu J, Mapouata M, Petroni T, Hammoudi N, Lambert Y, Dupas F, Laborne F, Lapostolle F, Lefort H, Juliard JM, Letarnec JY, Lamhaut L, Lebail G, Boche T, Jouven X, and Bataille S

Subjects
Age Factors, Aged, 80 and over, Female, Humans, Male, Middle Aged, Myocardial Infarction mortality, Registries, Treatment Outcome, Myocardial Infarction therapy, Percutaneous Coronary Intervention
Abstract

Background: Few data are available on primary percutaneous coronary intervention (pPCI) in nonagenarians. In a large prospective registry on pPCI for STEMI we compared the demographics, procedural and in-hospital outcomes between nonagenarians (age ≥ 90 years) and patients aged < 90 years., Methods and Results: We included 26,157 consecutive patients with pPCI in the Greater Paris Area region between 2003 and 2011. Of these, 418 (1.6%) were ≥ 90 years old. Nonagenarians (versus patients < 90 years) were more likely to be female (62.3% versus 22.5%, p < 0.0001), nonsmokers (81.6% versus 36.7%, p < 0.0001), in cardiogenic shock (Killip IV) upon admission (10.5% versus 4.8%, p < 0.001), and had significant co-morbidities. Over two-thirds of patients underwent procedures via the radial artery (61% versus 72.1%, p = 0.007). Both groups had high and similar angiographic success rates (98.1% versus 98.7%, p = 0.33). Drug-eluting stents were used less often in nonagenarians (4.4% versus 16.7%, p < 0.0001). Hospital mortality was significantly much higher in patients over 90 years old (24.9% versus 5.1%, p < 0.001) in univariate analysis. After adjustment for sex, cardiogenic shock, diabetes, triple vessel disease, drug-eluting stent use and glycoprotein IIb/IIIa inhibitors use, mortality remains higher in nonagenarian patients (OR: 4.31; 95% CI: 3.26-5.71, p < 0.0001)., Conclusions: In a real-world setting, we found important demographic differences in nonagenarian compared to younger patients. Despite achieving a high rate of reperfusion with pPCI using mainly radial access, similar to that achieved in younger patients, hospital mortality was higher in nonagenarians., (Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.)

Published
2015
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