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7. LB 02.3 Targeted Thromboprophylaxis in Patients with Lower Limb Trauma Requiring Immobilization : Stepped Wedge Randomized Trial

Author

Douillet, D., primary, Penaloza, A., additional, Viglino, D., additional, Banihachemi, J., additional, Abboodi, A., additional, Helderlé, M., additional, Montassier, E., additional, Balen, F., additional, Brice, C., additional, Laribi, S., additional, Duchenoy, T., additional, Vives, P., additional, Soulat, L., additional, Marjanovic, N., additional, Moumneh, T., additional, Savary, D., additional, Riou, J., additional, and Roy, P., additional

Published
2023
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8. Performances and limits of Bag-Valve-Device for pre-oxygenation and manual ventilation: A comparative bench and cadaver study

Author

Broc, A., primary, Morin, F., additional, Schmit, H., additional, Taillantou-Candau, M., additional, Vuillermoz, A., additional, Drouet, A., additional, Hutin, A., additional, Polard, L., additional, Lamhaut, L., additional, Brisset, U., additional, Charbonney, E., additional, Delisle, S., additional, Beloncle, F., additional, Richard, J.C., additional, and Savary, D., additional

Published
2023
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11. Emergency protocol for acute respiratory failure at the workplace or a remote site

Author

Descatha, A., Chanu, S., Jenkins, M., Savary, D, Lentz, T., Havette, P., Baer, M., 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 ), Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM), United Nations = Organisation des Nations unies (ONU), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), and La poste

Subjects
Respiratoire, Procedure, [SDV]Life Sciences [q-bio], Emergency, Respiratory, Professionnel, Urgence, Procédure, Occupational
Abstract

International audience; [No abstract available]

Published
2023

12. Protocole d'urgence en santé au travail ou milieu isolé. Généralités et mise à jour

Author

Descatha, A., Chanu, S., Jenkins, Jon, Savary, D, Lentz, T., Havette, P., Baer, M., 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 ), Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM), Hôpital Raymond Poincaré [Garches], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), and Le travail a bénéficié du soutien dans le cadre du projet TEC-TOP, de la région Pays-de-la-Loire, d’Angers Loire Métropole, de l’Université d’Angers et du CHU d’Angers.

Subjects
Procedure, [SDV]Life Sciences [q-bio], Emergency, Protocol, Protocole, Professionnel, Urgence, Procédure, Travail, Occupational work
Abstract

National audience; Le protocole d’urgence doit être adapté au contexte. Il doit être simple, court, exhaustif et facile à mémoriser. Il résume la conduite à tenir en cas d’urgence.Le protocole d’urgence est établi par le médecin du travail et validé par l’équipe notamment l’infirmier(ère) en santé au travail sous la responsabilité du médecin du travail. Il sera régulièrement actualisé en fonction de nouvelles connaissances et/ou de la situation locale.Deux types de protocoles sont à établir en fonction de la présence ou de l’absence de professionnel de Santé.Le protocole de gestion d’une urgence médicale en l’absence de professionnel de Santé est une procédure d’appel aux secouristes disponibles. L’objectif étant de déclencher les services d’urgence médicale en agissant de façon rationnelle.Le protocole d’urgences destiné au professionnel de Santé est basé sur le symptôme. Il permet de hiérarchiser l’urgence. Il se doit d’être ergonomique, adapté, traçable et (ré)évaluable.Cette mise au point est une mise à jour après la période COVID-19 à partir des généralités de l’ouvrage « Mémento et Protocoles » [1] et de l’article « six principes des protocoles de prise en charge des urgences en milieu de travail » [2]. L’objectif est de proposer un récapitulatif des principes permettant d’élaborer et d’appliquer un protocole pour l’équipe de santé au travail, en l’ouvrant à toute situation où le professionnel de santé en milieu isolé doit gérer les premières urgences avec peu de moyens. La principale différence entre le milieu de travail en France et un milieu isolé est le recours à la structure qui poursuivra la prise en charge, qui ne sera pas le SAMU mais une structure d’urgence et/ou d’évacuation.Après une brève introduction, nous rappellerons les bases du raisonnement de gestion des urgences en milieu de travail ou isolé, afin de poser les bases des protocoles dans ce cadre.

Published
2023

16. Traumatisme et température

Author

Lapostolle, F., Savary, D, Marqueurs cardiovasculaires en situation de stress (MASCOT (UMR_S_942 / U942)), Institut National de la Santé et de la Recherche Médicale (INSERM)-Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Centre National de la Recherche Scientifique (CNRS)-Université Paris Cité (UPCité)-Université Sorbonne Paris Nord, Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM), Institut de recherche en santé, environnement et travail (Irset), and 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 )

Subjects
Perfusion, Hemostasis, [SDV]Life Sciences [q-bio], Temperature, Hypothermia, Warming, Trauma
Abstract

National audience; Le patient traumatisé est exposé à l’hypothermie. La mortalité des traumatisés hypothermes est multipliée par quatre ou cinq. Les interactions de l’hypothermie avec l’hémostase et le système cardiovasculaire sont délétères. Les effets sur la coagulation sont multiples et concourent directement à la surmortalité faisant de l’hypothermie une composante majeure de la « triade létale ». Les causes d’hypothermie chez le patient traumatisé sont multiples : 1) environnementales, le risque augmente quand la température ambiante diminue ; 2) cliniques, le risque augmente avec la gravité ; et aussi 3) thérapeutiques, par exemple par la perfusion de solutés à température ambiante. Une prise en charge optimale repose sur une mesure précoce et un monitorage continu de la température corporelle. L’objectif thérapeutique est de maintenir une température corporelle au moins égale à 36 °C. Limiter le déshabillage du patient, le protéger du froid avec une couverture de survie, l’installer rapidement dans une ambulance chauffée, recourir à des dispositifs de réchauffement actifs, perfuser des solutés réchauffés sont les éléments fondamentaux de la prise en charge d’un patient traumatisé, potentiellement hypotherme.

Published
2022

20. Outpatient Management of Patients With COVID-19

Author

Douillet, Delphine, primary, Penaloza, Andrea, additional, Mahieu, Rafaël, additional, Morin, François, additional, Chauvin, Anthony, additional, Gennai, Stéphane, additional, Schotte, Thibault, additional, Montassier, Emmanuel, additional, Thiebaud, Pierre-Clément, additional, Ghuysen François, Alexandre, additional, Dall’acqua, David, additional, Benhammouda, Kasarra, additional, Bissokele, Pascal, additional, Violeau, Mathieu, additional, Joly, Luc-Marie, additional, Andrianjafy, Hery, additional, Soulie, Caroline, additional, Savary, Dominique, additional, Riou, Jérémie, additional, Roy, Pierre-Marie, additional, Andrianjafy, H., additional, Baudin, L., additional, Benhammouda, K., additional, Bissolokele, P., additional, Brice, C., additional, Cayeux, C., additional, Casalino, E., additional, Casarin, C., additional, Chauvin, A., additional, Choquet, C., additional, Claessens, Y.-E., additional, Couturaud, Francis, additional, Dall’acqua, D., additional, Dobanton, B., additional, Douillet, D., additional, Dupriez, F., additional, Eyer, X., additional, Ferrand, L., additional, Gennai, S., additional, Ghuysen, A., additional, Greau-Chauchet, A., additional, Joly, L.-M., additional, Karam, H.-H., additional, Layot, M., additional, Leroy, A., additional, Lopez, R., additional, Mahieu, R., additional, Marchant, N., additional, Marjanovic, N., additional, Montassier, E., additional, Morin, F., additional, Penaloza, Baeza A., additional, Plantefeve, G., additional, Roy, P.-M., additional, Savary, D., additional, Schmidt, J., additional, Schotte, T., additional, Sebbane, M., additional, Soulie, C., additional, Soulat, L., additional, Steiner, C., additional, Thiebaud, P.-C., additional, Timsit, E., additional, Trabattoni, E., additional, and Violeau, M., additional

Published
2021
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23. Interhospital transport of patients with COVID-19 under high-flow nasal cannula (HFNC)

Author

Morin, F., Dubie, E., Serruys, A., Usseglio, P., Richard, J.-C., Richard, Jean-Christophe, Douillet, D., Savary, D., Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM), Centre Hospitalier Métropole Savoie [Chambéry], Centre de Recherche en Acquisition et Traitement de l'Image pour la Santé (CREATIS), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-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)-Hospices Civils de Lyon (HCL)-Université Jean Monnet - Saint-Étienne (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Modeling & analysis for medical imaging and Diagnosis (MYRIAD), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Hospices Civils de Lyon (HCL)-Université Jean Monnet - Saint-Étienne (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université Claude Bernard Lyon 1 (UCBL), 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), 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 ), Chard-Hutchinson, Xavier, Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Université Jean Monnet - Saint-Étienne (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), and Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Université Jean Monnet - Saint-Étienne (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université Claude Bernard Lyon 1 (UCBL)

Subjects
Patient Transfer, 2019-20 coronavirus outbreak, Infectious Disease Transmission, Patient-to-Professional, Coronavirus disease 2019 (COVID-19), business.industry, [SDV]Life Sciences [q-bio], Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), COVID-19, General Medicine, medicine.disease_cause, Respiration, Artificial, Article, [SDV] Life Sciences [q-bio], Transportation of Patients, Anesthesia, Emergency Medicine, medicine, Cannula, Humans, High flow, business, Nasal cannula, ComputingMilieux_MISCELLANEOUS
Abstract

International audience; [No abstract available]

Published
2021

30. Venous Thromboembolic Risk in Patients with Lower Limb Trauma Requiring Immobilization: Towards an Individualized Approach

Author

Douillet, D., Barbere, T., Peintre, M., Moumneh, T., Morin, F., Savary, D., Penaloza, A., Roy, P-M, Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM), 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), Institut de recherche en santé, environnement et travail (Irset), 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 ), Université d'Angers (UA), Université Catholique de Louvain = Catholic University of Louvain (UCL), MitoVasc - Physiopathologie Cardiovasculaire et Mitochondriale (MITOVASC), and 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 )

Subjects
[SDV]Life Sciences [q-bio], Immobilisation, Thromboprophylaxis, Trauma, Risk stratification, Venous thromboembolism
Abstract

National audience; Lower limb trauma requiring immobilization is a situation at risk of developing venous thromboembolic (VTE) disease. However, recommendations and practices vary significantly from country to country and from center to center. The aims of this narrative review are to describe the epidemiology, prevention, and prediction algorithms for venous thromboembolic disease in patients with lower limb trauma requiring immobilization. The incidence of VTE varies between studies due to the great heterogeneity of the patients included (from ankle sprains to major injuries requiring surgery) and due to the heterogeneity of the evaluation criteria (consideration of asymptomatic proximal or distal or only symptomatic thrombosis). The estimated incidence of symptomatic venous thromboembolic events is 2.0% (95% confidence interval: 1.3 to 2.7). The efficacy of thromboprophylaxis has been confirmed in two meta-analyses that included randomized controlled trials. However, these results had to be carefully interpreted because many trials had methodological flaws. The largest and most recent study showed no benefit of low molecular weight heparin prevention on symptomatic events in an unselected population. These results suggest adopting a personalized strategy, keeping prophylaxis for at-risk patients. Several scores are currently being proposed to assess individual thromboembolic risk. Considering the characteristics of the patient, the trauma, and the immobilization, it is possible to identify a large subgroup of patients in whom prevention seems useless and a subgroup of high-risk patients in whom prevention should be prescribed or even reinforced. In conclusion, in the case of lower limb trauma requiring immobilization, the indication for thromboprophylaxis should be guided by the individual assessment of thrombotic risk.

Published
2021

37. Outpatient management or hospitalization of patients with proven or suspected SARS-CoV-2 infection: The HOME-CoV rule

Author

Douillet D., Mahieu R., Boiveau V., Vandamme Y.-M., Armand A., Morin F., Savary D., Dubée V., Annweiler C., and Roy P.-M.

Subjects
3. Good health
Abstract

In the context of the COVID-19 pandemic and overloaded hospitals, a central issue is the need to define reliable and consensual criteria for hospitalization or outpatient management in mild cases of COVID-19. Our aim was to define an easy-to-use clinical rule aiming to help emergency physicians in hospitalization or outpatient management decision-making for patients with suspected or confirmed SARS-CoV-2 infection (the HOME-CoV Rule). The Delphi method was used to reach a consensus of a large panel of 51 experts: emergency physicians, geriatricians, infectious disease specialists, and ethical consultants. A preliminary list of eligible criteria was compiled based on a literature review. Four rounds of anonymized expert consultations were performed. The experts were asked to score each item as relevant, possibly relevant and non-relevant, as major or minor, and to choose the cut-off. They were also able make suggestions and remarks. Eight criteria constituting the HOME-CoV were selected: six correspond to the severity of clinical signs, one to the clinical course (clinically significant worsening within the last 24 hours), and the last corresponds to the association of a severe comorbidity and an inadequate living context. Hospitalization is deemed necessary if a patient meets one or more of the criteria. In the end, 94.4% of the experts agreed with the defined rule. Thanks to the Delphi method, an absolute consensus was obtained of a large panel of experts on the HOME-CoV rule, a decision-making support mechanism for clinicians to target patients with suspected or confirmed COVID-19 requiring hospitalization.Trial registration: NCT04338841

Published
2020

47. Relationship Between Arterial Access and Outcomes in ST‐Elevation Myocardial Infarction With a Pharmacoinvasive Versus Primary Percutaneous Coronary Intervention Strategy: Insights From the STrategic Reperfusion Early After Myocardial Infarction (STREAM) Study

Author

Shavadia, Jay, Welsh, Robert, Gershlick, Anthony, Zheng, Yinggan, Huber, Kurt, Halvorsen, Sigrun, Steg, Phillipe G., Van de Werf, Frans, Armstrong, Paul W., Kaff, A., Malzer, R., Sebald, D., Glogar, D., Gyöngyösi, M., Weidinger, F., Weber, H., Gaul, G., Chmelizek, F., Seidl, S., Pichler, M., Pretsch, I., Vergion, M., Herssens, M., Van Haesendonck, C., Saraiva, J. F K, Sparenberg, A. L F, Souza, J. A., Moraes, J. B M, Sant'anna, F. M., Tarkieltaub, E., Hansen, J. R., Oliveira, E. M., Leonhard, O., Cantor, W., Senaratne, M., Aptecar, E., Asseman, P., Belle, L., Belliard, O., Berland, J., Berthier, A., Besnard, C., Bonneau, A., Bonnefoy, E., Brami, M., Canu, G., Capellier, G., Cattan, S., Champagnac, D., Chapon, P., Cheval, B., Claudel, J., Cohen Tenoudji, P., Coste, P., Debierre, V., Domergue, R., Echahed, K., El Khoury, C., Ferrari, E., Garrot, P., Henry, P., Jardel, B., Jilwan, R., Julie, V., Ketelers, R., Lapostolle, F., Le Tarnec, J., Livarek, B., Mann, Y., Marchand, X., Pajot, F., Perret, T., Petit, P., Probst, V., Ricard Hibon, A., Robin, C., Salama, A., Salengro, E., Savary, D., Schiele, F., Soulat, L., Tabone, X., Taboulet, P., Thicoïpe, M., Torres, J., Tron, C., Vanzetto, G., Villain-Coquet, L., Piper, S., Mochmann, H. C., Nibbe, L., Schniedermeier, U., Heuer, H., Marx, F., Schöls, W., Lepper, W., Grahl, R., Muth, G., Lappas, G., Mantas, I., Skoumbourdis, E., Dilanas, C., Kaprinis, I., Vogiatzis, I., Zarifis, I., Spyromitros, G., Konstantinides, S., Symeonides, D., Rossi, G. P., Bermano, F., Ferlito, S., Paolini, P., Valagussa, L., Della Rovere, F., Miccoli, F., Chiti, M., Vergoni, W., Comeglio, M., Percoco, G., Valgimigli, M., Berget, K., Skjetne, O., Schartum-Hansen, H., Andersen, K., Rolstad, O. J., Aguirre Zurita, O. N., Castillo León, R. P., Villar Quiroz, A. C., Glowka, A., Kulus, P., Kalinina, S., Bushuev, A., Barbarash, O., Tarasov, N., Fomin, I., Makarov, E., Markov, V., Danilenko, A., Volkova, E., Frolenkov, A., Burova, N., Yakovlev, A., Elchinskaya, L., Boldueva, S., Klein, G., Kolosova, I., Ovcharenko, E., Fairushin, R., Andjelic, S., Vukcevic, V., Neskovic, A., Krotin, M., Rajkovic, T., Pavlovic, M., Perunicic, J., Kovacevic, S., Petrovic, V., Mitov, V., Ruiz, A., García-Alcántara, A., Martínez, M., Díaz, J., Paz, M. A., Manzano, F. L., Martín, C., Macaya, C., Corral, E., Fernández, J. J., Martín, F., García, R., Siriwardena, N., Rawstorne, O., Baumbach, A., Manoharan, G., Menown, I., McHechan, S., and Morgan, D.

Subjects
Male, Epidemiology, medicine.medical_treatment, 030204 cardiovascular system & hematology, Coronary Angiography, 0302 clinical medicine, Recurrence, Odds Ratio, Thrombolytic Therapy, 030212 general & internal medicine, Myocardial infarction, Original Research, Primary percutaneous coronary intervention, Shock, Thrombolysis, Middle Aged, Clopidogrel, Femoral Artery, Tissue Plasminogen Activator, Radial Artery, Cardiology, Female, Cardiology and Cardiovascular Medicine, medicine.medical_specialty, Ticlopidine, Arterial access, Hemorrhage, 03 medical and health sciences, Percutaneous Coronary Intervention, Fibrinolytic Agents, Internal medicine, Catheterization, Peripheral, ST‐segment elevation myocardial infarction, Journal Article, medicine, Humans, Enoxaparin, Mortality, Aged, Heart Failure, Pharmacoinvasive strategy, Aspirin, business.industry, Percutaneous coronary intervention, Odds ratio, medicine.disease, ST-segment elevation myocardial infarction, Clinical trial, Blood pressure, Heart failure, Multivariate Analysis, Conventional PCI, Tenecteplase, ST Elevation Myocardial Infarction, business, Acute Coronary Syndromes, Platelet Aggregation Inhibitors
Abstract

Background The effectiveness of radial access ( RA ) in ST ‐elevation myocardial infarction ( STEMI ) has been predominantly established in primary percutaneous coronary intervention ( pPCI ) with limited exploration of this issue in the early postfibrinolytic patient. The purpose of this study was to compare the effectiveness and safety of RA versus femoral ( FA ) access in STEMI undergoing either a pharmacoinvasive ( PI ) strategy or pPCI . Methods and Results Within ST rategic Reperfusion Early After Myocardial Infarction ( STREAM ), we evaluated the relationship between arterial access site and primary outcome (30‐day composite of death, shock, congestive heart failure, or reinfarction) and major bleeding according to the treatment strategy received. A total of 1820 STEMI patients were included: 895 PI (49.2%; rescue PCI [n=379; 42.3%], scheduled PCI [n=516; 57.7%]) and 925 pPCI (50.8%). Irrespective of treatment strategy, there was comparable utilization of either access site ( FA : PI 53.4% and pPCI 57.6%). FA STEMI patients were younger, had lower presenting systolic blood pressure, lesser Thrombolysis In Myocardial Infarction risk, and more ∑ ST ‐elevation at baseline. The primary composite endpoint occurred in 8.9% RA versus 15.7% FA patients ( P RA persisted (adjusted odds ratio [ OR ], 0.59; 95% CI , 0.44–0.78; P pPCI (adjusted OR , 0.63; 95% CI , 0.43–0.92) and PI cohorts (adjusted OR , 0.57 95% CI , 0.37–0.86; P interaction=0.730). There was no difference in nonintracranial major bleeding with either access group ( RA vs FA , 5.2% vs 6.0%; P =0.489). Conclusions Regardless of the application of a PI or pPCI strategy, RA was associated with improved clinical outcomes, supporting current STEMI evidence in favor of RA in PCI . Clinical Trial Registration URL : https://www.clinicaltrials.gov/ . Unique identifier: NCT 00623623.

Published
2016

49. Relationship between arterial access and outcomes in ST-elevation myocardial infarction with a pharmacoinvasive versus primary percutaneous coronary intervention strategy: Insights from the STrategic reperfusion early after myocardial infarction (STREAM) study

Author

CMM Groep Coffer, Regenerative Medicine and Stem Cells, Infection & Immunity, Shavadia, Jay, Welsh, Robert, Gershlick, Anthony, Zheng, Yinggan, Huber, Kurt, Halvorsen, Sigrun, Steg, Phillipe G., Van de Werf, Frans, Armstrong, Paul W., Kaff, A., Malzer, R., Sebald, D., Glogar, D., Gyöngyösi, M., Weidinger, F., Weber, H., Gaul, G., Chmelizek, F., Seidl, S., Pichler, M., Pretsch, I., Vergion, M., Herssens, M., Van Haesendonck, C., Saraiva, J. F K, Sparenberg, A. L F, Souza, J. A., Moraes, J. B M, Sant'anna, F. M., Tarkieltaub, E., Hansen, J. R., Oliveira, E. M., Leonhard, O., Cantor, W., Senaratne, M., Aptecar, E., Asseman, P., Belle, L., Belliard, O., Berland, J., Berthier, A., Besnard, C., Bonneau, A., Bonnefoy, E., Brami, M., Canu, G., Capellier, G., Cattan, S., Champagnac, D., Chapon, P., Cheval, B., Claudel, J., Cohen Tenoudji, P., Coste, P., Debierre, V., Domergue, R., Echahed, K., El Khoury, C., Ferrari, E., Garrot, P., Henry, P., Jardel, B., Jilwan, R., Julie, V., Ketelers, R., Lapostolle, F., Le Tarnec, J., Livarek, B., Mann, Y., Marchand, X., Pajot, F., Perret, T., Petit, P., Probst, V., Ricard Hibon, A., Robin, C., Salama, A., Salengro, E., Savary, D., Schiele, F., Soulat, L., Tabone, X., Taboulet, P., Thicoïpe, M., Torres, J., Tron, C., Vanzetto, G., Villain-Coquet, L., Piper, S., Mochmann, H. C., Nibbe, L., Schniedermeier, U., Heuer, H., Marx, F., Schöls, W., Lepper, W., Grahl, R., Muth, G., Lappas, G., Mantas, I., Skoumbourdis, E., Dilanas, C., Kaprinis, I., Vogiatzis, I., Zarifis, I., Spyromitros, G., Konstantinides, S., Symeonides, D., Rossi, G. P., Bermano, F., Ferlito, S., Paolini, P., Valagussa, L., Della Rovere, F., Miccoli, F., Chiti, M., Vergoni, W., Comeglio, M., Percoco, G., Valgimigli, M., Berget, K., Skjetne, O., Schartum-Hansen, H., Andersen, K., Rolstad, O. J., Aguirre Zurita, O. N., Castillo León, R. P., Villar Quiroz, A. C., Glowka, A., Kulus, P., Kalinina, S., Bushuev, A., Barbarash, O., Tarasov, N., Fomin, I., Makarov, E., Markov, V., Danilenko, A., Volkova, E., Frolenkov, A., Burova, N., Yakovlev, A., Elchinskaya, L., Boldueva, S., Klein, G., Kolosova, I., Ovcharenko, E., Fairushin, R., Andjelic, S., Vukcevic, V., Neskovic, A., Krotin, M., Rajkovic, T., Pavlovic, M., Perunicic, J., Kovacevic, S., Petrovic, V., Mitov, V., Ruiz, A., García-Alcántara, A., Martínez, M., Díaz, J., Paz, M. A., Manzano, F. L., Martín, C., Macaya, C., Corral, E., Fernández, J. 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Published
2016

50. Use of troponin assay after electrical injuries: a 15-year multicentre retrospective cohort in emergency departments

Author

Douillet Delphine, Kalwant Stéphanie, Amro Yara, Gicquel Benjamin, Arnaudet Idriss, Savary Dominique, Le Bastard Quentin, and Javaudin François

Subjects
Electric injuries, Troponin, MACE, Emergency Department, Cardiac arrhythmias, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract

Abstract Background Patients with electrical injury are considered to be at risk of cardiac arrhythmia. Assessing the risk of developing a major adverse cardiac event (MACE) is the cornerstone of patient management. The aim of this study was to assess the performance of initial troponin and troponin rise to predict Major Adverse Cardiac Events (MACEs) in all patients with electrical injuries admitted to the Emergency Department. Methods This is a multicentre retrospective study in which consecutive patients with electrical injuries admitted to the Emergency Departments (ED) (adult and paediatric) of five French Hospitals were included between 2005 and 2019. The threshold for troponin elevation is based on the European Society of Cardiology guidelines for patients presenting without persistent ST segment elevation. The primary endpoint was the rate of MACE. Results A total of 785 included patients were admitted to ED with a first diagnosis of electrical injury during the study period. Troponin assays were performed in 533 patients (67.9%), including 465 of 663 adults (70.1%) and 68 of 122 children (55.7%) and 17/533 (3.2%) of patients had an initial elevated troponin. If none of the clinical criteria for MACE were present (i.e., previous known heart disease, exposure to a high voltage of ≥ 1000 Volts, initial loss of consciousness, or an abnormal initial ECG), this defined a low-risk subgroup (n = 573, 76.0%) that could be safely discharged. The initial positive troponin assay had a sensitivity of 83.3 (95% CI 35.9–99.6%), a specificity of 97.7 (95% CI 96.1–98.8%), a positive likelihood ratio 36.6 (95% CI 18.8–71.1%) and a negative predictive value of 99.9 (95% CI 99.2–99.9%) in predicting a MACE. Conclusions Troponin assay appears to be a predictive marker of MACE risk and should be considered in high-risk patients.

Published
2021
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