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Adami EA, Poillucci G, Di Saverio S, Khan M, Fransvea P, Podda M, Rampini A, Marini P. A critical appraisal of emergency resuscitative thoracotomy in a Western European level 1 trauma centre: a 13-year experience. Updates Surg 2024; 76:677-686. [PMID: 37839047 DOI: 10.1007/s13304-023-01667-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 09/29/2023] [Indexed: 10/17/2023]
Abstract
Emergency Resuscitative Thoracotomy (ERT) is a lifesaving procedure in selected patients. Outcome mostly in blunt trauma is believed to be poor. The primary aim of this study was to determine the predictors of postoperative mortality following ERT. We retrospectively reviewed 34 patients ≥ 18 years who underwent ERT at San Camillo-Forlanini Hospital (Rome, Italy) between January 2009 and December 2022 with traumatic arrest for blunt or penetrating injuries. Of 34 ERT, 28 (82.4%) were for blunt trauma and 6 (17.6%) were for penetrating trauma. Injury Severity Score (p-value 0.014), positive E-FAST (p-value 0.023), Systolic Blood Pressure (p-value 0.001), lactate arterial blood (p-value 0.012), pH arterial blood (p-value 0.007), and bicarbonate arterial blood (p-value < 0.001) were significantly associated with postoperative mortality in a univariate model. After adjustment, the only independent predictor of postoperative mortality was Injury Severity Score (p-value 0.048). Our experience suggests that ERT is a technique that should be utilized for patients with critical penetrating injuries and blunt trauma in patients in extremis. Our study highlights as negative prognostic factors high values of ISS and lactate arterial blood, a positive E-FAST, and low values of Systolic Blood Pressure, pH arterial blood and bicarbonate arterial blood.
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Affiliation(s)
- Ennio Alberto Adami
- General and Emergency Surgery, St. Camillo Forlanini's Hospital, Rome, Italy
| | - Gaetano Poillucci
- Division of General, Minimally Invasive and Robotic Surgery, Department of Surgery, San Matteo Hospital, Spoleto, Italy.
| | - Salomone Di Saverio
- Department of General Surgery, San Benedetto del Tronto General Hospital, San Benedetto del Tronto, Italy
| | - Mansoor Khan
- University Hospitals Sussex NHSFT, Eastern Rd, Brighton, UK
| | - Pietro Fransvea
- Emergency Surgery and Trauma, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Mauro Podda
- Department of Surgical Science, Policlinico Universitario "Duilio Casula", University of Cagliari, Cagliari, Italy
| | - Alessia Rampini
- General and Emergency Surgery, St. Camillo Forlanini's Hospital, Rome, Italy
| | - Pierluigi Marini
- General and Emergency Surgery, St. Camillo Forlanini's Hospital, Rome, Italy
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2
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Haruta K, Endo A, Shiraishi A, Otomo Y. Usefulness of resuscitative endovascular balloon occlusion of the aorta compared to aortic cross-clamping in severely injured trauma patients: Analysis from the Japan Trauma Data Bank. Acute Med Surg 2023; 10:e830. [PMID: 36936741 PMCID: PMC10014424 DOI: 10.1002/ams2.830] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 02/12/2023] [Indexed: 03/16/2023] Open
Abstract
Aim To compare in-hospital mortality of severely injured trauma patients who underwent resuscitative endovascular balloon occlusion of the aorta (REBOA) or aortic cross-clamping (ACC). Methods In this multicenter, retrospective cohort study using data from a nationwide trauma registry of tertiary emergency medical centers in Japan (n = 280), trauma patients who underwent aortic occlusion at the emergency department from 2004 to 2019 were divided into two groups according to the treatment they received: patients treated with ACC and patients who underwent placement of a REBOA catheter. Multiple imputations were used to handle the missing data. In-hospital mortality of the patients who underwent REBOA or ACC was compared using a mixed-effect logistic regression analysis and a propensity score-matching analysis, in which the confounders, including baseline patient demographics and severity, were adjusted. Results Of 1,670 patients (1,137 with REBOA and 533 with ACC), 66% were male. The median age was 56 years, and the mortality rate was 55.2% in the REBOA group and 81.6% in the ACC group. The mixed-effect model regression analysis showed a significantly lower odds ratio for in-hospital mortality rate in the REBOA group (odds ratio 0.17; 95% confidence interval, 0.12-0.26). A similar odds ratio was observed in the propensity score matching analysis (odds ratio 0.27; 95% confidence interval, 0.18-0.40). Conclusion Compared with ACC, REBOA use was associated with decreased mortality in severely injured trauma patients.
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Affiliation(s)
- Koichi Haruta
- Graduate School of MedicineTokyo Medical and Dental University HospitalTokyoJapan
- Department of Emergency Medicine, Shizuoka Prefectural Hospital OrganizationShizuoka General HospitalShizuokaJapan
| | - Akira Endo
- Department of Acute Critical Care and Disaster MedicineTokyo Medical and Dental University HospitalTokyoJapan
- Department of Acute Critical Care MedicineTsuchiura Kyodo General HospitalIbarakiJapan
| | - Atsushi Shiraishi
- Department of Acute Critical Care and Disaster MedicineTokyo Medical and Dental University HospitalTokyoJapan
- Emergency and Trauma CenterKameda Medical CenterChibaJapan
| | - Yasuhiro Otomo
- Department of Acute Critical Care and Disaster MedicineTokyo Medical and Dental University HospitalTokyoJapan
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3
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Sam ASY, Nawijn F, Benders KEM, Houwert RM, Leenen LPH, Hietbrink F. Outcomes of the resuscitative and emergency thoracotomy at a Dutch level-one trauma center: are there predictive factors for survival? Eur J Trauma Emerg Surg 2022; 48:4877-4887. [PMID: 35713680 DOI: 10.1007/s00068-022-02021-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 05/23/2022] [Indexed: 11/24/2022]
Abstract
PURPOSE To investigate the 30-day survival rate of resuscitative and emergency thoracotomies in trauma patients. Moreover, factors that positively influence 30-day survival rates were investigated. METHODS A retrospective study of patients (> 16 years), between 2008 and 2020, who underwent a resuscitative or emergency thoracotomy at a level-one trauma center in the Netherlands was conducted. RESULTS Fifty-six patients underwent a resuscitative (n = 45, 80%) or emergency (n = 11, 20%) thoracotomy. The overall 30-day survival rate was 32% (n = 18), which was 23% after blunt trauma and 72% after penetrating trauma, and which was 18% for the resuscitative thoracotomy and 91% for the emergency thoracotomy. The patients who survived had full neurologic recovery. Factors associated with survival were penetrating trauma (p < 0.001), (any) sign of life (SOL) upon presentation to the hospital (p = 0.005), Glasgow Coma Scale (GCS) of 15 (p < 0.001) and a thoracotomy in the operating room (OR) (p = 0.018). Every resuscitative thoracotomy after blunt trauma and pulseless electrical activity (PEA) or asystole in the pre-hospital phase was futile (0 survivors out of 11 patients), of those patients seven (64%) had concomitant severe neuro-trauma. CONCLUSION This study found a 30-day survival rate of 32% for resuscitative and emergency thoracotomies, all with good neurological recovery. Factors associated with survival were related to the trauma mechanism, the thoracotomy indication and response to resuscitation prior to thoracotomy (for instance, if resuscitation enables enough time for safe transport to the operating room, survival chances increase). Resuscitative thoracotomies after blunt trauma in combination with loss of SOL before arrival at the emergency room were in all cases futile, interestingly in nearly all cases due to concomitant neuro-trauma.
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Affiliation(s)
- A S Y Sam
- Department of Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - F Nawijn
- Department of Surgery, University Medical Center Utrecht, Utrecht, the Netherlands.
| | - K E M Benders
- Department of Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - R M Houwert
- Department of Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - L P H Leenen
- Department of Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - F Hietbrink
- Department of Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
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4
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de Malleray H, Cardinale M, Avaro JP, Meaudre E, Monchal T, Bourgouin S, Vasse M, Balandraud P, de Lesquen H. Emergency department thoracotomy in a physician-staffed trauma system: the experience of a French Military level-1 trauma center. Eur J Trauma Emerg Surg 2022; 48:4631-4638. [PMID: 35633378 DOI: 10.1007/s00068-022-01995-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 05/01/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE To investigate survival after emergency department thoracotomy (EDT) in a physician-staffed emergency medicine system. METHODS This single-center retrospective study included all in extremis trauma patients who underwent EDT between 2013 and 2021 in a military level 1 trauma center. CPR time exceeding 15 minutes for penetrating trauma of 10 minutes for blunt trauma, and identified head injury were the exclusion criteria. RESULTS Thirty patients (73% male, 22/30) with a median age of 42 y/o [27-64], who presented mostly with polytrauma (60%, 18/30), blunt trauma (60%, 18/30), and severe chest trauma with a median AIS of 4 3-5 underwent EDT. Mean prehospital time was 58 min (4-73). On admission, the mean ISS was 41 29-50, and 53% (16/30) of patients had lost all signs of life (SOL) before EDT. On initial work-up, Hb was 9.6 g/dL [7.0-11.1], INR was 2.5 [1.7-3.2], pH was 7.0 [6.8-7.1], and lactate level was 11.1 [7.0-13.1] mmol/L. Survival rates at 24 h and 90 days after penetrating versus blunt trauma were 58 and 41% versus 16 and 6%, respectively. If SOL were present initially, these values were 100 and 80% versus 22 and 11%. CONCLUSION Among in extremis patients supported in a physician-staffed emergency medicine system, implementation of a trauma protocol with EDT resulted in overall survival rates of 33% at 24 h and 20% at 90 days. Best survival was observed for penetrating trauma or in the presence of SOL on admission.
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Affiliation(s)
| | | | - Jean-Philippe Avaro
- Department of Thoracic and Vascular Surgery, Sainte Anne Military Teaching Hospital, Toulon, France
| | - Eric Meaudre
- ICU, Sainte Anne Military Teaching Hospital, Toulon, France
| | - Tristan Monchal
- Department of Visceral Surgery, Sainte Anne Military Teaching Hospital, Toulon, France
| | - Stéphane Bourgouin
- Department of Visceral Surgery, Sainte Anne Military Teaching Hospital, Toulon, France
| | - Mathieu Vasse
- Department of Thoracic and Vascular Surgery, Sainte Anne Military Teaching Hospital, Toulon, France
| | - Paul Balandraud
- Department of Visceral Surgery, Sainte Anne Military Teaching Hospital, Toulon, France
| | - Henri de Lesquen
- Department of Thoracic and Vascular Surgery, Sainte Anne Military Teaching Hospital, Toulon, France.
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5
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Tanikawa A, Sato T, Fujita M, Tsuchiya C, Katsuta K, Suzuki Y, Kumagai K, Saiki Y, Kushimoto S. Thoracic endovascular aortic repair for avulsion of aortic branches in a trauma patient requiring resuscitative thoracotomy: a case report. Surg Case Rep 2022; 8:71. [PMID: 35438386 PMCID: PMC9018930 DOI: 10.1186/s40792-022-01427-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 04/09/2022] [Indexed: 11/26/2022] Open
Abstract
Background Resuscitative thoracotomy is a lifesaving procedure for trauma patients that are hemodynamically unstable. Cross-clamping of the descending thoracic aorta is an essential procedure performed during resuscitative thoracotomy in patients with impending cardiac arrest. Although complications related to resuscitative thoracotomy have been reported, there is no report on avulsion of aortic branches related to cross-clamping of the descending aorta and its appropriate management. Case presentation We present the case of a 42-year-old woman who sustained blunt trauma due to an accidental fall. The patient was hemodynamically unstable and required resuscitative thoracotomy with cross-clamping of the thoracic aorta. However, hemorrhage from avulsion of aortic branches related to aortic cross-clamping was identified. Initially, transcatheter arterial embolization was attempted to achieve hemostasis; however, when that proved ineffective, thoracic endovascular aortic repair was performed, which resulted in successful hemorrhage control without any sequelae. Conclusions Thoracic endovascular aortic repair may be a management option for aortic branch avulsion due to cross-clamping of the descending aorta during resuscitative thoracotomy.
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Edwards J, Abdou H, Patel N, Lang E, Richmond MJ, Rasmussen TE, Scalea TM, Morrison JJ. Open chest selective aortic arch perfusion vs open cardiac massage as a means of perfusion during in exsanguination cardiac arrest: a comparison of coronary hemodynamics in swine. Eur J Trauma Emerg Surg 2022; 48:2089-2096. [PMID: 34984495 DOI: 10.1007/s00068-021-01810-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 10/25/2021] [Indexed: 11/29/2022]
Abstract
AIM To describe and compare the aortic-right atrial pressure (AoP-RAP) gradients and mean coronary perfusion pressures (CPPs) generated during open chest selective aortic arch perfusion (OCSAAP) with those generated during open cardiac massage (OCM) in hypovolemic swine. METHODS Ten male Hanford swine utilized in a prior poly-trauma study were included in the study. Animals were rendered hypovolemic via a 30% volume bleed. Upon confirmation of death, animals underwent immediate clamshell thoracotomy and aortic cross-clamping followed by 5 min of OCM. A catheter suitable for OCSAAP was then inserted into the aorta and animals underwent 1 min of OCSAAP at a rate of 10 mL/kg/min. Aortic and right atrial pressures were recorded continuously using solid-state blood pressure catheters. Representative 10-s intervals from each resuscitation method were extracted. Hemodynamic parameters including AoP-RAP gradients and CPPs were calculated and compared. RESULTS At baseline, time from death to intervention was significantly shorter for OCM. However, mean CPPs and AoP-RAP gradients were significantly higher in animals undergoing OCSAAP. 98% of OCSAAP segments had a mean CPP > 15, compared to 35% of OCM intervals. While OCM had a significant negative correlation between time to intervention and maximum CPP, this correlation was not significant for OCSAAP. CONCLUSION OCSAAP generates favorable and potentially time-resistant pressure gradients when compared to those generated by OCM. Further investigation of the technique of OCSAAP is warranted, as it may have potential utility as a therapy during resuscitative thoracotomy (RT).
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Affiliation(s)
- Joseph Edwards
- Adams Cowley Shock Trauma Center, University of Maryland Medical System, 22 S. Greene Street, Baltimore, MD, 21201, USA
| | - Hossam Abdou
- Adams Cowley Shock Trauma Center, University of Maryland Medical System, 22 S. Greene Street, Baltimore, MD, 21201, USA
| | - Neerav Patel
- Adams Cowley Shock Trauma Center, University of Maryland Medical System, 22 S. Greene Street, Baltimore, MD, 21201, USA
| | - Eric Lang
- Adams Cowley Shock Trauma Center, University of Maryland Medical System, 22 S. Greene Street, Baltimore, MD, 21201, USA
| | - Michael J Richmond
- Adams Cowley Shock Trauma Center, University of Maryland Medical System, 22 S. Greene Street, Baltimore, MD, 21201, USA
| | - Todd E Rasmussen
- Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Thomas M Scalea
- Adams Cowley Shock Trauma Center, University of Maryland Medical System, 22 S. Greene Street, Baltimore, MD, 21201, USA
| | - Jonathan J Morrison
- Adams Cowley Shock Trauma Center, University of Maryland Medical System, 22 S. Greene Street, Baltimore, MD, 21201, USA.
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7
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Douglas A, Puzio T, Murphy P, Menard L, Meagher AD. Damage Control Thoracotomy: A Systematic Review of Techniques and Outcomes. Injury 2021; 52:1123-1127. [PMID: 33386155 DOI: 10.1016/j.injury.2020.12.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 12/19/2020] [Accepted: 12/20/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Damage control surgery is the practice of delaying definitive management of traumatic injuries by controlling hemorrhage in the operating room and restoring normal physiology in the intensive care unit prior to definitive therapy. Presently, damage control or "abbreviated" laparotomy is used extensively for abdominal trauma in an unstable patient. The application of a damage control approach in thoracic trauma is less established and there is a paucity of literature supporting or refuting this practice. We aimed to systematically review the current data on damage control thoracotomy (DCT), to identify gaps in the literature and techniques in temporary closure. METHODS An electronic literature search of Pubmed, MEDLINE, and the Cochrane Database of Collected Reviews from 1972-2018 was performed using the keywords "thoracic," "damage control," and "thoracotomy." Studies were included if they reported the use of DCT following thoracic trauma and included survival as an outcome. RESULTS Of 723 studies, seven met inclusion criteria for a total of a 130 DCT operations. Gauze packing with temporary closure of the skin with suture was the most frequently reported form of closure. The overall survival rate for the seven studies was 67%. Survival rates ranged from 42-77%. Average injury severity score was 30, and 64% of injuries were penetrating in nature. The most common complications included infections (57%; pneumonia, empyema, wound infection, bacteremia), respiratory failure (21%), ARDS (8%), and renal failure (18%). CONCLUSION DCT may be associated with improved survival in the critically injured patient population. Delaying definitive operation by temporarily closing the thorax in order to allow time to restore normal physiology may be considered as a strategy in the unstable thoracic trauma patient population. The impact an open chest has on respiratory physiology remains inconclusive as well as best mechanisms of temporary closure. Multi-center studies are required to elucidate these important questions.
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Affiliation(s)
- Anthony Douglas
- Indiana University School of Medicine, 340 W. 10(th) St. Fairbanks Hall Suite 6200. Indianapolis, IN, 46202 USA.
| | - Thaddeus Puzio
- Department of Surgery, University of Texas Health Science Center at Houston, 7000 Fannin St. Houston, TX, 77030, USA.
| | - Patrick Murphy
- Department of Surgery, Department of Surgery, Medical College of Wisconsin, 8701 W. Watertown Plank Rd. Wauwatosa, WI, 53226, USA.
| | - Laura Menard
- Indiana University School of Medicine, 340 W. 10(th) St. Fairbanks Hall Suite 6200. Indianapolis, IN, 46202 USA.
| | - Ashley D Meagher
- Department of Surgery, Indiana University School of Medicine, 340 W. 10(th) St. Fairbanks Hall Suite 6200. Indianapolis, IN, 46202, USA.
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8
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Dahmen J, Brade M, Gerach C, Glombitza M, Schmitz J, Zeitter S, Steinhausen E. [Successful prehospital emergency thoracotomy after blunt thoracic trauma : Case report and lessons learned]. Unfallchirurg 2019; 121:839-849. [PMID: 29872865 DOI: 10.1007/s00113-018-0516-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND The European Resuscitation Council guidelines for resuscitation in patients with traumatic cardiac arrest recommend the immediate treatment of all reversible causes, if necessary even prior to continuous chest compression. In the case of cardiac tamponade immediate emergency thoracotomy should also be considered. OBJECTIVE The authors report the case of a 23-year-old male patient with multiple injuries including blunt thoracic trauma, which caused a witnessed cardiac arrest. He successfully underwent prehospital emergency resuscitative thoracotomy. The lessons learned from this case on internal and external quality measures are discussed in detail. RESULTS After 60 min of technical rescue, extensive trauma life support including intubation, chest decompression and bleeding control was carried out. The cardiovascular insufficiency progressively deteriorated and under the suspicion of a cardiac tamponade a prehospital emergency thoracotomy was carried out. After successful resuscitative thoracotomy and return of spontaneous circulation (ROSC) the patient was airlifted to the next level 1 trauma center for damage control surgery (DCS). The patient could be discharged 59 days after the accident and now 2 years later is living a normal life without neurological or cardiopulmonary limitations. Airway management, chest decompression including resuscitative thoracotomy, fluid resuscitation and blood products were the key components to ensure that the patient achieved ROSC. Advanced Trauma Life Support® as well as structural prerequisites made these measures and good results for the patient possible.
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Affiliation(s)
- Janosch Dahmen
- BG Klinikum Duisburg, Großenbaumer Allee 250, 47249, Duisburg, Deutschland. .,Luftrettungszentrum CHRISTOPH 9, Großenbaumer Allee 250, 47249, Duisburg, Deutschland. .,Fakultät für Gesundheit, Universität Witten/Herdecke, Alfred-Herrhausen-Straße 50, 58455, Witten, Deutschland.
| | - Marko Brade
- BG Klinikum Duisburg, Großenbaumer Allee 250, 47249, Duisburg, Deutschland.,Luftrettungszentrum CHRISTOPH 9, Großenbaumer Allee 250, 47249, Duisburg, Deutschland
| | - Christian Gerach
- BG Klinikum Duisburg, Großenbaumer Allee 250, 47249, Duisburg, Deutschland
| | - Martin Glombitza
- BG Klinikum Duisburg, Großenbaumer Allee 250, 47249, Duisburg, Deutschland
| | - Jan Schmitz
- BG Klinikum Duisburg, Großenbaumer Allee 250, 47249, Duisburg, Deutschland
| | - Simon Zeitter
- BG Klinikum Duisburg, Großenbaumer Allee 250, 47249, Duisburg, Deutschland
| | - Eva Steinhausen
- BG Klinikum Duisburg, Großenbaumer Allee 250, 47249, Duisburg, Deutschland.,Fakultät für Gesundheit, Universität Witten/Herdecke, Alfred-Herrhausen-Straße 50, 58455, Witten, Deutschland
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9
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Peru N, Malgras B, Pocard M. Left anterolateral thoracotomy with cross-clamping of the descending thoracic aorta and open cardiac massage to control massive intra-abdominal bleeding. J Visc Surg 2018; 155:407-411. [PMID: 30146448 DOI: 10.1016/j.jviscsurg.2018.07.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- N Peru
- Service de chirurgie digestive et oncologique, hôpital Lariboisière, AP-HP, 2, rue Ambroise-Paré, 75010 Paris, France
| | - B Malgras
- Service de chirurgie digestive et oncologique, hôpital Lariboisière, AP-HP, 2, rue Ambroise-Paré, 75010 Paris, France; Service de chirurgie digestive et endocrinienne, hôpital d'instruction des armées Begin, 69, avenue de Paris, 94160 Saint-Mandé, France.
| | - M Pocard
- Service de chirurgie digestive et oncologique, hôpital Lariboisière, AP-HP, 2, rue Ambroise-Paré, 75010 Paris, France
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