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Hong Tuan Ha V, Jost D, Bougouin W, Joly G, Jouffroy R, Jabre P, Beganton F, Derkenne C, Lemoine S, Frédéric L, Lamhaut L, Loeb T, Revaux F, Dumas F, Trichereau J, Stibbe O, Deye N, Marijon E, Cariou A, Jouven X, Travers S. Trends in survival from out-of-hospital cardiac arrest with a shockable rhythm and its association with bystander resuscitation: a retrospective study. Emerg Med J 2023; 40:761-767. [PMID: 37640438 DOI: 10.1136/emermed-2023-213220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 08/18/2023] [Indexed: 08/31/2023]
Abstract
OBJECTIVE Over 300 000 cases of out-of-hospital cardiac arrests (OHCAs) occur each year in the USA and Europe. Despite decades of investment and research, survival remains disappointingly low. We report the trends in survival after a ventricular fibrillation/pulseless ventricular tachycardia OHCA, over a 13-year period, in a French urban region, and describe the simultaneous evolution of the rescue system. METHODS We investigated four 18-month periods between 2005 and 2018. The first period was considered baseline and included patients from the randomised controlled trial 'DEFI 2005'. The three following periods were based on the Paris Sudden Death Expertise Center Registry (France). Inclusion criteria were non-traumatic cardiac arrests treated with at least one external electric shock with an automated external defibrillator from the basic life support team and resuscitated by a physician-staffed ALS team. Primary outcome was survival at hospital discharge with a good neurological outcome. RESULTS Of 21 781 patients under consideration, 3476 (16%) met the inclusion criteria. Over all study periods, survival at hospital discharge increased from 12% in 2005 to 25% in 2018 (p<0.001), and return of spontaneous circulation at hospital admission increased from 43% to 58% (p=0.004).Lay-rescuer cardiopulmonary resuscitation (CPR) and telephone CPR (T-CPR) rates increased significantly, but public defibrillator use remained limited. CONCLUSION In a two-tiered rescue system, survival from OHCA at hospital discharge doubled over a 13-year study period. Concomitantly, the system implemented an OHCA patient registry and increased T-CPR frequency, despite a consistently low rate of public defibrillator use.
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Affiliation(s)
- Vivien Hong Tuan Ha
- Prehospital Emergency Medicine Department, Paris Fire Brigade, Paris, France
| | - Daniel Jost
- Prehospital Emergency Medicine Department, Paris Fire Brigade, Paris, France
- Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research Center (PARCC), Paris, France
| | - Wulfran Bougouin
- Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research Center (PARCC), Paris, France
- Paris Descartes-Sorbonne Cité University, Paris, France
| | - Guillaume Joly
- Prehospital Emergency Medicine Department, Paris Fire Brigade, Paris, France
| | - Romain Jouffroy
- Prehospital Emergency Medicine Department, Paris Fire Brigade, Paris, France
- Service de médecine intensive et réanimation, Hôpital Universitaire Ambroise Paré, Assistance Publique-Hopitaux de Paris, Paris, France
| | - Patricia Jabre
- Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research Center (PARCC), Paris, France
- SAMU de Paris, Necker Hospital, Paris, France
| | - Frankie Beganton
- Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research Center (PARCC), Paris, France
| | - Clément Derkenne
- Prehospital Emergency Medicine Department, Paris Fire Brigade, Paris, France
| | - Sabine Lemoine
- Prehospital Emergency Medicine Department, Paris Fire Brigade, Paris, France
| | - Lemoine Frédéric
- Prehospital Emergency Medicine Department, Paris Fire Brigade, Paris, France
| | - Lionel Lamhaut
- Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research Center (PARCC), Paris, France
- SAMU de Paris, Necker Hospital, Paris, France
| | - Thomas Loeb
- SAMU 92 - Prehospital Emergency Department, Hôpital Raymond-Poincare, Garches, France
| | - François Revaux
- SAMU 94, Assistance Publique-Hopitaux de Paris, Créteil, France
| | - Florence Dumas
- Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research Center (PARCC), Paris, France
- Paris Descartes-Sorbonne Cité University, Paris, France
| | - Julie Trichereau
- Prehospital Emergency Medicine Department, Paris Fire Brigade, Paris, France
| | - Olivier Stibbe
- Prehospital Emergency Medicine Department, Paris Fire Brigade, Paris, France
| | - Nicolas Deye
- Intensive Care Unit, Lariboisière Hospital, Paris, France
- Inserm U942, Sorbonne Paris Nord University, Paris, France
| | - Eloi Marijon
- Paris Descartes-Sorbonne Cité University, Paris, France
| | - Alain Cariou
- Paris Descartes-Sorbonne Cité University, Paris, France
| | - Xavier Jouven
- Paris Descartes-Sorbonne Cité University, Paris, France
| | - Stephane Travers
- Prehospital Emergency Medicine Department, Paris Fire Brigade, Paris, France
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Jost D, Derkenne C, Daniel Y, Lemoine S, Lemoine F, Pierre Corcostegui S, Franchin M, Stibbe O, Travers S. L-01 Evolution de la politique transfusionnelle à la Brigade de sapeurs-pompiers de Paris. Transfus Clin Biol 2022. [DOI: 10.1016/j.tracli.2022.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Jost D, Lemoine S, Lemoine F, Derkenne C, Beaume S, Lanoë V, Maurin O, Louis-Delaurière E, Delacote M, Dang-Minh P, Franchin-Frattini M, Bihannic R, Savary D, Levrat A, Baudouin C, Trichereau J, Salomé M, Frattini B, Ha VHT, Jouffroy R, Seguineau E, Titreville R, Roquet F, Stibbe O, Vivien B, Verret C, Bignand M, Travers S, Martinaud C, Arock M, Raux M, Prunet B, Ausset S, Sailliol A, Tourtier JP. Prehospital Lyophilized Plasma Transfusion for Trauma-Induced Coagulopathy in Patients at Risk for Hemorrhagic Shock: A Randomized Clinical Trial. JAMA Netw Open 2022; 5:e2223619. [PMID: 35881397 PMCID: PMC9327575 DOI: 10.1001/jamanetworkopen.2022.23619] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
IMPORTANCE Blood transfusion is a mainstay of therapy for trauma-induced coagulopathy, but the optimal modalities for plasma transfusion in the prehospital setting remain to be defined. OBJECTIVE To determine whether lyophilized plasma transfusion can reduce the incidence of trauma-induced coagulopathy compared with standard care consisting of normal saline infusion. DESIGN, SETTING, AND PARTICIPANTS This randomized clinical trial was performed at multiple centers in France involving prehospital medical teams. Participants included 150 adults with trauma who were at risk for hemorrhagic shock and associated coagulopathy between April 1, 2016, and September 30, 2019, with a 28-day follow-up. Data were analyzed from November 1, 2019, to July 1, 2020. INTERVENTION Patients were randomized in a 1:1 ratio to receive either plasma or standard care with normal saline infusion (control). MAIN OUTCOMES AND MEASURES The primary outcome was the international normalized ratio (INR) on arrival at the hospital. Secondary outcomes included the need for massive transfusion and 30-day survival. As a safety outcome, prespecified adverse events included thrombosis, transfusion-related acute lung injury, and transfusion-associated circulatory overload. RESULTS Among 150 randomized patients, 134 were included in the analysis (median age, 34 [IQR, 26-49] years; 110 men [82.1%]), with 68 in the plasma group and 66 in the control group. Median INR values were 1.21 (IQR, 1.12-1.49) in the plasma group and 1.20 (IQR, 1.10-1.39) in the control group (median difference, -0.01 [IQR, -0.09 to 0.08]; P = .88). The groups did not differ significantly in the need for massive transfusion (7 [10.3%] vs 4 [6.1%]; relative risk, 1.78 [95% CI, 0.42-8.68]; P = .37) or 30-day survival (hazard ratio for death, 1.07 [95% CI, 0.44-2.61]; P = .89). In the full intention-to-treat population (n = 150), the groups did not differ in the rates of any of the prespecified adverse events. CONCLUSIONS AND RELEVANCE In this randomized clinical trial including severely injured patients at risk for hemorrhagic shock and associated coagulopathy, prehospital transfusion of lyophilized plasma was not associated with significant differences in INR values vs standard care with normal saline infusion. Nevertheless, these findings show that lyophilized plasma transfusion is a feasible and safe procedure for this patient population. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02736812.
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Affiliation(s)
- Daniel Jost
- Paris Fire Brigade Medical Emergency Department, Paris, France
| | - Sabine Lemoine
- Paris Fire Brigade Medical Emergency Department, Paris, France
| | | | | | | | - Vincent Lanoë
- Paris Fire Brigade Medical Emergency Department, Paris, France
| | - Olga Maurin
- Paris Fire Brigade Medical Emergency Department, Paris, France
| | - Emilie Louis-Delaurière
- Direction de la Formation, de la Recherche et de l’Innovation, Service de Santé des Armées, Paris, France
| | - Maëlle Delacote
- Paris Fire Brigade Medical Emergency Department, Paris, France
| | | | | | - René Bihannic
- Paris Fire Brigade Medical Emergency Department, Paris, France
| | - Dominique Savary
- Emergency Department, Angers University Hospital, Angers, France
- Research Institute for Environmental and Occupational Health–Unité Mixte de Recherche (UMR)_S 1085, France Emergency Department, Angers University Hospital, Angers, France
| | - Albrice Levrat
- Department of Intensive Care, Annecy Hospital, Annecy, France
| | - Clémence Baudouin
- Service Mobile d’Urgence et de Réanimation de Paris, Hôpital Lariboisière, Assistance Publique–Hôpitaux de Paris (AP-HP) and Université de Paris, Paris, France
| | | | - Marina Salomé
- Paris Fire Brigade Medical Emergency Department, Paris, France
| | - Benoit Frattini
- Paris Fire Brigade Medical Emergency Department, Paris, France
| | | | - Romain Jouffroy
- Paris Fire Brigade Medical Emergency Department, Paris, France
- Intensive Care Unit, Ambroise Paré Hospital, AP-HP and Paris Saclay University, Boulogne Billancourt, France
| | | | - Rudy Titreville
- Paris Fire Brigade Medical Emergency Department, Paris, France
| | - Florian Roquet
- Paris Fire Brigade Medical Emergency Department, Paris, France
- Service d’Anesthésie-Réanimation, Hôpital Européen Georges-Pompidou, AP-HP, Paris, France
- Service de Biostatistique et Informatique Médicale, Unité Institut National de la Santé et de la Recherche Médicale, UMR 1153, Université Paris Diderot, Paris, France
| | - Olivier Stibbe
- Paris Fire Brigade Medical Emergency Department, Paris, France
| | - Benoit Vivien
- Service d’Aide Médicale Urgente de Paris, Hôpital Necker-Enfants Malades, AP-HP and Université de Paris, Paris, France
| | - Catherine Verret
- Direction de la Formation, de la Recherche et de l’Innovation, Service de Santé des Armées, Paris, France
| | - Michel Bignand
- Paris Fire Brigade Medical Emergency Department, Paris, France
| | | | - Christophe Martinaud
- Department of Clinical Operations, French Military Blood Institute, Clamart, France
| | - Michel Arock
- Laboratory of Hematology, Pitié-Salpêtrière Hospital, Paris, France
| | - Mathieu Raux
- Département d’Anesthésie Réanimation, AP-HP Groupe Hospitalier Universitaire, AP-HP–Sorbonne Université, Site Pitié-Salpêtrière, Paris, France
| | - Bertrand Prunet
- Paris Fire Brigade Medical Emergency Department, Paris, France
| | - Sylvain Ausset
- Department of Anesthesiology and Intensive Care, Percy Military Teaching Hospital, Clamart, France
| | - Anne Sailliol
- Department of Clinical Operations, French Military Blood Institute, Clamart, France
| | - Jean-Pierre Tourtier
- Paris Fire Brigade Medical Emergency Department, Paris, France
- Department of Anesthesiology and Intensive Care, Bégin Military Teaching Hospital, Saint-Mandé, France
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Thiery C, Jost D, Klein I, Dufour-Gaume F, Stibbe O, Prunet B. Advances in prehospital hemorrhagic shock management since Paris' terrorist attacks in 2015: A before-and-after retrospective study. Am J Disaster Med 2022; 14:247-252. [PMID: 35325460 DOI: 10.5055/ajdm.2021.0408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND In France, in 2015, prehospital emergency doctors were faced with civilian casualties in hemorrhagic shock resulting from terrorist attacks with automatic rifle fire and explosive weapons. The present study aimed to evaluate the impact of these attacks on the advanced life support (ALS) team's practices and equipment and on physician training in the prehospital management of traumatic hemorrhagic shock. METHODS This before-and-after multicenter study evaluated professional practices based on a questionnaire sent to emergency department heads and medical practitioners in 370 ALS teams in metropolitan France. RESULTS We analyzed 672 responses from 209 (56.5 percent) ALS teams in 91 of 95 emergency medical services (EMS) headquarters. Of these 91, 73 (80.2 percent) had a protocol in use for managing traumatic hemorrhagic shock after the attacks, compared with 45 (49.5 percent) who had protocols in use before the attacks (p < 0.001). Ultrasound equipment was available in 49 (53.8 percent) of the EMS headquarters after the attacks, compared to 39 (42.9 percent) before (p < 0.001). Limb tourniquets were available in 90 (98.9 percent) EMS headquarters after the attacks, versus 27 (29.7 percent) before (p < 0.001). Tranexamic acid was available in 88 (96.7 percent) EMS headquarters after the attacks, versus 71 (78 percent) before (p < 0.001). During the post-attack period, training in war medicine did not affect individual practices, neither for using the shock index or the Focused Assessment with Sonography for Trauma (FAST) nor the tourniquet. However, this training was associated with more frequent use of hemostatic dressings (p = 0.002). CONCLUSION Following the attacks in Paris and Nice, ALS teams received additional equipment and training to prepare for future mass causality events.
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Affiliation(s)
- Christophe Thiery
- University of Lorraine, Nancy, France; Intensive Care Medicine, CHU Nancy, Paris Fire Brigade Emergency Medicine Department, Paris, France. ORCID: https://orcid.org/0000-0003-0680-5240
| | - Daniel Jost
- Paris Fire Brigade Emergency Medicine Department, Paris, France
| | - Isabelle Klein
- Paris Fire Brigade Emergency Medicine Department, Paris, France
| | | | - Olivier Stibbe
- Paris Fire Brigade Emergency Medicine Department, Paris, France
| | - Bertrand Prunet
- Paris Fire Brigade Emergency Medicine Department, Paris, France
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Derkenne C, Jost D, Miron De L'Espinay A, Corpet P, Frattini B, Hong V, Lemoine F, Jouffroy R, Roquet F, Marijon E, Beganton F, Stibbe O, Lemoine S, Salome M, Kedzierewicz R, Prunet B. Automatic external defibrillator provided by unmanned aerial vehicle (drone) in Greater Paris: A real world-based simulation. Resuscitation 2021; 162:259-265. [PMID: 33766669 DOI: 10.1016/j.resuscitation.2021.03.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 02/22/2021] [Accepted: 03/08/2021] [Indexed: 10/21/2022]
Abstract
AIM To reduce the delay in defibrillation of out-of-hospital cardiac arrest (OHCA) patients, recent publications have shown that drones equipped with an automatic external defibrillator (AED) appear to be effective in sparsely populated areas. To study the effectiveness of AED-drones in high-density urban areas, we developed an algorithm based on emergency dispatch parameters for the rate and detection speed of cardiac arrests and technical and meteorological parameters. METHODS We ran a numerical simulation to compare the actual time required by the Basic Life Support team (BLSt) for OHCA patients in Greater Paris in 2017 to the time required by an AED-drone. Endpoints were the proportion of patients with "AED-drone first" and the defibrillation time gained. We built an open-source website (https://airborne-aed.org/) to allow modelling by modifying one or more parameters and to help other teams model their own OHCA data. RESULTS Of 3014 OHCA patients, 72.2 ± 0.7% were in the "no drone flight" group, 25.8 ± 0.2% in the "AED-drone first" group, and 2.1 ± 0.2% in the "BLSt-drone first" group. When a drone flight was authorized, it arrived an average 190 s before BLSt in 93% of cases. The possibility of flying the drone during the aeronautical night improved the results of the "AED-drone first" group the most (+60%). CONCLUSIONS In our very high-density urban model, at most 26% of OHCA patients received an AED from an AED-drone before BLSt. The flexible parameters of our website model allows evaluation of the impact of each choice and concrete implementation of the AED-drone.
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Affiliation(s)
- Clément Derkenne
- Emergency Medical Department, Paris Fire Brigade, 1, Place Jules Renard, 75017 Paris, France.
| | - Daniel Jost
- Emergency Medical Department, Paris Fire Brigade, 1, Place Jules Renard, 75017 Paris, France; Sudden Death Expertise Center, Hôpital Pompidou, 1, Rue Leblanc, 75015 Paris, France
| | | | - Pascal Corpet
- Bayes Impact, 24, Boulevard Saint Denis, 75010, Paris, France
| | - Benoit Frattini
- Emergency Medical Department, Paris Fire Brigade, 1, Place Jules Renard, 75017 Paris, France
| | - Vivien Hong
- Emergency Medical Department, Paris Fire Brigade, 1, Place Jules Renard, 75017 Paris, France
| | - Frédéric Lemoine
- Emergency Medical Department, Paris Fire Brigade, 1, Place Jules Renard, 75017 Paris, France
| | - Romain Jouffroy
- Emergency Medical Department, Paris Fire Brigade, 1, Place Jules Renard, 75017 Paris, France
| | - Florian Roquet
- European Georges Pompidou Hospital, Critical Care Department, 1, Rue Leblanc, 75015 Paris, France; INSERM 1153 Unit, Hôpital St Louis 1, Avenue Claude Vellefaux, 75010 Paris, France
| | - Eloi Marijon
- Université de Paris, Centre de Recherche Cardiovasculaire de Paris, INSERM, 1, Rue Leblanc, 75015 Paris, France; European Georges Pompidou Hospital, Cardiology Department, 1, Rue Leblanc, 75015 Paris, France; Paris-Sudden Death Expertise Center, Paris, 1, Rue Leblanc, 75015 Paris, France
| | - Frankie Beganton
- Université de Paris, Centre de Recherche Cardiovasculaire de Paris, INSERM, 1, Rue Leblanc, 75015 Paris, France; Paris-Sudden Death Expertise Center, Paris, 1, Rue Leblanc, 75015 Paris, France
| | - Olivier Stibbe
- Emergency Medical Department, Paris Fire Brigade, 1, Place Jules Renard, 75017 Paris, France
| | - Sabine Lemoine
- Emergency Medical Department, Paris Fire Brigade, 1, Place Jules Renard, 75017 Paris, France
| | - Marina Salome
- Emergency Medical Department, Paris Fire Brigade, 1, Place Jules Renard, 75017 Paris, France
| | - Romain Kedzierewicz
- Emergency Medical Department, Paris Fire Brigade, 1, Place Jules Renard, 75017 Paris, France
| | - Bertrand Prunet
- Emergency Medical Department, Paris Fire Brigade, 1, Place Jules Renard, 75017 Paris, France; French Military Health Service, Val de Grâce Military Academy, 1, Place Alphonse Laveran, 75005 Paris, France
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- Emergency Medical Department, Paris Fire Brigade, 1, Place Jules Renard, 75017 Paris, France
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Derkenne C, Jost D, Roquet F, Dardel P, Kedzierewicz R, Mignon A, Travers S, Frattini B, Prieux L, Rozenberg E, Demaison X, Gaudet J, Charry F, Stibbe O, Briche F, Lemoine F, Lesaffre X, Maurin O, Gauyat E, Faraon E, Lemoine S, Prunet B. Mobile Smartphone Technology Is Associated With Out-of-hospital Cardiac Arrest Survival Improvement: The First Year "Greater Paris Fire Brigade" Experience. Acad Emerg Med 2020; 27:951-962. [PMID: 32445436 DOI: 10.1111/acem.13987] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 02/25/2020] [Accepted: 03/25/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Out-of-hospital cardiac arrest (OHCA) remains associated with very high mortality. Accelerating the initiation of efficient cardiopulmonary resuscitation (CPR) is widely perceived as key to improving outcomes. The main goal was to determine whether identification and activation of nearby first responders through a smartphone application named Staying Alive (SA) can improve survival following OHCA in a large urban area (Paris). METHODS We conducted a nonrandomized cohort study of all adults with OHCA managed by the Greater Paris Fire Brigade during 2018, irrespective of mobile application usage. We compared survival data in cases where SA did or did not lead to the activation of nearby first responders. During dispatch, calls for OHCA were managed with or without SA. The intervention group included all cases where nearby first responders were successfully identified by SA and actively contributed to CPR. The control group included all other cases. We compared survival at hospital discharge between the intervention and control groups. We analyzed patient data, CPR metrics, and first responders' characteristics. RESULTS Approximately 4,107 OHCA cases were recorded in 2018. Among those, 320 patients were in the control group, whereas 46 patients, in the intervention group, received first responder-initiated CPR. After adjustment for confounders, survival at hospital discharge was significantly improved for patients in the intervention group (35% vs. 16%, adjusted odds ratio = 5.9, 95% confidence interval = 2.1 to 16.5, p < 0.001). All CPR metrics were improved in the intervention group. CONCLUSIONS We report that mobile smartphone technology was associated with OHCA survival through accelerated initiation of efficient CPR by first responders in a large urban area.
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Affiliation(s)
- Clément Derkenne
- From the Emergency Medical Department Paris Fire Brigade Paris France
| | - Daniel Jost
- From the Emergency Medical Department Paris Fire Brigade Paris France
- the Sudden Death Expertise Center Hôpital Pompidou Paris France
| | - Florian Roquet
- the Critical Care Department Hôpital Pompidou Paris France
- INSERM 1153 Unit Hôpital St Louis Paris France
| | - Paul Dardel
- Staying Alive Responder Endowment Fund Boulogne Billancourt France
| | | | - Alexandre Mignon
- Université Paris Descartes Paris France
- Hôpital Cochin 24 Assistance Publique–Hôpitaux de Paris Paris France
| | - Stéphane Travers
- From the Emergency Medical Department Paris Fire Brigade Paris France
- and the French Military Health Service Val de Grâce Military Academy Paris France
| | - Benoit Frattini
- From the Emergency Medical Department Paris Fire Brigade Paris France
| | - Laurent Prieux
- From the Emergency Medical Department Paris Fire Brigade Paris France
| | | | - Xavier Demaison
- From the Emergency Medical Department Paris Fire Brigade Paris France
| | - John Gaudet
- From the Emergency Medical Department Paris Fire Brigade Paris France
| | - Félicité Charry
- From the Emergency Medical Department Paris Fire Brigade Paris France
| | - Olivier Stibbe
- From the Emergency Medical Department Paris Fire Brigade Paris France
| | - Frédérique Briche
- From the Emergency Medical Department Paris Fire Brigade Paris France
| | - Frédéric Lemoine
- From the Emergency Medical Department Paris Fire Brigade Paris France
| | - Xavier Lesaffre
- From the Emergency Medical Department Paris Fire Brigade Paris France
| | - Olga Maurin
- From the Emergency Medical Department Paris Fire Brigade Paris France
| | - Eric Gauyat
- From the Emergency Medical Department Paris Fire Brigade Paris France
| | - Eric Faraon
- From the Emergency Medical Department Paris Fire Brigade Paris France
| | - Sabine Lemoine
- From the Emergency Medical Department Paris Fire Brigade Paris France
| | - Bertrand Prunet
- From the Emergency Medical Department Paris Fire Brigade Paris France
- and the French Military Health Service Val de Grâce Military Academy Paris France
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Robardet F, Bertho K, Lemoine F, Scannavino M, Demaison X, Millet M, Bihannic R, Stibbe O, Prunet B. Bilan des actions conduites par la Brigade de sapeurs-pompiers de Paris durant la crise du COVID-19 du printemps 2020. Médecine de Catastrophe - Urgences Collectives 2020. [PMCID: PMC7428679 DOI: 10.1016/j.pxur.2020.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Jost D, Hong Tuan Ha V, Trichereau J, Frattini B, Derkenne C, Lemoine S, Lemoine F, Jouffroy R, Kedzierewicz R, Briche F, Diegelmann P, Bihannic R, Stibbe O, Prunet B. Contributing factors to early recurrence of ventricular fibrillation during out-of-hospital cardiac arrest: An observational retrospective study. Resuscitation 2020; 154:19-24. [DOI: 10.1016/j.resuscitation.2020.06.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Revised: 06/14/2020] [Accepted: 06/23/2020] [Indexed: 11/29/2022]
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Chanzy E, Gentile M, Nahon M, Paty AC, Stibbe O, Tourtier JP, Petrovic T, Goix L, Adnet F, Lapostolle F. COP21 – Organisation et bilan d’une médicalisation sous haute tension. Rev Epidemiol Sante Publique 2019; 67:201-204. [DOI: 10.1016/j.respe.2019.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2016] [Revised: 02/11/2019] [Accepted: 02/15/2019] [Indexed: 10/27/2022] Open
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Cayla G, Lapostolle F, Ecollan P, Stibbe O, Benezet JF, Henry P, Hammett CJ, Lassen JF, Storey RF, Ten Berg JM, Hamm CW, Van't Hof AW, Montalescot G. Pre-hospital ticagrelor in ST-segment elevation myocardial infarction in the French ATLANTIC population. Int J Cardiol 2017. [PMID: 28622941 DOI: 10.1016/j.ijcard.2017.06.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND ATLANTIC was a randomized study comparing pre- and in-hospital treatment with a ticagrelor loading dose (LD) in ongoing ST-segment elevation myocardial infarction (STEMI). We sought to compare patient characteristics and clinical outcomes in France with other countries participating in ATLANTIC. METHODS The population comprised 1862 patients, 660 (35.4%) from France and 1202 from 12 other countries. The main endpoints were reperfusion (≥70% ST-segment elevation resolution) and TIMI flow grade 3 before (co-primary endpoints) and after percutaneous coronary intervention (PCI). Other endpoints included a composite ischaemic endpoint (death/myocardial infarction/stroke/urgent revascularization/definite stent thrombosis) and bleeding events at 30days. RESULTS In France, median times from first LD to angiography and between first and second LDs were 49 and 35min, respectively, and were similar to other countries. French patients were younger (mean 58.7 vs 61.9years, p<0.0001) and characterized by a higher rate of radial access (89.9% vs 54.8%, p<0.0001), more frequent use of pre-hospital glycoprotein (GP) IIb/IIIa inhibitors (14.1% vs 3.1%, p<0.0001) and intravenous enoxaparin (57.3% vs 10.1%, p<0.0001). In France, as in other countries, the co-primary endpoints did not differ between the two randomization groups. The composite ischaemic endpoint was numerically lower in France (3.3% vs 5.1%, p=0.07), with a lower mortality (1.4% vs 3.3%, p=0.01). PLATO major bleeding was numerically less frequent in France (1.8% vs 3.2%, p=0.07). CONCLUSIONS The French population appears to have better outcomes than the rest of the study population, and seems related to differences in demographics and management characteristics. TRIAL REGISTRY ClinicalTrials.gov (NCT01347580).
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Affiliation(s)
- Guillaume Cayla
- Department of Cardiology, CHU Caremeau, Université de Montpellier, Nîmes, France.
| | | | | | | | | | | | - Christopher J Hammett
- Department of Cardiology, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Jens Flensted Lassen
- Department of Cardiology B, Aarhus University Hospital, Skejby, Aarhus N, Denmark
| | - Robert F Storey
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Jur M Ten Berg
- Department of Cardiology, St Antonius Hospital Nieuwegein, Nieuwegein, Netherlands
| | - Christian W Hamm
- Department of Cardiology, Kerckhoff Heart Center, Bad Neuheim, Germany
| | | | - Gilles Montalescot
- Sorbonne Université Paris 6, ACTION Study Group, Institut de Cardiologie (AP-HP), CHU Pitié-Salpêtrière, INSERM UMRS, 1166 Paris, France
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Lapostolle F, van ‘t Hof AW, Hamm CW, Lassen JF, Stibbe O, Ecollan P, Heutz WM, Licour M, Tsatsaris A, Montalescot G. INTERACTION BETWEEN MORPHINE AND TICAGRELOR IN THE ATLANTIC STUDY. J Am Coll Cardiol 2016. [DOI: 10.1016/s0735-1097(16)30546-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Montalescot G, van ’t Hof AW, Bolognese L, Cantor WJ, Cequier A, Chettibi M, Collet JP, Goodman SG, Hammett CJ, Huber K, Janzon M, Lapostolle F, Lassen JF, Licour M, Merkely B, Salhi N, Silvain J, Storey RF, ten Berg JM, Tsatsaris A, Zeymer U, Vicaut E, Hamm CW, Bougherbal R, Bouafia MT, Chettibi M, Nibouche D, Moklati A, Benalia A, Kaid O, Krim M, Hammett C, Garrahy P, Jayasinghe R, Rashford S, Huber K, Neunteufl T, Brussee H, Alber H, Weidinger F, Brunner M, Sipoetz J, Prause G, Baubin M, Sebald D, Cantor W, Vijayaraghavan R, Bata I, Lavoie A, Lassen JF, Ravkilde J, Jensen LO, Christensen AM, Toftegaard M, Köhler D, Montalescot G, Ducrocq G, Danchin N, Henry P, Livarek B, Berthier R, Hovasse T, Garot P, Payot L, Benamer H, Esteve JB, Elhadad S, Teiger E, Bonnet JL, Paganelli F, Cottin Y, Schiele F, Thuaire C, Cayla G, Coste P, Ohlmann P, Cudraz EB, Lantelme P, Perret T, Tron C, De Labriolle A, Aptecar E, Beliard O, Varenne O, El Mahmoud R, Filippi-Codaccioni E, Angoulvant D, Peycher P, Poitrineau O, Tabone X, Ecollan P, Broche C, Lambert Y, Briole N, Beruben A, Porcher N, Auffray JP, Freysz M, Depardieu F, Poubel D, De La Cousaye JE, Bartier JC, Jardel B, Boulanger B, Labourel H, Soulat LC, Lapostolle F, Julie V, Thicoipe M, Capel O, Stibbe O, Carli P, Tazarourte K, Alcouffe F, Aboucaya D, Aubert G, Kierzek G, Cahun-Giraud S, Zeymer U, Hamm C, Dengler T, Prondzinsky R, Biever PM, Schäfer A, Seyfarth M, Lemke B, Werner G, Nef H, Steiger H, Leschke M, Münzel T, Dell Orto MC, Loges C, Schinke M, Koberne F, Reiffen HP, Tiroch K, Wierich D, Kneussel M, Little S, Sauer H, Laufenberg-Feldmann R, Merkely B, Ungi I, Horváth I, Édes I, Mártai I, Bolognese L, Berti S, Chiarella F, Calabria P, Fineschi M, Galvani M, Valgimigli M, Moretti L, Tespili M, Mandó M, Bermano F, Biagioni R, Fabbri A, Ricciardelli A, Petroni MR, Vatteroni UR, Palumbo F, Willems FF, Al Mafragi A, Heestermans TA, Van Eck MJ, Heutz WM, Meppelder H, Jong ARD, Van de Pas H, Fillat ÁC, Tenas MS, Ferrer JM, Peñaranda AS, Ferrer JÁ, Del Blanco BG, Guardiola FM, Ruiz Nodar JM, Romo AÍ, González NV, Nouche RT, De La Llera LD, Hernández García JM, Rivero-Crespo F, Hernández FH, Zamorano Gómez JL, Fárega XJ, Fernández GA, Toboso JL, Carrasco M, Barreiro V, Iglesias Vázquez JA, Montero MDMR, Ortiz FR, Escudero GG, Ingelmo VSB, García AL, Janzon M, Oldgren J, Calais F, Kastberg R, Bergsten PA, Blomberg H, Thörn K, Skoog G, Storey RF, Zaman A, Gerber R, Ryding A, Spence M, Swanson N, Been M, Grosser K, Schofield P, Mackin D, Fell P, Quinn T, Foster T, McManus D, Carson A. Effect of Pre-Hospital Ticagrelor During the First 24 h After Primary Percutaneous Coronary Intervention in Patients With ST-Segment Elevation Myocardial Infarction. JACC Cardiovasc Interv 2016; 9:646-56. [DOI: 10.1016/j.jcin.2015.12.024] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Revised: 11/30/2015] [Accepted: 12/15/2015] [Indexed: 01/20/2023]
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Montalescot G, van 't Hof AW, Lapostolle F, Silvain J, Lassen JF, Bolognese L, Cantor WJ, Cequier A, Chettibi M, Goodman SG, Hammett CJ, Huber K, Janzon M, Merkely B, Storey RF, Zeymer U, Stibbe O, Ecollan P, Heutz WMJM, Swahn E, Collet JP, Willems FF, Baradat C, Licour M, Tsatsaris A, Vicaut E, Hamm CW. Prehospital ticagrelor in ST-segment elevation myocardial infarction. N Engl J Med 2014; 371:1016-27. [PMID: 25175921 DOI: 10.1056/nejmoa1407024] [Citation(s) in RCA: 435] [Impact Index Per Article: 43.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND The direct-acting platelet P2Y12 receptor antagonist ticagrelor can reduce the incidence of major adverse cardiovascular events when administered at hospital admission to patients with ST-segment elevation myocardial infarction (STEMI). Whether prehospital administration of ticagrelor can improve coronary reperfusion and the clinical outcome is unknown. METHODS We conducted an international, multicenter, randomized, double-blind study involving 1862 patients with ongoing STEMI of less than 6 hours' duration, comparing prehospital (in the ambulance) versus in-hospital (in the catheterization laboratory) treatment with ticagrelor. The coprimary end points were the proportion of patients who did not have a 70% or greater resolution of ST-segment elevation before percutaneous coronary intervention (PCI) and the proportion of patients who did not have Thrombolysis in Myocardial Infarction flow grade 3 in the infarct-related artery at initial angiography. Secondary end points included the rates of major adverse cardiovascular events and definite stent thrombosis at 30 days. RESULTS The median time from randomization to angiography was 48 minutes, and the median time difference between the two treatment strategies was 31 minutes. The two coprimary end points did not differ significantly between the prehospital and in-hospital groups. The absence of ST-segment elevation resolution of 70% or greater after PCI (a secondary end point) was reported for 42.5% and 47.5% of the patients, respectively. The rates of major adverse cardiovascular events did not differ significantly between the two study groups. The rates of definite stent thrombosis were lower in the prehospital group than in the in-hospital group (0% vs. 0.8% in the first 24 hours; 0.2% vs. 1.2% at 30 days). Rates of major bleeding events were low and virtually identical in the two groups, regardless of the bleeding definition used. CONCLUSIONS Prehospital administration of ticagrelor in patients with acute STEMI appeared to be safe but did not improve pre-PCI coronary reperfusion. (Funded by AstraZeneca; ATLANTIC ClinicalTrials.gov number, NCT01347580.).
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Montalescot G, Zeymer U, Silvain J, Boulanger B, Cohen M, Goldstein P, Ecollan P, Combes X, Huber K, Pollack C, Bénezet JF, Stibbe O, Filippi E, Teiger E, Cayla G, Elhadad S, Adnet F, Chouihed T, Gallula S, Greffet A, Aout M, Collet JP, Vicaut E. Intravenous enoxaparin or unfractionated heparin in primary percutaneous coronary intervention for ST-elevation myocardial infarction: the international randomised open-label ATOLL trial. Lancet 2011; 378:693-703. [PMID: 21856483 DOI: 10.1016/s0140-6736(11)60876-3] [Citation(s) in RCA: 186] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Primary percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction has traditionally been supported by unfractionated heparin, which has never been directly compared with a new anticoagulant using consistent anticoagulation and similar antiplatelet strategies in both groups. We compared traditional heparin treatment with intravenous enoxaparin in primary PCI. METHODS In a randomised open-label trial, patients presenting with ST-elevation myocardial infarction were randomly assigned (1:1) to receive an intravenous bolus of 0·5 mg/kg of enoxaparin or unfractionated heparin before primary PCI. Wherever possible, medical teams travelling in mobile intensive care units (ambulances) selected, randomly assigned (using an interactive voice response system at the central randomisation centre), and treated patients. Patients who had received any anticoagulant before randomisation were excluded. Patients and caregivers were not masked to treatment allocation. The primary endpoint was 30-day incidence of death, complication of myocardial infarction, procedure failure, or major bleeding. The main secondary endpoint was the composite of death, recurrent acute coronary syndrome, or urgent revascularisation. Analysis was by intention to treat. This trial is registered at ClinicalTrials.gov, number NCT00718471. FINDINGS 910 patients were assigned to treatment with enoxaparin (n=450) or unfractionated heparin (n=460). The primary endpoint occurred in 126 (28%) patients after anticoagulation with enoxaparin versus 155 (34%) patients on unfractionated heparin (relative risk [RR] 0·83, 95% CI 0·68-1·01, p=0·06). The incidence of death (enoxaparin, 17 [4%] vs heparin, 29 [6%] patients; p=0·08), complication of myocardial infarction (20 [4%] vs 29 [6%]; p=0·21), procedure failure (100 [26%] vs 109 [28%]; p=0·61), and major bleeding (20 [5%] vs 22 [5%]; p=0·79) did not differ between groups. Enoxaparin resulted in a significantly reduced rate of the main secondary endpoint (30 [7%] vs 52 [11%] patients; RR 0·59, 95% CI 0·38-0·91, p=0·015). Death, complication of myocardial infarction, or major bleeding (46 [10%] vs 69 [15%] patients; p=0·03), death or complication of myocardial infarction (35 [8%] vs 57 [12%]; p=0·02), and death, recurrent myocardial infarction, or urgent revascularisation (23 [5%] vs 39 [8%]; p=0·04) were all reduced with enoxaparin. INTERPRETATION Intravenous enoxaparin compared with unfractionated heparin significantly reduced clinical ischaemic outcomes without differences in bleeding and procedural success. Therefore, enoxaparin provided an improvement in net clinical benefit in patients undergoing primary PCI. FUNDING Direction de la Recherche Clinique, Assistance Publique-Hôpitaux de Paris; Sanofi-Aventis.
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Affiliation(s)
- Gilles Montalescot
- Institut de Cardiologie, CHU Pitié-Salpêtrière (AP-HP), Université Paris 6, Paris, France.
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