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Rousson V, Hall N, Pasquier M. Recommendation on the Use of the HOPE Score at the Hospital for Outcome Prediction in Critically Buried Hypothermic Avalanche Victims Considered for ECLS Rewarming. Wilderness Environ Med 2024; 35:251-252. [PMID: 38549350 DOI: 10.1177/10806032241242084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2024]
Affiliation(s)
- Valentin Rousson
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Nicolas Hall
- Department of Emergency Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Mathieu Pasquier
- Department of Emergency Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
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Kottmann A, Pasquier M, Carron PN, Maudet L, Rouvé JD, Suppan L, Caillet-Bois D, Riva T, Albrecht R, Krüger A, Sollid SJM. Feasibility of quality indicators on prehospital advanced airway management in a physician-staffed emergency medical service: survey-based assessment of the provider point of view. BMJ Open 2024; 14:e081951. [PMID: 38453207 PMCID: PMC10921492 DOI: 10.1136/bmjopen-2023-081951] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 02/20/2024] [Indexed: 03/09/2024] Open
Abstract
OBJECTIVE We aimed to determine the feasibility of quality indicators (QIs) for prehospital advanced airway management (PAAM) from a provider point of view. DESIGN The study is a survey based feasibility assessment following field testing of QIs for PAAM. SETTING The study was performed in two physician staffed emergency medical services in Switzerland. PARTICIPANTS 42 of the 44 emergency physicians who completed at least one case report form (CRF) dedicated to the collection of the QIs on PAAM between 1 January 2019 and 31 December 2021 participated in the study. INTERVENTION The data required to calculate the 17 QIs was systematically collected through a dedicated electronic CRF. PRIMARY AND SECONDARY OUTCOME MEASURES Primary outcomes were provider-related feasibility criteria: relevance and acceptance of the QIs, as well as reliability of the data collection. Secondary outcomes were effort to collect specific data and to complete the CRF. RESULTS Over the study period, 470 CRFs were completed, with a median of 11 per physician (IQR 4-17; range 1-48). The median time to complete the CRF was 7 min (IQR 3-16) and was considered reasonable by 95% of the physicians. Overall, 75% of the physicians assessed the set of QIs to be relevant, and 74% accepted that the set of QIs assessed the quality of PAAM. The reliability of data collection was rated as good or excellent for each of the 17 QIs, with the lowest rated for the following 3 QIs: duration of preoxygenation, duration of laryngoscopy and occurrence of desaturation during laryngoscopy. CONCLUSIONS Collection of QIs on PAAM appears feasible. Electronic medical records and technological solutions facilitating automatic collection of vital parameters and timing during the procedure could improve the reliability of data collection for some QIs. Studies in other services are needed to determine the external validity of our results.
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Affiliation(s)
- Alexandre Kottmann
- Emergency Department, Department of Interdisciplinary Centres, Lausanne University Hospital, Lausanne, Vaud, Switzerland
- Medicine, REGA, Zurich, Switzerland
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Vaud, Switzerland
- Department of Anaesthesiology and Pain Medicine, Inselspital University Hospital Bern, Bern, Switzerland
- Department of Research and Development, Norwegian Air Ambulance Foundation, Drøbak, Norway
- Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Mathieu Pasquier
- Emergency Department, Department of Interdisciplinary Centres, Lausanne University Hospital, Lausanne, Vaud, Switzerland
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Vaud, Switzerland
| | - Pierre-Nicolas Carron
- Emergency Department, Department of Interdisciplinary Centres, Lausanne University Hospital, Lausanne, Vaud, Switzerland
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Vaud, Switzerland
| | - Ludovic Maudet
- Emergency Department, Department of Interdisciplinary Centres, Lausanne University Hospital, Lausanne, Vaud, Switzerland
- Anaesthesiology, Department of Interdisciplinary Centres, Lausanne University Hospital, Lausanne, Vaud, Switzerland
| | - Jean-Daniel Rouvé
- Anaesthesiology, Department of Interdisciplinary Centres, Lausanne University Hospital, Lausanne, Vaud, Switzerland
| | - L Suppan
- Division of Emergency Medicine, Department of Anaesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals, Geneve, Switzerland
| | - David Caillet-Bois
- Emergency Department, Department of Interdisciplinary Centres, Lausanne University Hospital, Lausanne, Vaud, Switzerland
| | - Thomas Riva
- Department of Anaesthesiology and Pain Medicine, Inselspital University Hospital Bern, Bern, Switzerland
- Faculty of Medicine, University of Bern, Bern, Switzerland
| | - Roland Albrecht
- Medicine, REGA, Zurich, Switzerland
- Faculty of Medicine, University of Bern, Bern, Switzerland
| | - Andreas Krüger
- Department of Research and Development, Norwegian Air Ambulance Foundation, Drøbak, Norway
- Department of Emergency Medicine and Prehospital Services, St. Olavs University Hospital, Trondheim, Norway
- Institute of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
| | - Stephen Johan Mikal Sollid
- Department of Research and Development, Norwegian Air Ambulance Foundation, Drøbak, Norway
- Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
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Cools E, Brugger H, Darocha T, Gordon L, Pasquier M, Walpoth B, Zafren K, Peek G, Paal P. About Rewarming Young Children After Drowning-Associated Hypothermia and Out-of-Hospital Cardiac Arrest. Pediatr Crit Care Med 2024; 25:e171-e172. [PMID: 38451805 PMCID: PMC10903992 DOI: 10.1097/pcc.0000000000003411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/09/2024]
Affiliation(s)
- Evelien Cools
- Division of Anaesthesiology, Department of Anaesthesiology, Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Hermann Brugger
- Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy
- International Commission for Mountain Emergency Medicine (ICAR MedCom), Zürich, Switzerland
| | - Tomasz Darocha
- Department of Anaesthesiology and Intensive Care, Medical University of Silesia, Katowice, Poland
| | - Les Gordon
- Department of Anaesthesia, University Hospitals of Morecambe Bay Trust, Lancaster, England, United Kingdom
| | - Mathieu Pasquier
- International Commission for Mountain Emergency Medicine (ICAR MedCom), Zürich, Switzerland
- Emergency Department, Lausanne University Hospital, Lausanne, Switzerland
| | - Beat Walpoth
- Department of Cardiovascular Surgery, Geneva University Hospitals, Geneva, Switzerland
| | - Ken Zafren
- International Commission for Mountain Emergency Medicine (ICAR MedCom), Zürich, Switzerland
- Department of Emergency Medicine, Stanford University Medical Center, Stanford, CA
- Department of Emergency Medicine, Alaska Native Medical Center, Anchorage, AK
| | - Giles Peek
- Congenital Heart Center, University of Florida, Gainesville, FL
- Guidelines Subcommittee for the Extracorporeal Life Support Organization, Salzburg, Austria
| | - Peter Paal
- International Commission for Mountain Emergency Medicine (ICAR MedCom), Zürich, Switzerland
- Department of Anaesthesiology and Intensive Care Medicine, St. John of God Hospital, Paracelsus Medical University, Salzburg, Austria
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Rauch S, Lechner R, Strapazzon G, Mortimer RB, Ellerton J, Skaiaa SC, Huber T, Brugger H, Pasquier M, Paal P. Suspension syndrome: a scoping review and recommendations from the International Commission for Mountain Emergency Medicine (ICAR MEDCOM). Scand J Trauma Resusc Emerg Med 2023; 31:95. [PMID: 38071341 PMCID: PMC10710713 DOI: 10.1186/s13049-023-01164-z] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 12/02/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Suspension syndrome describes a multifactorial cardio-circulatory collapse during passive hanging on a rope or in a harness system in a vertical or near-vertical position. The pathophysiology is still debated controversially. AIMS The International Commission for Mountain Emergency Medicine (ICAR MedCom) performed a scoping review to identify all articles with original epidemiological and medical data to understand the pathophysiology of suspension syndrome and develop updated recommendations for the definition, prevention, and management of suspension syndrome. METHODS A literature search was performed in PubMed, Embase, Web of Science and the Cochrane library. The bibliographies of the eligible articles for this review were additionally screened. RESULTS The online literature search yielded 210 articles, scanning of the references yielded another 30 articles. Finally, 23 articles were included into this work. CONCLUSIONS Suspension Syndrome is a rare entity. A neurocardiogenic reflex may lead to bradycardia, arterial hypotension, loss of consciousness and cardiac arrest. Concomitant causes, such as pain from being suspended, traumatic injuries and accidental hypothermia may contribute to the development of the Suspension Syndrome. Preventive factors include using a well-fitting sit harness, which does not cause discomfort while being suspended, and activating the muscle pump of the legs. Expediting help to extricate the suspended person is key. In a peri-arrest situation, the person should be positioned supine and standard advanced life support should be initiated immediately. Reversible causes of cardiac arrest caused or aggravated by suspension syndrome, e.g., hyperkalaemia, pulmonary embolism, hypoxia, and hypothermia, should be considered. In the hospital, blood and further exams should assess organ injuries caused by suspension syndrome.
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Affiliation(s)
- Simon Rauch
- Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy.
- Department of Anaesthesia and Intensive Care Medicine, Hospital of Merano (SABES-ASDAA), Merano-Meran, Italy.
- Medical University Innsbruck, Innsbruck, Austria.
| | - Raimund Lechner
- Department of Anesthesiology, Intensive Care Medicine, Emergency Medicine and Pain Therapy, Bundeswehr Hospital Ulm, Ulm, Germany
| | - Giacomo Strapazzon
- Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy
- International Commission for Mountain Emergency Medicine (ICAR MedCom), Zurich, Switzerland
- Corpo Nazionale del Soccorso Alpino E Speleologico (CNSAS), Milan, Italy
| | - Roger B Mortimer
- International Commission for Mountain Emergency Medicine (ICAR MedCom), Zurich, Switzerland
- Fresno Medical Education Program, Department of Family and Community Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - John Ellerton
- International Commission for Mountain Emergency Medicine (ICAR MedCom), Zurich, Switzerland
| | - Sven Christjar Skaiaa
- International Commission for Mountain Emergency Medicine (ICAR MedCom), Zurich, Switzerland
- Division of Prehospital Services, Air Ambulance Department, Oslo University Hospital, Oslo, Norway
| | - Tobias Huber
- Department of Anaesthesiology and Intensive Care Medicine, Salzkammergut Klinikum Vöcklabruck, Vöcklabruck, Austria
| | - Hermann Brugger
- Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy
- Medical University Innsbruck, Innsbruck, Austria
- International Commission for Mountain Emergency Medicine (ICAR MedCom), Zurich, Switzerland
| | - Mathieu Pasquier
- International Commission for Mountain Emergency Medicine (ICAR MedCom), Zurich, Switzerland
- Emergency Department, Lausanne University Hospital, Lausanne, Switzerland
| | - Peter Paal
- International Commission for Mountain Emergency Medicine (ICAR MedCom), Zurich, Switzerland
- Department of Anaesthesiology and Intensive Care Medicine, St. John of God Hospital, Paracelsus Private Medical University, Salzburg, Austria
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Affiliation(s)
- Natalia Buda
- From the Simulation Laboratory of Endoscopic and Minimally Invasive Techniques, Medical University of Gdansk, and the Lung Transplantation Department, Cardiac Surgery Clinic, University Clinical Center, Gdansk (N.B.), the Department of Anesthesiology and Intensive Care (K.M., T.D.) and the Department of Lung Diseases and Tuberculosis, Faculty of Medical Sciences in Zabrze (S.S.), Medical University of Silesia, Katowice, and the Institute of Cardiology, Jagiellonian University Medical College, Krakow (P.M.) - all in Poland; the Emergency Department, Lausanne University Hospital, Lausanne, Switzerland (M.P., E.G.); and the Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN (P.M.)
| | - Konrad Mendrala
- From the Simulation Laboratory of Endoscopic and Minimally Invasive Techniques, Medical University of Gdansk, and the Lung Transplantation Department, Cardiac Surgery Clinic, University Clinical Center, Gdansk (N.B.), the Department of Anesthesiology and Intensive Care (K.M., T.D.) and the Department of Lung Diseases and Tuberculosis, Faculty of Medical Sciences in Zabrze (S.S.), Medical University of Silesia, Katowice, and the Institute of Cardiology, Jagiellonian University Medical College, Krakow (P.M.) - all in Poland; the Emergency Department, Lausanne University Hospital, Lausanne, Switzerland (M.P., E.G.); and the Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN (P.M.)
| | - Szymon Skoczyński
- From the Simulation Laboratory of Endoscopic and Minimally Invasive Techniques, Medical University of Gdansk, and the Lung Transplantation Department, Cardiac Surgery Clinic, University Clinical Center, Gdansk (N.B.), the Department of Anesthesiology and Intensive Care (K.M., T.D.) and the Department of Lung Diseases and Tuberculosis, Faculty of Medical Sciences in Zabrze (S.S.), Medical University of Silesia, Katowice, and the Institute of Cardiology, Jagiellonian University Medical College, Krakow (P.M.) - all in Poland; the Emergency Department, Lausanne University Hospital, Lausanne, Switzerland (M.P., E.G.); and the Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN (P.M.)
| | - Mathieu Pasquier
- From the Simulation Laboratory of Endoscopic and Minimally Invasive Techniques, Medical University of Gdansk, and the Lung Transplantation Department, Cardiac Surgery Clinic, University Clinical Center, Gdansk (N.B.), the Department of Anesthesiology and Intensive Care (K.M., T.D.) and the Department of Lung Diseases and Tuberculosis, Faculty of Medical Sciences in Zabrze (S.S.), Medical University of Silesia, Katowice, and the Institute of Cardiology, Jagiellonian University Medical College, Krakow (P.M.) - all in Poland; the Emergency Department, Lausanne University Hospital, Lausanne, Switzerland (M.P., E.G.); and the Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN (P.M.)
| | - Piotr Mazur
- From the Simulation Laboratory of Endoscopic and Minimally Invasive Techniques, Medical University of Gdansk, and the Lung Transplantation Department, Cardiac Surgery Clinic, University Clinical Center, Gdansk (N.B.), the Department of Anesthesiology and Intensive Care (K.M., T.D.) and the Department of Lung Diseases and Tuberculosis, Faculty of Medical Sciences in Zabrze (S.S.), Medical University of Silesia, Katowice, and the Institute of Cardiology, Jagiellonian University Medical College, Krakow (P.M.) - all in Poland; the Emergency Department, Lausanne University Hospital, Lausanne, Switzerland (M.P., E.G.); and the Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN (P.M.)
| | - Elena Garcia
- From the Simulation Laboratory of Endoscopic and Minimally Invasive Techniques, Medical University of Gdansk, and the Lung Transplantation Department, Cardiac Surgery Clinic, University Clinical Center, Gdansk (N.B.), the Department of Anesthesiology and Intensive Care (K.M., T.D.) and the Department of Lung Diseases and Tuberculosis, Faculty of Medical Sciences in Zabrze (S.S.), Medical University of Silesia, Katowice, and the Institute of Cardiology, Jagiellonian University Medical College, Krakow (P.M.) - all in Poland; the Emergency Department, Lausanne University Hospital, Lausanne, Switzerland (M.P., E.G.); and the Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN (P.M.)
| | - Tomasz Darocha
- From the Simulation Laboratory of Endoscopic and Minimally Invasive Techniques, Medical University of Gdansk, and the Lung Transplantation Department, Cardiac Surgery Clinic, University Clinical Center, Gdansk (N.B.), the Department of Anesthesiology and Intensive Care (K.M., T.D.) and the Department of Lung Diseases and Tuberculosis, Faculty of Medical Sciences in Zabrze (S.S.), Medical University of Silesia, Katowice, and the Institute of Cardiology, Jagiellonian University Medical College, Krakow (P.M.) - all in Poland; the Emergency Department, Lausanne University Hospital, Lausanne, Switzerland (M.P., E.G.); and the Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN (P.M.)
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Hall N, Métrailler-Mermoud J, Cools E, Fehlmann C, Carron PN, Rousson V, Grabherr S, Schrag B, Kirsch M, Frochaux V, Pasquier M. Hypothermic cardiac arrest patients admitted to hospital who were not rewarmed with extracorporeal life support: A retrospective study. Resusc Plus 2023; 15:100443. [PMID: 37638095 PMCID: PMC10448201 DOI: 10.1016/j.resplu.2023.100443] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 07/13/2023] [Accepted: 07/25/2023] [Indexed: 08/29/2023] Open
Abstract
Aims Our goal was to study hypothermic cardiac arrest (CA) patients who were not rewarmed by Extracorporeal Life Support (ECLS) but were admitted to a hospital equipped for it. The focus was on whether the decisions of non-rewarming, meaning termination of resuscitation, were compliant with international guidelines based on serum potassium at hospital admission. Methods We retrospectively included all hypothermic CA who were not rewarmed, from three Swiss centers between 1st January 2000 and 2nd May 2021. Data were extracted from medical charts and assembled into two groups for analysis according to serum potassium. We identified the criteria used to terminate resuscitation. We also retrospectively calculated the HOPE score, a multivariable tool predicting the survival probability in hypothermic CA undergoing ECLS rewarming. Results Thirty-eight victims were included in the study. The decision of non-rewarming was compliant with international guidelines for 12 (33%) patients. Among the 36 patients for whom the serum potassium was measured at hospital admission, 24 (67%) had a value that - alone - would have indicated ECLS. For 13 of these 24 (54%) patients, the HOPE score was <10%, meaning that ECLS was not indicated. The HOPE estimation of the survival probabilities, when used with a 10% threshold, supported 23 (68%) of the non-rewarming decisions made by the clinicians. Conclusions This study showed a low adherence to international guidelines for hypothermic CA patients. In contrast, most of these non-rewarming decisions made by clinicians would have been compliant with current guidelines based on the HOPE score.
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Affiliation(s)
- Nicolas Hall
- Department of Emergency Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | | | - Evelien Cools
- Acute Medicine Department, Anesthesiology Service, Geneva, Switzerland
| | | | - Pierre-Nicolas Carron
- Department of Emergency Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Valentin Rousson
- Center for Primary Care and Public Health (Unisanté), Lausanne, Switzerland
| | - Silke Grabherr
- University Center of Legal Medicine, Lausanne – Geneva, Switzerland
- Lausanne University Hospital and University of Lausanne, Geneva University Hospital and University of Geneva, Switzerland
| | - Bettina Schrag
- Legal Medicine Service, Hospitals Central Institute (ICH), Sion, Switzerland
| | - Matthias Kirsch
- Department of Cardiac Surgery, Lausanne University Hospital, Lausanne, Switzerland
| | | | - Mathieu Pasquier
- Department of Emergency Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
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Balet L, Ageron FX, Pasquier M, Zingg T. Performance Assessment of Out-of-Hospital Use of Pelvic Circumferential Compression Devices for Severely Injured Patients in Switzerland: A Nationwide Retrospective Cross-Sectional Study. J Clin Med 2023; 12:5509. [PMID: 37685575 PMCID: PMC10487807 DOI: 10.3390/jcm12175509] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 08/09/2023] [Accepted: 08/22/2023] [Indexed: 09/10/2023] Open
Abstract
BACKGROUND Patients with severe pelvic fractures carry a greater risk of severe bleeding, and pelvic compression devices (PCCD) are used to stabilize the pelvis on the pre-hospital scene. The aim of this study was to describe the use of PCCD in the pre-hospital setting on a nationwide scale (Switzerland) and determine the sensitivity, specificity and rates of over- and under-triage of the current application practices. The secondary objective was to identify pre-hospital factors associated with unstable pelvic fractures. METHODS Retrospective cross-sectional study using anonymized patient data (1 January 2015-31 December 2020) from the Swiss Trauma Registry (STR). Based on AIS scores, patients were assigned a unique principal diagnosis among three categories (unstable pelvic fracture-stable pelvic fracture-other) and assessed for use or not of PCCD. Secondarily, patient characteristics, initial pre-hospital vital signs, means of pre-hospital transport and trauma mechanism were also extracted from the database. RESULTS 2790 patients were included for analysis. A PCCD was used in 387 (13.9%) patients. In the PCCD group, 176 (45.5%) had an unstable pelvic fracture, 52 (13.4%) a stable pelvic fracture and 159 (41.1%) an injury unrelated to the pelvic region. In the group who did not receive a PCCD, 214 (8.9%) had an unstable pelvic fracture, 182 (7.6%) a stable pelvic fracture and 2007 (83.5%) an injury unrelated to the pelvic region. The nationwide sensitivity of PCCD application was 45.1% (95% CI 40.1-50.2), the specificity 91.2% (95% CI 90-92.3), with both over- and under-triage rates of 55%. The prevalence of unstable fractures in our population was 14% (390/2790). We identified female sex, younger age, lower systolic blood pressure, higher shock index, pedestrian hit and fall ≥3 m as possible risk factors for an unstable pelvic fracture. CONCLUSIONS Our results demonstrate a nationwide both over- and under-triage rate of 55% for out-of-hospital PCCD application. Female gender, younger age, lower blood pressure, higher shock index, pedestrian hit and fall >3 m are possible risk factors for unstable pelvic fracture, but it remains unclear if those parameters are relevant clinically to perform pre-hospital triage.
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Affiliation(s)
- Lionel Balet
- Faculty of Biology and Medicine, University of Lausanne, 1005 Lausanne, Switzerland
| | - François-Xavier Ageron
- Department of Emergency Medicine, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 46, 1011 Lausanne, Switzerland
| | - Mathieu Pasquier
- Department of Emergency Medicine, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 46, 1011 Lausanne, Switzerland
| | - Tobias Zingg
- Department of Visceral Surgery, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 46, 1011 Lausanne, Switzerland
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Libersa M, Marxer L, Zafren K, Oggier S, Pucci L, Pasquier M. Takotsubo Cardiomyopathy Following Complete Avalanche Burial: A Case Report. High Alt Med Biol 2023; 24:149-151. [PMID: 37262197 DOI: 10.1089/ham.2023.0026] [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] [Indexed: 06/03/2023] Open
Abstract
Libersa, Marie, Louis Marxer, Ken Zafren, Stephane Oggier, Lorenzo Pucci, and Mathieu Pasquier. Takotsubo cardiomyopathy following complete avalanche burial: a case report. High Alt Med Biol. 24:149-151, 2023.-Takotsubo cardiomyopathy is a transient left ventricular dyskinesia triggered by a stressful physical or emotional event. We report a case of mid-ventricular Takotsubo stress cardiomyopathy in an avalanche victim. The patient was a 41-year-old woman who was completely buried under 1.2 m of snow for 30 minutes. On arrival at the hospital, she was conscious and hypothermic (core temperature 33.7°C). Her ECG showed rapid atrial fibrillation (142 beats/min) that converted to sinus rhythm after rewarming and administration of crystalloids. Echocardiography showed akinesia of the left mid-ventricle with a left ventricular ejection fraction of 41%. At 48-hour follow-up, echocardiography showed an almost complete recovery. During her hospital stay the patient was diagnosed with an acute stress disorder with symptoms of dissociation. She was discharged home after 5 days. At 2-week follow-up echocardiography was normal. Psychological follow-up was normal at 7 months. The physical and psychological stress of the avalanche, as well as hypothermia, were all possible triggers of Takotsubo cardiomyopathy.
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Affiliation(s)
- Marie Libersa
- Intensive Care Department, Valais Hospital, Sion, Switzerland
| | - Louis Marxer
- Department of Anesthesiology, Valais Hospital, Viège, Switzerland
| | - Ken Zafren
- Department of Emergency Medicine Stanford University Medical Center, Stanford, California, USA
- Department of Emergency Medicine, Alaska Native Medical Center, Anchorage, Alaska, USA
| | | | - Lorenzo Pucci
- Honorary Fellow, Royal Brompton and Harefield Hospitals, London, United Kingdom
| | - Mathieu Pasquier
- Emergency Department, Lausanne University Hospital, Lausanne, Switzerland
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Massin N, Abdennebi I, Porcu-Buisson G, Chevalier N, Descat E, Piétin-Vialle C, Goro S, Brussieux M, Pinto M, Pasquier M, Bry-Gauillard H. The BISTIM study: a randomized controlled trial comparing dual ovarian stimulation (duostim) with two conventional ovarian stimulations in poor ovarian responders undergoing IVF. Hum Reprod 2023; 38:927-937. [PMID: 36864699 PMCID: PMC10152167 DOI: 10.1093/humrep/dead038] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 02/04/2023] [Indexed: 03/04/2023] Open
Abstract
STUDY QUESTION Is the total number of oocytes retrieved with dual ovarian stimulation in the same cycle (duostim) higher than with two consecutive antagonist cycles in poor responders? SUMMARY ANSWER Based on the number of total and mature oocytes retrieved in women with poor ovarian response (POR), there is no benefit of duostim versus two consecutive antagonist cycles. WHAT IS KNOWN ALREADY Recent studies have shown the ability to obtain oocytes with equivalent quality from the follicular and the luteal phase, and a higher number of oocytes within one cycle when using duostim. If during follicular stimulation smaller follicles are sensitized and recruited, this may increase the number of follicles selected in the consecutive luteal phase stimulation, as shown in non-randomized controlled trials (RCT). This could be particularly relevant for women with POR. STUDY DESIGN, SIZE, DURATION This is a multicentre, open-labelled RCT, performed in four IVF centres from September 2018 to March 2021. The primary outcome was the number of oocytes retrieved over the two cycles. The primary objective was to demonstrate in women with POR that two ovarian stimulations within the same cycle (first in the follicular phase, followed by a second in the luteal phase) led to the retrieval of 1.5 (2) more oocytes than the cumulative number of oocytes from two consecutive conventional stimulations with an antagonist protocol. In a superiority hypothesis, with power 0.8 alpha-risk 0.05 and a 35% cancellation rate, 44 patients were needed in each group. Patients were randomized by computer allocation. PARTICIPANTS/MATERIALS, SETTING, METHODS Eighty-eight women with POR, defined using adjusted Bologna criteria (antral follicle count ≤5 and/or anti-Müllerian hormone ≤1.2 ng/ml) were randomized, 44 in the duostim group and 44 in the conventional (control) group. HMG 300 IU/day with flexible antagonist protocol was used for ovarian stimulation, except in luteal phase stimulation of the duostim group. In the duostim group, oocytes were pooled and inseminated after the second retrieval, with a freeze-all protocol. Fresh transfers were performed in the control group, frozen embryo transfers were performed in both control and duostim groups in natural cycles. Data underwent intention-to-treat and per-protocol analyses. MAIN RESULTS AND THE ROLE OF CHANCE There was no difference between the groups regarding demographics, ovarian reserve markers, and stimulation parameters. The mean (SD) cumulative number of oocytes retrieved from two ovarian stimulations was not statistically different between the control and duostim groups, respectively, 4.6 (3.4) and 5.0 (3.4) [mean difference (MD) [95% CI] +0.4 [-1.1; 1.9], P = 0.56]. The mean cumulative numbersof mature oocytes and total embryos obtained were not significantly different between groups. The total number of embryos transferred by patient was significantly higher in the control group 1.5 (1.1) versus the duostim group 0.9 (1.1) (P = 0.03). After two cumulative cycles, 78% of women in the control group and 53.8% in the duostim group had at least one embryo transfer (P = 0.02). There was no statistical difference in the mean number of total and mature oocytes retrieved per cycle comparing Cycle 1 versus Cycle 2, both in control and duostim groups. The time to the second oocyte retrieval was significantly longer in controls, at 2.8 (1.3) months compared to 0.3 (0.5) months in the duostim group (P < 0.001). The implantation rate was similar between groups. The cumulative live birth rate was not statistically different, comparing controls versus the duostim group, 34.1% versus 17.9%, respectively (P = 0.08). The time to transfer resulting in an ongoing pregnancy did not differ in controls 1.7 (1.5) months versus the duostim group, 3.0 (1.6) (P = 0.08). No serious adverse events were reported. LIMITATIONS, REASONS FOR CAUTION The RCT was impacted by the coronavirus disease 2019 pandemic and the halt in IVF activities for 10 weeks. Delays were recalculated to exclude this period; however, one woman in the duostim group could not have the luteal stimulation. We also faced unexpected good ovarian responses and pregnancies after the first oocyte retrieval in both groups, with a higher incidence in the control group. However, our hypothesis was based on 1.5 more oocytes in the luteal than the follicular phase in the duostim group, and the number of patients to treat was reached in this group (N = 28). This study was only powered for cumulative number of oocytes retrieved. WIDER IMPLICATIONS OF THE FINDINGS This is the first RCT comparing the outcome of two consecutive cycles, either in the same menstrual cycle or in two consecutive menstrual cycles. In routine practice, the benefit of duostim in patients with POR regarding fresh embryo transfer is not confirmed in this RCT: first, because this study demonstrates no improvement in the number of oocytes retrieved in the luteal phase after follicular phase stimulation, in contrast to previous non-randomized studies, and second, because the freeze-all strategy avoids a pregnancy with fresh embryo transfer after the first cycle. However, duostim appears to be safe for women. In duostim, the two consecutive processes of freezing/thawing are mandatory and increase the risk of wastage of oocytes/embryos. The only benefit of duostim is to shorten the time to a second retrieval by 2 weeks if accumulation of oocytes/embryos is needed. STUDY FUNDING/COMPETING INTERESTS This is an investigator-initiated study supported by a research Grant from IBSA Pharma. N.M. declares grants paid to their institution from MSD (Organon France); consulting fees from MSD (Organon France), Ferring, and Merck KGaA; honoraria from Merck KGaA, General Electrics, Genevrier (IBSA Pharma), and Theramex; support for travel and meetings from Theramex, Merck KGaG, and Gedeon Richter; and equipment paid to their institution from Goodlife Pharma. I.A. declares honoraria from GISKIT and support for travel and meetings from GISKIT. G.P.-B. declares Consulting fees from Ferring and Merck KGaA; honoraria from Theramex, Gedeon Richter, and Ferring; payment for expert testimony from Ferring, Merck KGaA, and Gedeon Richter; and support for travel and meetings from Ferring, Theramex, and Gedeon Richter. N.C. declares grants from IBSA pharma, Merck KGaA, Ferring, and Gedeon Richter; support for travel and meetings from IBSA pharma, Merck KGaG, MSD (Organon France), Gedeon Richter, and Theramex; and participation on advisory board from Merck KGaA. E.D. declares support for travel and meetings from IBSA pharma, Merck KGaG, MSD (Organon France), Ferring, Gedeon Richter, Theramex, and General Electrics. C.P.-V. declares support for travel and meetings from IBSA Pharma, Merck KGaA, Ferring, Gedeon Richter, and Theramex. M.Pi. declares support for travel and meetings from Ferring, Gedeon Richetr, and Merck KGaA. M.Pa. declares honoraria from Merck KGaA, Theramex, and Gedeon Richter; support for travel and meetings from Merck KGaA, IBSA Pharma, Theramex, Ferring, Gedeon Richter, and MSD (Organon France). H.B.-G. declares honoraria from Merck KGaA, and Gedeon Richter and support for travel and meetings from Ferring, Merck KGaA, IBSA Pharma, MSD (Organon France), Theramex, and Gedeon Richter. S.G. and M.B. have nothing to declare. TRIAL REGISTRATION NUMBER Registration number EudraCT: 2017-003223-30. ClinicalTrials.gov identifier: NCT03803228. TRIAL REGISTRATION DATE EudraCT: 28 July 2017. ClinicalTrials.gov: 14 January 2019. DATE OF FIRST PATIENT’S ENROLMENT 3 September 2018.
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Affiliation(s)
- N Massin
- Intercommunal Hospital of Creteil, Reproductive Medicine Department, Creteil, France
| | - I Abdennebi
- Intercommunal Hospital of Creteil, Reproductive Medicine Department, Creteil, France
| | - G Porcu-Buisson
- Institut de Médecine de la Reproduction, Reproductive Medicine, Marseille, France
| | - N Chevalier
- Clinique Saint Roch, Reproductive Medicine, Montpellier, France
| | - E Descat
- Clinique Jean Villar, Reproductive Medicine, Bruges, France
| | - C Piétin-Vialle
- Intercommunal Hospital of Creteil, Reproductive Medicine Department, Creteil, France
| | - S Goro
- Intercommunal Hospital of Creteil, Clinical Research Centre, Creteil, France
| | - M Brussieux
- Intercommunal Hospital of Creteil, Clinical Research Centre, Creteil, France
| | - M Pinto
- Intercommunal Hospital of Creteil, Reproductive Medicine Department, Creteil, France
| | - M Pasquier
- Intercommunal Hospital of Creteil, Reproductive Medicine Department, Creteil, France
| | - H Bry-Gauillard
- Intercommunal Hospital of Creteil, Reproductive Medicine Department, Creteil, France
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Pasquier M, Strapazzon G, Kottmann A, Paal P, Zafren K, Oshiro K, Artoni C, Van Tilburg C, Sheets A, Ellerton J, McLaughlin K, Gordon L, Martin RW, Jacob M, Musi M, Blancher M, Jaques C, Brugger H. On-site treatment of avalanche victims: Scoping review and 2023 recommendations of the international commission for mountain emergency medicine (ICAR MedCom). Resuscitation 2023; 184:109708. [PMID: 36709825 DOI: 10.1016/j.resuscitation.2023.109708] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [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: 12/14/2022] [Revised: 01/17/2023] [Accepted: 01/18/2023] [Indexed: 01/27/2023]
Abstract
INTRODUCTION The International Commission for Mountain Emergency Medicine (ICAR MedCom) developed updated recommendations for the management of avalanche victims. METHODS ICAR MedCom created Population Intervention Comparator Outcome (PICO) questions and conducted a scoping review of the literature. We evaluated and graded the evidence using the American College of Chest Physicians system. RESULTS We included 120 studies including original data in the qualitative synthesis. There were 45 retrospective studies (38%), 44 case reports or case series (37%), and 18 prospective studies on volunteers (15%). The main cause of death from avalanche burial was asphyxia (range of all studies 65-100%). Trauma was the second most common cause of death (5-29%). Hypothermia accounted for few deaths (0-4%). CONCLUSIONS AND RECOMMENDATIONS For a victim with a burial time ≤ 60 minutes without signs of life, presume asphyxia and provide rescue breaths as soon as possible, regardless of airway patency. For a victim with a burial time > 60 minutes, no signs of life but a patent airway or airway with unknown patency, presume that a primary hypothermic CA has occurred and initiate cardiopulmonary resuscitation (CPR) unless temperature can be measured to rule out hypothermic cardiac arrest. For a victim buried > 60 minutes without signs of life and with an obstructed airway, if core temperature cannot be measured, rescuers can presume asphyxia-induced CA, and should not initiate CPR. If core temperature can be measured, for a victim without signs of life, with a patent airway, and with a core temperature < 30 °C attempt resuscitation, regardless of burial duration.
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Affiliation(s)
- M Pasquier
- Emergency Department, Lausanne University Hospital, Lausanne, Switzerland; International Commission for Mountain Emergency Medicine (ICAR MedCom), Zürich, Switzerland.
| | - G Strapazzon
- Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy; Medical University Innsbruck, Innsbruck, Austria; International Commission for Mountain Emergency Medicine (ICAR MedCom), Zurich, Switzerland.
| | - A Kottmann
- Swiss Air Ambulance - Rega, Zurich Airport, Switzerland; Emergency Department, Lausanne University Hospital, Lausanne, Switzerland; Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; International Commission for Mountain Emergency Medicine (ICAR MedCom), Zürich, Switzerland.
| | - P Paal
- Department of Anaesthesiology and Intensive Care Medicine, St. John of God Hospital, Paracelsus Medical University Salzburg, Austria; International Commission for Mountain Emergency Medicine (ICAR MedCom), Zurich, Switzerland
| | - K Zafren
- Department of Emergency Medicine, Alaska Native Medical Center Anchorage, Alaska, USA; Department of Emergency Medicine Stanford University Medical Center Stanford, CA, USA; International Commission for Mountain Emergency Medicine (ICAR MedCom), Zürich, Switzerland
| | - K Oshiro
- Cardiovascular Department, Mountain Medicine, Research, & Survey Division, Hokkaido Ohno Memorial Hospital, Hokkaido, Japan; Department of Internal Medicine, Nihon University School of Medicine, Tokyo, Japan; International Commission for Mountain Emergency Medicine (ICAR MedCom), Zürich, Switzerland
| | - C Artoni
- ICAR Avalanche Rescue Commission, Zürich, Switzerland.
| | - C Van Tilburg
- Providence Hood River Memorial Hospital, Hood River, Oregon, USA; Mountain Rescue Association, USA; International Commission for Mountain Emergency Medicine (ICAR MedCom), Zürich, Switzerland.
| | - A Sheets
- Emergency Department, Boulder Community Health, Boulder, CO, USA; University of Colorado Wilderness and Environmental Medicine Fellowship Faculty, Aurora, CO, USA; International Commission for Mountain Emergency Medicine (ICAR MedCom), Zürich, Switzerland.
| | - J Ellerton
- International Commission for Mountain Emergency Medicine (ICAR MedCom), Zürich, Switzerland
| | - K McLaughlin
- Canmore Hospital, Alberta, Canada; University of Calgary, Canada; International Commission for Mountain Emergency Medicine (ICAR MedCom), Zürich, Switzerland.
| | - L Gordon
- Department of Anaesthesia, University Hospitals of Morecambe Bay Trust, Lancaster, England; Langdale Ambleside Mountain Rescue Team, England; International Commission for Mountain Emergency Medicine (ICAR MedCom), Zürich, Switzerland
| | - R W Martin
- Mountain Rescue Association, USA; ICAR Avalanche Rescue Commission, Zürich, Switzerland.
| | - M Jacob
- Bavarian Mountain Rescue Service, Bad Tölz, Germany; International Commission for Mountain Emergency Medicine (ICAR MedCom), Zürich, Switzerland.
| | - M Musi
- Emergency Department, University of Colorado, Aurora, Colorado, USA; International Commission for Mountain Emergency Medicine (ICAR MedCom), Zürich, Switzerland.
| | - M Blancher
- Department of Emergency Medicine, University Hospital of Grenoble Alps Grenoble, France; International Commission for Mountain Emergency Medicine (ICAR MedCom), Zürich, Switzerland.
| | - C Jaques
- Lausanne University Medical Library, Lausanne, Switzerland.
| | - H Brugger
- Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy; Medical University Innsbruck, Innsbruck, Austria; International Commission for Mountain Emergency Medicine (ICAR MedCom), Zurich, Switzerland.
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Sabione I, Giacalone S, Herkert C, Carron P, Pasquier M. Tamponnade cardiaque. Ann Fr Med Urgence 2023. [DOI: 10.3166/afmu-2022-0482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023]
Abstract
La tamponnade cardiaque est une urgence vitale. Elle se définit comme une accumulation de liquide dans l’espace intrapéricardique, favorisant une augmentation de la pression intrapéricardique et une altération du remplissage cardiaque. Il s’agit d’une des causes du choc obstructif, et la rapidité d’installation détermine le degré d’instabilité hémodynamique. La morbidité et la mortalité dépendent de la rapidité du diagnostic et de sa prise en charge. Peu fréquemment, l’étiologie est tumorale. Ce type d’étiologie se traduit le plus souvent par des tableaux cliniques d’installation lente et progressive. C’est le cas du sujet qui est présenté dans cet article : un homme de 50 ans sans suivi médical et consommateur d’alcool et de tabac, vivant dans un contexte social difficile. L’issue fatale du cas clinique témoigne de la gravité du tableau de présentation initiale. L’électrocardiogramme peut révéler des signes caractéristiques comme le microvoltage du QRS et l’alternance électrique. La méthode standard pour détecter un épanchement péricardique est l’échocardiographie : le diagnostic de tamponnade cardiaque requiert la présence de collapsus complet du coeur droit et dans les cas plus graves des cavités gauches. Les compétences de l’urgentiste en termes d’échographie permettent un diagnostic plus rapide et précis. Le traitement de la tamponnade cardiaque repose principalement sur le soutien hémodynamique (administration volumique et traitement des éventuels troubles du rythme secondaires) en urgence. Cependant, le traitement définitif reste le drainage du liquide accumulé par péricardiocentèse ou par approche chirurgicale.
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Ellerton JA, Pasquier M, Paal P, Strapazzon G, Darocha T, Brugger H. A Response to "EDCB ET AA: A Mnemonic for Resuscitating Hypothermic Patients Under Extreme Conditions.". Anesth Analg 2022; 135:e40-e41. [PMID: 36269996 DOI: 10.1213/ane.0000000000006202] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
| | - Mathieu Pasquier
- Department of Emergency Medicine, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Peter Paal
- Department of Anaesthesiology and Intensive Care Medicine, St John of God Hospital, Paracelsus Medical University, Salzburg, Austria
| | - Giacomo Strapazzon
- Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy
| | - Tomasz Darocha
- Department of Anaesthesiology and Intensive Care, Medical University of Silesia, Katowice, Poland
| | - Hermann Brugger
- Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy
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13
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Gosselin M, Mabire C, Pasquier M, Carron PN, Hugli O, Ageron FX, Dami F. Prevalence and clinical significance of point of care elevated lactate at emergency admission in older patients: a prospective study. Intern Emerg Med 2022; 17:1803-1812. [PMID: 35678940 PMCID: PMC9178320 DOI: 10.1007/s11739-022-03005-w] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 05/14/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Patients who are over 65 years old represent up to 24% of emergency department (ED) admissions. They are at increased risk of under-triage due to impaired physiological responses. The primary objective of this study was to assess the prevalence of elevated lactate by point of care testing (POCT) in this population. The secondary objective was to assess the additional value of lactate level in predicting an early poor outcome, as compared to and combined with common clinical scores and triage scales. METHODS This monocentric prospective study recruited ED patients who were over 65 years old between July 19th 2019 and June 17th 2020. Patients consulting for seizures or needing immediate assessment were excluded. POCT lactates were considered elevated if ≥ 2.5 mmol/L. A poor outcome was defined based on certain complications or therapeutic decisions. RESULTS In total, 602 patients were included; 163 (27.1%) had elevated lactate and 44 (7.3%) had a poor outcome. There was no association between poor outcome and lactate level. Modified Early Warning Score (MEWS) was significantly associated with poor outcome, alongside National Early Warning Score (NEWS). Logistic regression also associated lactate level combined with MEWS and poor outcome. CONCLUSION The prevalence of elevated lactate was 27.1%. Lactate level alone or combined with different triage scales or clinical scores such as MEWS, NEWS and qSOFA was not associated with prediction of a poor outcome. MEWS alone performed best in predicting poor outcome. The usefulness of POCT lactate measurement at triage is questionable in the population of 65 and above.
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Affiliation(s)
- Mélanie Gosselin
- grid.9851.50000 0001 2165 4204Emergency Department, Lausanne University Hospital, University of Lausanne, 1011 Lausanne, Switzerland
| | - Cédric Mabire
- grid.8515.90000 0001 0423 4662Institute of Higher Education and Research in Healthcare, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Mathieu Pasquier
- grid.9851.50000 0001 2165 4204Emergency Department, Lausanne University Hospital, University of Lausanne, 1011 Lausanne, Switzerland
| | - Pierre-Nicolas Carron
- grid.9851.50000 0001 2165 4204Emergency Department, Lausanne University Hospital, University of Lausanne, 1011 Lausanne, Switzerland
| | - Olivier Hugli
- grid.9851.50000 0001 2165 4204Emergency Department, Lausanne University Hospital, University of Lausanne, 1011 Lausanne, Switzerland
| | - Françcois-Xavier Ageron
- grid.9851.50000 0001 2165 4204Emergency Department, Lausanne University Hospital, University of Lausanne, 1011 Lausanne, Switzerland
| | - Fabrice Dami
- grid.9851.50000 0001 2165 4204Emergency Department, Lausanne University Hospital, University of Lausanne, 1011 Lausanne, Switzerland
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Pasquier M, Hugli O, Hall N, Rousson V, Darocha T. Outcome prediction for hypothermic patients in cardiac arrest. J Intensive Care 2022; 10:37. [PMID: 35902949 PMCID: PMC9331069 DOI: 10.1186/s40560-022-00630-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 07/21/2022] [Indexed: 11/13/2022] Open
Abstract
The 5A score predicts in-hospital mortality of patients suffering from accidental hypothermia, including those not in cardiac arrest. The HOPE score was specifically developed to predict survival for the subgroup of hypothermic patients in cardiac considered for extracorporeal life support rewarming. The C-statistic in the external validation study of the HOPE score was 0.825 (95% CI: 0.753–0.897), confirming its excellent discrimination. In addition, its good calibration allows for a reliable interpretation of the corresponding survival probability after rewarming. The HOPE score should be used for predicting outcome and selecting hypothermic patients in cardiac arrest for rewarming.
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Affiliation(s)
- Mathieu Pasquier
- Department of Emergency Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
| | - Olivier Hugli
- Department of Emergency Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Nicolas Hall
- Department of Emergency Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Valentin Rousson
- Institute of Social and Preventive Medicine, Unisanté, route de la Corniche 10, 1010, Lausanne, Switzerland
| | - Tomasz Darocha
- Severe Accidental Hypothermia Center, Department of Anaesthesiology and Intensive Care, Medical University of Silesia, Katowice, Poland
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15
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Massin N, Chevalier N, Descat E, Piétin-Vialle C, Bry-Gauillard H, Issa A, Brussieux M, Pasquier M, Porcu-Buisson G. O-068 The BISTIM study: first RCT comparing dual ovarian stimulation on the same cycle (duostim) vs 2 conventional ovarian stimulations in poor ovarian responders undergoing IVF. Hum Reprod 2022. [DOI: 10.1093/humrep/deac104.082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Study question
Is the number of cumulated oocytes with dual ovarian stimulation on the same cycle (duostim) higher compared to 2 consecutive antagonist cycles in poor responders?
Summary answer
Considering the number of total and mature oocytes collected in poor ovarian responders, there is no benefit of duostim vs two consecutive antagonist cycles.
What is known already
Several waves of follicular development exist on the same cycle. Recent studies have shown the ability to obtain oocytes with equivalent quality in the luteal phase, even after a previous ovarian stimulation in the follicular phase. During stimulation, smaller follicles are recruited and sensitized, which may increase the selection of follicles available on the second stimulation. In poor ovarian responders (POR) this potentialization may have a great interest, as 2 stimulations on the same cycle could give a higher number of oocytes compared to two conventional stimulations. However, these preliminary data need to be confirmed with a randomized controlled trial.
Study design, size, duration
This is a multicenter, open-labeled randomized control trial (2018, september – 2021, march). The primary objective was to demonstrate that two ovarian stimulations within the same cycle (first in the follicular phase, followed by a second in the luteal phase) lead to the retrevial of 1.5 more oocytes than the cumulative number of oocytes from two consecutive conventional stimulation, in POR women. According to this hypothesis, 44 patients were needed in each group.
Participants/materials, setting, methods
88 POR women, defined with Bologna criteria (AFC≤5 and/or AMH≤1.2ng/ml and ≤3 oocytes if previous IVF) were randomized, 44 in duostim group (D) and 44 in conventional group (C). FertistartKit® 300IU/day with antagonist protocol was used except in luteal phase stimulation of group D. In group D, oocytes were pooled and inseminated after the second retrieval, with freeze all embryos. Fresh transfer was performed in group C. The analysis is presented in intention to treat.
Main results and the role of chance
There was no difference between the groups regarding demographics, ovarian reserve markers (AFC, AMH) and stimulation parameters. The mean number of cumulated oocytes retrieved with 2 ovarian stimulation was not statistically different in group D and C, respectively 5.0+/-3.4 and 4.6+/-3.4 (p = 0.56). The mean number of cumulated mature oocytes was not statistically different, 3.7+/-3.3 in group D vs 3.1+/-3.0 in group C (p = 0.38). The mean number of embryos was significantly lower in the group D, 0.8+/-1.3 vs group C 1.6+/-1.3 (p < 0.01). There was no statistical difference of the mean number of oocytes retrieved per cycle in cycle 1 vs cycle 2 in both group D and C. The delay, between the first and the second day 1 of stimulation was statistically different in group D 14.4 days (10-19) vs group C 90.6 (28-232). The ongoing pregnancy rate in group D 17.9% (7/39) was not statistically different with group C 29.3% (12/41), (p = 0.23). And the mean time to ongoing pregnancy tends to be longer in group D (144 days) vs group C (115 days) but was not statistically different (p = 0.21).
Limitations, reasons for caution
The RCT was impacted by Covid pandemia and stop of IVF activities for 10 weeks. Delays were recalculated to exclude this period, however one women in group D cannot have the luteal stimulation. We also faced unexpected good ovarian responses and pregnancies after the first oocyte pick-up in group C.
Wider implications of the findings
In routine practice, the benefit of duostim in patients with POR is not confirmed. Firstly, because there is no potentialization on the number of oocyte retrieved in luteal phase after follicular phase stimulation. Secondly, because the freeze all strategy avoids a pregnancy with fresh embryo transfer after the first cycle.
Trial registration number
2017-A00498-45
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Affiliation(s)
- N Massin
- Intercommunal Hospital of Créteil, Reproductive Medicine Departement, Créteil , France
| | - N Chevalier
- Clinique Saint Roch, Reproductive Medicine, Montpellier , France
| | - E Descat
- Clinique Jean Vilar, Reproductive Medicine, Bruges , France
| | - C Piétin-Vialle
- Intercommunal Hospital of Créteil, Reproductive Medicine Departement, Créteil , France
| | - H Bry-Gauillard
- Intercommunal Hospital of Créteil, Reproductive Medicine Departement, Créteil , France
| | - A Issa
- Intercommunal Hospital of Créteil, Clinical Research Center, Créteil , France
| | - M Brussieux
- Intercommunal Hospital of Créteil, Clinical Research Center, Créteil , France
| | - M Pasquier
- Intercommunal Hospital of Créteil, Reproductive Medicine Departement, Créteil , France
| | - G Porcu-Buisson
- Institut de Médecine de la Reproduction, Reproductive Medicine, Marseille , France
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Tataru C, Dessapt AL, Pietin-Vialle C, Pasquier M, Bry-Gauillard H, Massin N. [Dydrogesterone versus micronized vaginal progesterone as luteal phase support after fresh embryo transfer in IVF]. Gynecol Obstet Fertil Senol 2022; 50:455-461. [PMID: 34999287 DOI: 10.1016/j.gofs.2021.12.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 12/28/2021] [Accepted: 12/30/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVES The objective of the study was to compare the live birth rate and miscarriage rate after fresh embryo transfer (Fresh ET) when patients are treated either with oral dydrogesterone or micronized vaginal progesterone (MVP) as luteal phase support (LPS). The vaginal route is still preferred, despite the discomfort for the patients and recent RCTs showing similar results for dydrogesterone and MVP. METHODS All 556 consecutive Fresh ET after autologous IVF procedure, from December 2011 to March 2013 in one centre in France were included. Patients were treated either with dydrogesterone 10mg every 12hours (n=267) or MVP 200mg every 12hours (n=289), the physician's arbitrary choice on the day of the oocyte aspiration procedure. RESULTS The groups were comparable regarding the demographic data and stimulation protocols, except for the rank of the oocyte pickup procedure [1.54±0.80 vs. 1.74±0.96, (P=0.01)], with no significant difference in live birth rates (22.4% vs. 23.8%, P=0.77) and miscarriage rates (4.1% vs. 5.5%, P=0.55) for dydrogesterone vs. MVP respectively. The results were similar in a good prognosis patients' subgroup. CONCLUSIONS LPS with either dydrogesterone or MVP after Fresh ET showed similar live birth rates and miscarriage rates. The benefits of the oral over vaginal route might be higher tolerance and possibly better compliance. Dydrogesterone seems to be a safe treatment, but its long-term innocuity needs to be further proven.
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Affiliation(s)
- C Tataru
- Service de Gynécologie-Obstétrique et Médecine de la Reproduction, Centre Hospitalier Intercommunal de Créteil, Université Paris-Est-Val-de-Marne, 40, Avenue de Verdun, 94000 Créteil, France.
| | - A-L Dessapt
- Service de Gynécologie-Obstétrique et Médecine de la Reproduction, Centre Hospitalier Intercommunal de Créteil, Université Paris-Est-Val-de-Marne, 40, Avenue de Verdun, 94000 Créteil, France
| | - C Pietin-Vialle
- Service de Gynécologie-Obstétrique et Médecine de la Reproduction, Centre Hospitalier Intercommunal de Créteil, Université Paris-Est-Val-de-Marne, 40, Avenue de Verdun, 94000 Créteil, France
| | - M Pasquier
- Service de Gynécologie-Obstétrique et Médecine de la Reproduction, Centre Hospitalier Intercommunal de Créteil, Université Paris-Est-Val-de-Marne, 40, Avenue de Verdun, 94000 Créteil, France
| | - H Bry-Gauillard
- Service de Gynécologie-Obstétrique et Médecine de la Reproduction, Centre Hospitalier Intercommunal de Créteil, Université Paris-Est-Val-de-Marne, 40, Avenue de Verdun, 94000 Créteil, France
| | - N Massin
- Service de Gynécologie-Obstétrique et Médecine de la Reproduction, Centre Hospitalier Intercommunal de Créteil, Université Paris-Est-Val-de-Marne, 40, Avenue de Verdun, 94000 Créteil, France
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Rauch S, Koppenberg J, Josi D, Meuli L, Strapazzon G, Pasquier M, Albrecht R, Brugger H, Zweifel B, Pietsch U. Avalanche survival depends on the time of day of the accident: A retrospective observational study. Resuscitation 2022; 174:47-52. [PMID: 35341911 DOI: 10.1016/j.resuscitation.2022.03.023] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 03/15/2022] [Accepted: 03/18/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION We aimed to investigate the relationship between the time of the day and the probability of survival of completely buried avalanche victims. We explored the frequency of avalanche burials occurring after sunset, and described victims' characteristics, duration of burial and rescue circumstances compared to daytime avalanches. METHODS In this retrospective, observational study, we analysed avalanche data from the registry of the Swiss Institute for Snow and Avalanche Research, from 1998 to 2020. RESULTS A total of 3,892 avalanche victims were included in the analysis, with 72 of the accidents (1.85%) occurring in the nighttime. Nearly 50% of the victims involved in nighttime avalanche accidents were completely buried, compared to about 25% of victims in daytime avalanches. Completely buried victims were rescued by a companion less often at night than in the daytime (15% vs. 51%, p<.001). The search and rescue of completely buried avalanche victims took longer during the nighttime compared to the daytime (median 89 min vs 20 min, p=.002). The probability of survival decreased as the day progressed; it was highest at around midday (63.0%), but decreased at sunset (40.4%) and was the lowest at midnight (28.7%). CONCLUSIONS Avalanche accidents at night are a rare event, and probability of survival after complete burial is lower during the nighttime compared to the daytime. The most relevant reason for this is the longer duration of burial, which is explained in part by the lower rate of companion rescue and the lower rate of victim localisation with an avalanche transceiver.
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Affiliation(s)
- Simon Rauch
- Department of Anaesthesiology and Intensive Care Medicine, F. Tappeiner Hospital, Merano, Italy; Institute of Mountain Emergency Medicine, Eurac Research, Bozen, Italy.
| | - Joachim Koppenberg
- Department of Anaesthesiology, Pain Therapy and Emergency Medicine, Lower Engadine Hospital and Health Centre, Scuol, Switzerland; Aquatic Ecology, Institute of Ecology and Evolution, University of Bern, Bern, Switzerland.
| | - Dario Josi
- Aquatic Ecology, Institute of Ecology and Evolution, University of Bern, Bern, Switzerland; Department of Fish Ecology and Evolution, EAWAG Swiss Federal Institute of Aquatic Science and Technology, Center for Ecology, Evolution and Biogeochemistry, Kastanienbaum, Switzerland.
| | - Lorenz Meuli
- Department of Vascular Surgery, University Hospital Zurich, Zurich, Switzerland.
| | - Giacomo Strapazzon
- Institute of Mountain Emergency Medicine, Eurac Research, Bozen, Italy; Department of Anaesthesiology and Intensive Care Medicine, Innsbruck Medical University, Innsbruck, Austria.
| | - Mathieu Pasquier
- Emergency Department, Lausanne University Hospital, Lausanne, Switzerland.
| | - Roland Albrecht
- Swiss Air-Ambulance, Rega (Rettungsflugwacht/Guarde Aérienne), Zurich, Switzerland; Department of Anaesthesiology and Intensive Care Medicine, Cantonal Hospital St, Gallen, St. Gallen, Switzerland.
| | - Hermann Brugger
- Institute of Mountain Emergency Medicine, Eurac Research, Bozen, Italy; Department of Anaesthesiology and Intensive Care Medicine, Innsbruck Medical University, Innsbruck, Austria.
| | - Benjamin Zweifel
- WSL Institute for Snow and Avalanche Research SLF, Davos, Switzerland.
| | - Urs Pietsch
- Swiss Air-Ambulance, Rega (Rettungsflugwacht/Guarde Aérienne), Zurich, Switzerland; Department of Anaesthesiology and Intensive Care Medicine, Cantonal Hospital St, Gallen, St. Gallen, Switzerland; Department of Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
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Swol J, Darocha T, Paal P, Brugger H, Podsiadło P, Kosiński S, Puślecki M, Ligowski M, Pasquier M. Extracorporeal Life Support in Accidental Hypothermia with Cardiac Arrest-A Narrative Review. ASAIO J 2022; 68:153-162. [PMID: 34261875 PMCID: PMC8797003 DOI: 10.1097/mat.0000000000001518] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Severely hypothermic patients, especially suffering cardiac arrest, require highly specialized treatment. The most common problems affecting the recognition and treatment seem to be awareness, logistics, and proper planning. In severe hypothermia, pathophysiologic changes occur in the cardiovascular system leading to dysrhythmias, decreased cardiac output, decreased central nervous system electrical activity, cold diuresis, and noncardiogenic pulmonary edema. Cardiac arrest, multiple organ dysfunction, and refractory vasoplegia are indicative of profound hypothermia. The aim of these narrative reviews is to describe the peculiar pathophysiology of patients suffering cardiac arrest from accidental hypothermia. We describe the good chances of neurologic recovery in certain circumstances, even in patients presenting with unwitnessed cardiac arrest, asystole, and the absence of bystander cardiopulmonary resuscitation. Guidance on patient selection, prognostication, and treatment, including extracorporeal life support, is given.
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Affiliation(s)
- Justyna Swol
- From the Deparment of Respiratory Medicine, Allergology and Sleep Medicine, Paracelsus Medical University, Nuremberg, Germany
| | - Tomasz Darocha
- Department of Anesthesiology and Intensive Care, Severe Accidental Hypothermia Center, Medical University of Silesia, Katowice, Poland
| | - Peter Paal
- Department of Anesthesiology and Intensive Care Medicine, Hospitallers Brothers Hospital, Paracelsus Medical University, Salzburg, Austria
| | - Hermann Brugger
- Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy
| | - Paweł Podsiadło
- Department of Emergency Medicine, Jan Kochanowski University, Kielce, Poland
| | - Sylweriusz Kosiński
- Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland
| | - Mateusz Puślecki
- Department of Medical Rescue, Poznan University of Medical Sciences, Poznan, Poland
- Departmentf Cardiac Surgery and Transplantology, Poznan University of Medical Sciences, Poznan, Poland
| | - Marcin Ligowski
- Departmentf Cardiac Surgery and Transplantology, Poznan University of Medical Sciences, Poznan, Poland
| | - Mathieu Pasquier
- Emergency Department, Lausanne University Hospital, Lausanne, Switzerland
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Paal P, Lott C, Brugger H, Falk M, Rousson V, Pasquier M. Reply to Wallner B et al. Prognostication of outcome for hypothermic avalanche victims in cardiac arrest. Resuscitation 2022; 171:123-125. [DOI: 10.1016/j.resuscitation.2021.12.034] [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: 12/28/2021] [Accepted: 12/29/2021] [Indexed: 11/29/2022]
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20
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Kosiński S, Podsiadło P, Darocha T, Pasquier M, Mendrala K, Sanak T, Zafren K. Prehospital Use of Ultrathin Reflective Foils. Wilderness Environ Med 2022; 33:134-139. [PMID: 34998706 DOI: 10.1016/j.wem.2021.11.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 04/14/2021] [Revised: 10/20/2021] [Accepted: 11/15/2021] [Indexed: 11/19/2022]
Abstract
Ultrathin reflective foils (URFs) are widely used to protect patients from heat loss, but there is no clear evidence that they are effective. We review the physics of thermal insulation by URFs and discuss their clinical applications. A conventional view is that the high reflectivity of the metallic side of the URF is responsible for thermal protection. In most circumstances, the heat radiated from a well-clothed body is minimal and the reflecting properties of a URF are relatively insignificant. The reflection of radiant heat can be impaired by condensation and freezing of the moisture on the inner surface and by a tight fit of the URF against the outermost layer of insulation. The protection by thermal insulating materials depends mostly on the ability to trap air and increases with the number of covering layers. A URF as a single layer may be useful in low wind conditions and moderate ambient temperature, but in cold and windy conditions a URF probably best serves as a waterproof outer covering. When a URF is used to protect against hypothermia in a wilderness emergency, it does not matter whether the gold or silver side is facing outward.
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Affiliation(s)
- Sylweriusz Kosiński
- Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland
| | - Paweł Podsiadło
- Institute of Medical Sciences, Jan Kochanowski University Medical College, Kielce, Poland
| | - Tomasz Darocha
- Department of Anaesthesiology and Intensive Care, Medical University of Silesia, Katowice, Poland
| | - Mathieu Pasquier
- Emergency Department, Lausanne University Hospital, Lausanne, Switzerland
| | - Konrad Mendrala
- Department of Anaesthesiology and Intensive Care, Medical University of Silesia, Katowice, Poland
| | - Tomasz Sanak
- Center for Innovative Medical Education, Jagiellonian University Medical College, Krakow, Poland
| | - Ken Zafren
- Department of Emergency Medicine Stanford University Medical Center, Stanford, California Department of Emergency Medicine, Alaska Native Medical Center, Anchorage, Alaska.
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21
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Paal P, Pasquier M, Darocha T, Lechner R, Kosinski S, Wallner B, Zafren K, Brugger H. Accidental Hypothermia: 2021 Update. Int J Environ Res Public Health 2022; 19:501. [PMID: 35010760 PMCID: PMC8744717 DOI: 10.3390/ijerph19010501] [Citation(s) in RCA: 52] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 12/08/2021] [Accepted: 12/09/2021] [Indexed: 12/13/2022]
Abstract
Accidental hypothermia is an unintentional drop of core temperature below 35 °C. Annually, thousands die of primary hypothermia and an unknown number die of secondary hypothermia worldwide. Hypothermia can be expected in emergency patients in the prehospital phase. Injured and intoxicated patients cool quickly even in subtropical regions. Preventive measures are important to avoid hypothermia or cooling in ill or injured patients. Diagnosis and assessment of the risk of cardiac arrest are based on clinical signs and core temperature measurement when available. Hypothermic patients with risk factors for imminent cardiac arrest (temperature < 30 °C in young and healthy patients and <32 °C in elderly persons, or patients with multiple comorbidities), ventricular dysrhythmias, or systolic blood pressure < 90 mmHg) and hypothermic patients who are already in cardiac arrest, should be transferred directly to an extracorporeal life support (ECLS) centre. If a hypothermic patient arrests, continuous cardiopulmonary resuscitation (CPR) should be performed. In hypothermic patients, the chances of survival and good neurological outcome are higher than for normothermic patients for witnessed, unwitnessed and asystolic cardiac arrest. Mechanical CPR devices should be used for prolonged rescue, if available. In severely hypothermic patients in cardiac arrest, if continuous or mechanical CPR is not possible, intermittent CPR should be used. Rewarming can be accomplished by passive and active techniques. Most often, passive and active external techniques are used. Only in patients with refractory hypothermia or cardiac arrest are internal rewarming techniques required. ECLS rewarming should be performed with extracorporeal membrane oxygenation (ECMO). A post-resuscitation care bundle should complement treatment.
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Affiliation(s)
- Peter Paal
- Department of Anesthesiology and Intensive Care Medicine, St. John of God Hospital, Paracelsus Medical University, 5020 Salzburg, Austria
- International Commission for Mountain Emergency Medicine (ICAR MedCom), 8302 Kloten, Switzerland; (M.P.); (K.Z.); (H.B.)
| | - Mathieu Pasquier
- International Commission for Mountain Emergency Medicine (ICAR MedCom), 8302 Kloten, Switzerland; (M.P.); (K.Z.); (H.B.)
- Department of Emergency Medicine, Lausanne University Hospital, 1011 Lausanne, Switzerland
| | - Tomasz Darocha
- Department of Anesthesiology and Intensive Care, Medical University of Silesia, 40-001 Katowice, Poland;
| | - Raimund Lechner
- Department of Anesthesiology, Intensive Care Medicine, Emergency Medicine and Pain Therapy, Military Hospital, 89081 Ulm, Germany;
| | - Sylweriusz Kosinski
- Faculty of Health Sciences, Jagiellonian University Medical College, 34-500 Krakow, Poland;
| | - Bernd Wallner
- Department of Anesthesiology and Critical Care Medicine, Medical University of Innsbruck, 6020 Innsbruck, Austria;
| | - Ken Zafren
- International Commission for Mountain Emergency Medicine (ICAR MedCom), 8302 Kloten, Switzerland; (M.P.); (K.Z.); (H.B.)
- Department of Emergency Medicine, Alaska Native Medical Center, Anchorage, AK 99508, USA
- Department of Emergency Medicine, Stanford University Medical Center, Stanford University, Palo Alto, CA 94304, USA
| | - Hermann Brugger
- International Commission for Mountain Emergency Medicine (ICAR MedCom), 8302 Kloten, Switzerland; (M.P.); (K.Z.); (H.B.)
- Institute of Mountain Emergency Medicine, Eurac Research, 39100 Bolzano, Italy
- Department of Anesthesiology and Intensive Care Medicine, Medical University of Innsbruck, 6020 Innsbruck, Austria
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22
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Beysard N, Pasquier M, Zingg T, Carron PN, Darioli V. The use of Foley catheter tamponade for bleeding control in penetrating injuries. Scand J Trauma Resusc Emerg Med 2021; 29:165. [PMID: 34863261 PMCID: PMC8642887 DOI: 10.1186/s13049-021-00975-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 11/02/2021] [Indexed: 11/10/2022] Open
Affiliation(s)
- Nicolas Beysard
- Department of Emergency Medicine, Lausanne University Hospital, 1011, Lausanne, Switzerland
| | - Mathieu Pasquier
- Department of Emergency Medicine, Lausanne University Hospital and University of Lausanne, 1011, Lausanne, Switzerland
| | - Tobias Zingg
- Department of Surgery, Lausanne University Hospital and University of Lausanne, 1011, Lausanne, Switzerland
| | - Pierre-Nicolas Carron
- Department of Emergency Medicine, Lausanne University Hospital and University of Lausanne, 1011, Lausanne, Switzerland
| | - Vincent Darioli
- Department of Emergency Medicine, Lausanne University Hospital, 1011, Lausanne, Switzerland.
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23
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Paal P, Zafren K, Pasquier M. Higher pre-hospital anaesthesia case volumes result in lower mortality rates: implications for mass casualty care. Br J Anaesth 2021; 128:e89-e92. [PMID: 34794765 DOI: 10.1016/j.bja.2021.10.022] [Citation(s) in RCA: 1] [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] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 10/18/2021] [Accepted: 10/19/2021] [Indexed: 01/30/2023] Open
Abstract
Senior physicians with a higher pre-hospital anaesthesia case volume have higher first-pass tracheal intubation success rates, shorter on-site times, and lower patient mortality rates than physicians with lower case volumes. A senior physician's skill set includes the basics of management of airway and breathing (ventilating and oxygenating the patient), circulation, disability (anaesthesia), and environment (especially maintaining core temperature). Technical rescue skills may be required to care for patients requiring pre-hospital airway management especially in hazardous environments, such as road traffic accidents, chemical incidents, terror attacks or warfare, and natural disasters. Additional important tactical skills in mass casualty situations include patient triage, prioritising, allocating resources, and making transport decisions.
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Affiliation(s)
- Peter Paal
- Department of Anaesthesiology and Intensive Care Medicine, St. John of God Hospital, Paracelsus Medical University, Salzburg, Austria.
| | - Ken Zafren
- Department of Emergency Medicine, Alaska Native Medical Center, Anchorage, AK, USA; Department of Emergency Medicine, Stanford University Medical Center, Stanford, CA, USA
| | - Mathieu Pasquier
- Emergency Department, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
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24
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Giacalone S, Kottmann A, Darioli V, Carron PN, Desseauve D, Albrecht R, Pasquier M. Clinical characteristics and haemodynamic state of patients undergoing interhospital transfer for postpartum haemorrhage: A study of a single-centre helicopter emergency medical service. Eur J Obstet Gynecol Reprod Biol 2021; 268:48-55. [PMID: 34800817 DOI: 10.1016/j.ejogrb.2021.11.004] [Citation(s) in RCA: 1] [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] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 10/24/2021] [Accepted: 11/02/2021] [Indexed: 11/04/2022]
Abstract
OBJECTIVE Uterine artery embolization is an attractive option for the management of postpartum haemorrhage, however it is not available in every hospital. We compared the clinical characteristics and haemodynamic state of patients with postpartum haemorrhage, before and after helicopter transfer to a tertiary hospital for possible uterine artery embolization. We also analysed whether the type of treatment could modify the outcome. STUDY DESIGN Between 1999 and 2019 in Switzerland, we retrospectively found 82 consecutive patients with postpartum haemorrhage who were transferred by a physician-staffed helicopter emergency medical service to the tertiary hospital for potential uterine artery embolization. The collected data included the type of delivery, estimated blood loss, shock index and blood lactate levels before transfer and at destination, uterine artery embolization rate and hospital mortality rate. Our primary outcome was to describe the clinical characteristics, outcomes and haemodynamic state of the patients with postpartum haemorrhage before and after helicopter transfer. Our secondary outcome was to report the treatments performed at the tertiary hospital. The collected data were analysed with Stata version 14 (Stata Corporation, College Station, TX, USA). Continuous data are compared by using the Student's t-test or the Mann-Whitney U test, as appropriate. RESULTS We included 69 patients. Postpartum haemorrhage occurred after vaginal delivery in 38 cases (55%). Blood loss prior to transfer exceeded 2 L in 34% of cases. The median shock index was 1 (IQR 0.8-1.1) before transfer and 0.9 (IQR 0.8-1.1) after transfer (p = 0.41). The median lactate level was 2.9 mmol/L (IQR 2.1-6.8) before, and 2.1 mmol/L (IQR 1.55-3.5) after transfer (p = 0.90). Forty-four patients underwent uterine artery embolization (64%), with an overall success rate of 93%. One patient died (1.4%), from a haemorrhagic shock of abdominal origin. CONCLUSIONS Interhospital helicopter transfer of patients with postpartum haemorrhage to a tertiary hospital seems to be safe in our setting, despite a significant proportion of patients exhibiting signs of haemodynamic instability. Decision criteria would be helpful to better guide choices regarding the transfer of patients with postpartum haemorrhage.
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Affiliation(s)
- S Giacalone
- Emergency Department, Lausanne University Hospital, and University of Lausanne, Lausanne, Switzerland
| | - A Kottmann
- Emergency Department, Lausanne University Hospital, and University of Lausanne, Lausanne, Switzerland; Swiss Air Ambulance (Rega), Zürich, Switzerland
| | - V Darioli
- Emergency Department, Lausanne University Hospital, and University of Lausanne, Lausanne, Switzerland
| | - P N Carron
- Emergency Department, Lausanne University Hospital, and University of Lausanne, Lausanne, Switzerland
| | - D Desseauve
- Department of Gynaecology and Obstetrics, Lausanne University Hospital, and University of Lausanne, Lausanne, Switzerland
| | - R Albrecht
- Swiss Air Ambulance (Rega), Zürich, Switzerland
| | - M Pasquier
- Emergency Department, Lausanne University Hospital, and University of Lausanne, Lausanne, Switzerland.
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25
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Wallner B, Giesbrecht G, Pasquier M, Gordon L, Lechner R, Brugger H, Paal P, Darocha T, Zafren K. Resuscitation of an Unconscious Victim of Accidental Hypothermia in 1805. Wilderness Environ Med 2021; 32:548-553. [PMID: 34620550 DOI: 10.1016/j.wem.2021.08.007] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 08/23/2021] [Accepted: 08/25/2021] [Indexed: 10/20/2022]
Abstract
In 1805, W.D., a 16-y-old boy, became hypothermic after he was left alone on a grounded boat in Leith Harbour, near Edinburgh, Scotland. He was brought to his own house and resuscitated with warm blankets, smelling salts, and massage by Dr. George Kellie. W.D. made an uneventful recovery. We discuss the pathophysiology and treatment of accidental hypothermia, contrasting treatment in 1805 with treatment today. W.D. was hypothermic when found by passersby. Although he appeared dead, he was rewarmed with help from Dr. Kellie and his assistants over 200 y ago using simple methods. One concept that has not changed is the critical importance of attempting resuscitation, even if it seems to be futile. Don't give up!
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Affiliation(s)
- Bernd Wallner
- Department of Anaesthesiology and Intensive Care Medicine, Medical University of Innsbruck, Innsbruck, Austria; Department of General and Surgical Intensive Care Medicine, Medical University of Innsbruck, Innsbruck, Austria; Institute of Mountain Emergency Medicine, EURAC Research, Bolzano, Italy
| | - Gordon Giesbrecht
- Faculty of Kinesiology and Recreation Management, University of Manitoba, Winnipeg, Canada; Department of Emergency Medicine, University of Manitoba, Winnipeg, Canada; Department of Anesthesia, University of Manitoba, Winnipeg, Canada
| | - Mathieu Pasquier
- Emergency Department, Lausanne University Hospital, and University of Lausanne, Lausanne, Switzerland; International Commission for Mountain Emergency Medicine (ICAR MedCom), Zürich, Switzerland
| | - Les Gordon
- Department of Anaesthesia, University Hospitals of Morecambe Bay Trust, Royal Lancaster Infirmary, Lancaster, UK; Langdale Ambleside Mountain Rescue Team, Ambleside, UK
| | - Raimund Lechner
- Department of Anesthesiology, Intensive Care Medicine, Emergency Medicine, and Pain, Medicine, Armed Forces Hospital Ulm, Ulm, Germany
| | - Hermann Brugger
- Institute of Mountain Emergency Medicine, EURAC Research, Bolzano, Italy; International Commission for Mountain Emergency Medicine (ICAR MedCom), Zürich, Switzerland; Medical University of Innsbruck, Innsbruck, Austria
| | - Peter Paal
- International Commission for Mountain Emergency Medicine (ICAR MedCom), Zürich, Switzerland; Department of Anaesthesiology and Intensive Care Medicine, Hospitallers Brothers Hospital, Paracelsus Medical University, Salzburg, Austria
| | - Tomasz Darocha
- Department of Anesthesiology and Intensive Care, Medical University of Silesia, Katowice, Poland
| | - Ken Zafren
- International Commission for Mountain Emergency Medicine (ICAR MedCom), Zürich, Switzerland; Department of Emergency Medicine, Alaska Native Medical Center, Anchorage, Alaska; Department of Emergency Medicine, Stanford University Medical Center, Stanford, California.
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26
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Razafintsalama-Bourdet M, Bah M, Amand G, Vienet-Lègue L, Pietin-Vialle C, Bry-Gauillard H, Pinto M, Pasquier M, Vernet T, Jung C, Levaillant JM, Massin N. Random antral follicle count performed on any day of the menstrual cycle has the same predictive value as AMH for good ovarian response in IVF cycles. J Gynecol Obstet Hum Reprod 2021; 51:102233. [PMID: 34571198 DOI: 10.1016/j.jogoh.2021.102233] [Citation(s) in RCA: 1] [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] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 08/28/2021] [Accepted: 09/22/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To determine whether the predictive value of AFC for ovarian response to stimulation for IVF depends on the day of the menstrual cycle when ultrasound is performed. METHODS 410 women undergoing their first IVF cycle were included. All the women had AFC performed twice. The first measurement, random AFC (r-AFC), was performed during the fertility workup whatever the day of their menstrual cycle. Three groups were constituted according to the period of ultrasound performance: at early follicular phase i.e., day 1 to day 6 (eFP-AFC); at mid follicular phase i.e., day 7 to 12 (mFP-AFC) and at luteal phase i.e., day 13 or after (LP-AFC). A second AFC measurement was performed before the start of the ovarian stimulation (SD1-AFC). AMH dosing was done in the early follicular phase. RESULTS Random AFC (r-AFC) was correlated to AMH (r = 0.69; p<0.001), SD1-AFC (r = 0.75; p<0.001) and number of oocytes retrieved (r = 0.49; p<0.001). When regarding AFC depending on the cycle day group, the correlation with AMH was 0.65, 0.66 and 0.85 for the eFP-AFC, the mFP-AFC and the LP-AFC respectively (all p were <0.001). The ROC analysis showed the same predictive value for good ovarian response (more than 6 oocytes retrieved) for the eFP-AFC, mFP-AFC and LP-AFC (AUC 0.73, 0.75 and 0.84 respectively; p = 0.28). The AUC of r-AFC (0.76) were similar to those of AMH (0.74) and SD1-AFC (0.74) (p = 0.21 and 0.92 respectively). CONCLUSION AFC is strongly correlated with AMH and highly predictive of good ovarian response during the whole menstrual cycle.
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Affiliation(s)
- M Razafintsalama-Bourdet
- Department of Gynecology-Obstetrics and Reproductive Medicine, Intercommunal Hospital- University Paris XII, Creteil, France
| | - M Bah
- Department of Gynecology-Obstetrics and Reproductive Medicine, Intercommunal Hospital- University Paris XII, Creteil, France
| | - G Amand
- Department of Gynecology-Obstetrics and Reproductive Medicine, Intercommunal Hospital- University Paris XII, Creteil, France
| | - L Vienet-Lègue
- Department of Gynecology-Obstetrics and Reproductive Medicine, Intercommunal Hospital- University Paris XII, Creteil, France
| | - C Pietin-Vialle
- Department of Gynecology-Obstetrics and Reproductive Medicine, Intercommunal Hospital- University Paris XII, Creteil, France
| | - H Bry-Gauillard
- Department of Gynecology-Obstetrics and Reproductive Medicine, Intercommunal Hospital- University Paris XII, Creteil, France
| | - M Pinto
- Department of Gynecology-Obstetrics and Reproductive Medicine, Intercommunal Hospital- University Paris XII, Creteil, France
| | - M Pasquier
- Department of Gynecology-Obstetrics and Reproductive Medicine, Intercommunal Hospital- University Paris XII, Creteil, France
| | - T Vernet
- Department of Gynecology-Obstetrics and Reproductive Medicine, Intercommunal Hospital- University Paris XII, Creteil, France
| | - C Jung
- Clinical Research Center, Intercommunal Hospital- University Paris XII, Creteil, France
| | - J M Levaillant
- Department of Gynecology-Obstetrics and Reproductive Medicine, Intercommunal Hospital- University Paris XII, Creteil, France; Hopital privé Armand Brillard, Nogent sur Marne, France
| | - N Massin
- Department of Gynecology-Obstetrics and Reproductive Medicine, Intercommunal Hospital- University Paris XII, Creteil, France.
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Hymczak H, Podsiadło P, Kosiński S, Pasquier M, Mendrala K, Hudziak D, Gocoł R, Plicner D, Darocha T. Prognosis of Hypothermic Patients Undergoing ECLS Rewarming-Do Alterations in Biochemical Parameters Matter? Int J Environ Res Public Health 2021; 18:ijerph18189764. [PMID: 34574690 PMCID: PMC8468166 DOI: 10.3390/ijerph18189764] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 09/07/2021] [Accepted: 09/13/2021] [Indexed: 11/25/2022]
Abstract
Background: While ECLS is a highly invasive procedure, the identification of patients with a potentially good prognosis is of high importance. The aim of this study was to analyse changes in the acid-base balance parameters and lactate kinetics during the early stages of ECLS rewarming to determine predictors of clinical outcome. Methods: This single-centre retrospective study was conducted at the Severe Hypothermia Treatment Centre at John Paul II Hospital in Krakow, Poland. Patients ≥18 years old who had a core temperature (Tc) < 30 °C and were rewarmed with ECLS between December 2013 and August 2018 were included. Acid-base balance parameters were measured at ECLS implantation, at Tc 30 °C, and at 2 and 4 h after Tc 30 °C. The alteration in blood lactate kinetics was calculated as the percent change in serum lactate concentration relative to the baseline. Results: We included 50 patients, of which 36 (72%) were in cardiac arrest. The mean age was 56 ± 15 years old, and the mean Tc was 24.5 ± 12.6 °C. Twenty-one patients (42%) died. Lactate concentrations in the survivors group were significantly lower than in the non-survivors at all time points. In the survivors group, the mean lactate concentration decreased −2.42 ± 4.49 mmol/L from time of ECLS implantation until 4 h after reaching Tc 30 °C, while in the non-survivors’ group (p = 0.024), it increased 1.44 ± 6.41 mmol/L. Conclusions: Our results indicate that high lactate concentration is associated with a poor prognosis for hypothermic patients undergoing ECLS rewarming. A decreased value of lactate kinetics at 4 h after reaching 30 °C is also associated with a poor prognosis.
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Affiliation(s)
- Hubert Hymczak
- Department of Anesthesiology and Intensive Care, John Paul II Hospital, 31-202 Krakow, Poland;
- Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski Krakow University, 30-705 Krakow, Poland
| | - Paweł Podsiadło
- Institute of Medical Sciences, Jan Kochanowski University, 25-369 Kielce, Poland;
| | - Sylweriusz Kosiński
- Faculty of Health Sciences, Jagiellonian University Medical College, 31-008 Krakow, Poland;
| | - Mathieu Pasquier
- Emergency Department, Lausanne University Hospital, University of Lausanne, 1015 Lausanne, Switzerland;
| | - Konrad Mendrala
- Department of Anaesthesiology and Intensive Care, Medical University of Silesia, 40-055 Katowice, Poland; (K.M.); (T.D.)
| | - Damian Hudziak
- Department of Cardiac Surgery, Medical University of Silesia, 40-055 Katowice, Poland; (D.H.); (R.G.)
| | - Radosław Gocoł
- Department of Cardiac Surgery, Medical University of Silesia, 40-055 Katowice, Poland; (D.H.); (R.G.)
| | - Dariusz Plicner
- Unit of Experimental Cardiology and Cardiac Surgery, Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski Krakow University, 30-705 Krakow, Poland
- Correspondence:
| | - Tomasz Darocha
- Department of Anaesthesiology and Intensive Care, Medical University of Silesia, 40-055 Katowice, Poland; (K.M.); (T.D.)
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Mendrala K, Kosiński S, Podsiadło P, Pasquier M, Paal P, Mazur P, Darocha T. The Efficacy of Renal Replacement Therapy for Rewarming of Patients in Severe Accidental Hypothermia-Systematic Review of the Literature. Int J Environ Res Public Health 2021; 18:ijerph18189638. [PMID: 34574562 PMCID: PMC8467292 DOI: 10.3390/ijerph18189638] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 09/09/2021] [Accepted: 09/10/2021] [Indexed: 12/29/2022]
Abstract
Background: Renal replacement therapy (RRT) can be used to rewarm patients in deep hypothermia. However, there is still no clear evidence for the effectiveness of RRT in this group of patients. This systematic review aims to summarize the rewarming rates during RRT in patients in severe hypothermia, below or equal to 32 °C. Methods: This systematic review was registered in the PROSPERO International Prospective Register of Systematic Reviews (identifier CRD42021232821). We searched Embase, Medline, and Cochrane databases using the keywords hypothermia, renal replacement therapy, hemodialysis, hemofiltration, hemodiafiltration, and their abbreviations. The search included only articles in English with no time limit, up until 30 June 2021. Results: From the 795 revised articles, 18 studies including 21 patients, were selected for the final assessment and data extraction. The mean rate of rewarming calculated for all studies combined was 1.9 °C/h (95% CI 1.5–2.3) and did not differ between continuous (2.0 °C/h; 95% CI 0.9–3.0) and intermittent (1.9 °C/h; 95% CI 1.5–2.3) methods (p > 0.9). Conclusions: Based on the reviewed literature, it is currently not possible to provide high-quality recommendations for RRT use in specific groups of patients in accidental hypothermia. While RRT appears to be a viable rewarming strategy, the choice of rewarming method should always be determined by the specific clinical circumstances, the available resources, and the current resuscitation guidelines.
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Affiliation(s)
- Konrad Mendrala
- Department of Anesthesiology and Intensive Care, Medical University of Silesia, Medykow 14, 40-752 Katowice, Poland;
- Correspondence:
| | - Sylweriusz Kosiński
- Faculty of Health Sciences, Jagiellonian University Medical College, Michalowskiego 12, 31-126 Krakow, Poland;
| | - Paweł Podsiadło
- Institute of Medical Sciences, Jan Kochanowski University, Al. IX Wiekow Kielc 19A, 25-317 Kielce, Poland;
| | - Mathieu Pasquier
- Emergency Department, Lausanne University Hospital, University of Lausanne, BH 09, CHUV, 1011 Lausanne, Switzerland;
| | - Peter Paal
- Department of Anesthesiology and Intensive Care Medicine, St. John of God Hospital, Paracelsus Medical University, Kajetanerplatz 1, 5020 Salzburg, Austria;
| | - Piotr Mazur
- Department of Cardiovascular Surgery, Mayo Clinic, 200 First St. SW, Rochester, MN 55902, USA;
- Institute of Cardiology, Jagiellonian University Medical College, Pradnicka 80, 31-202 Krakow, Poland
| | - Tomasz Darocha
- Department of Anesthesiology and Intensive Care, Medical University of Silesia, Medykow 14, 40-752 Katowice, Poland;
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Kottmann A, Pasquier M, Strapazzon G, Zafren K, Ellerton J, Paal P. Quality Indicators for Avalanche Victim Management and Rescue. Int J Environ Res Public Health 2021; 18:ijerph18189570. [PMID: 34574495 PMCID: PMC8464975 DOI: 10.3390/ijerph18189570] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 09/05/2021] [Accepted: 09/07/2021] [Indexed: 12/29/2022]
Abstract
Decisions in the management and rescue of avalanche victims are complex and must be made in difficult, sometimes dangerous, environments. Our goal was to identify indicators for quality measurement in the management and rescue of avalanche victims. The International Commission for Mountain Emergency Medicine (ICAR MedCom) convened a group of internal and external experts. We used brainstorming and a five-round modified nominal group technique to identify the most relevant quality indicators (QIs) according to the National Quality Forum Measure Evaluation Criteria. Using a consensus process, we identified a set of 23 QIs to measure the quality of the management and rescue of avalanche victims. These QIs may be a valuable tool for continuous quality improvement. They allow objective feedback to rescuers regarding clinical performance and identify areas that should be the foci of further quality improvement efforts in avalanche rescue.
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Affiliation(s)
- Alexandre Kottmann
- Rega—Swiss Air Ambulance, Zürich Airport, 8058 Zürich, Switzerland
- Emergency Department, Lausanne University Hospital, 1011 Lausanne, Switzerland;
- International Commission for Mountain Emergency Medicine (ICAR MedCom), 8058 Zürich, Switzerland; (G.S.); (K.Z.); (J.E.); (P.P.)
- Correspondence:
| | - Mathieu Pasquier
- Emergency Department, Lausanne University Hospital, 1011 Lausanne, Switzerland;
- International Commission for Mountain Emergency Medicine (ICAR MedCom), 8058 Zürich, Switzerland; (G.S.); (K.Z.); (J.E.); (P.P.)
| | - Giacomo Strapazzon
- International Commission for Mountain Emergency Medicine (ICAR MedCom), 8058 Zürich, Switzerland; (G.S.); (K.Z.); (J.E.); (P.P.)
- Institute of Mountain Emergency Medicine, Eurac Research, 39100 Bolzano, Italy
- CNSAS—Corpo Nazionale Soccorso Alpino e Speleologico, National Medical School, 20124 Milano, Italy
| | - Ken Zafren
- International Commission for Mountain Emergency Medicine (ICAR MedCom), 8058 Zürich, Switzerland; (G.S.); (K.Z.); (J.E.); (P.P.)
- Alaska Native Medical Center, Department of Emergency Medicine, 4300 Diplomacy Drive, Anchorage, AK 99508, USA
- Stanford University Medical Center, Department of Emergency Medicine, 900 Welch Road, Palo Alto, CA 94304, USA
| | - John Ellerton
- International Commission for Mountain Emergency Medicine (ICAR MedCom), 8058 Zürich, Switzerland; (G.S.); (K.Z.); (J.E.); (P.P.)
| | - Peter Paal
- International Commission for Mountain Emergency Medicine (ICAR MedCom), 8058 Zürich, Switzerland; (G.S.); (K.Z.); (J.E.); (P.P.)
- Department of Anaesthesiology and Intensive Care Medicine, St. John of God Hospital, Paracelsus Medical University, Kajetanerplatz 1, 5020 Salzburg, Austria
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Diserens RV, Marmy C, Pasquier M, Zingg T, Joost S, Hugli O. Modelling transport time to trauma centres and 30-day mortality in road accidents in Switzerland: an exploratory study. Swiss Med Wkly 2021; 151. [PMID: 34495599 DOI: 10.4414/smw.2021.w30007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Rapid access to a trauma centre for severely injured road accident victims, conceptualised as the Golden Hour, links access time to definitive treatment within 1 hour of trauma with reduced risks of morbidity and mortality. Access times have not been studied in Switzerland. The aim of this work was to model the transport time by ambulance of seriously injured road traffic accident victims to one of the 12 trauma centres in Switzerland and to investigate whether this time influenced mortality. METHODS Isochronous travel curves in 10-minute increments were modelled around each of the 12 Swiss trauma centres to assess travel times at the Swiss national level, based on the shortest travel time from the location of a serious road accident to the nearest trauma centre. We used the national database of the Federal Roads Office, which provided the geolocation of these accidents occurring between 2011 and 2017. The association between mortality and transport time to the nearest trauma centre was then analysed. RESULTS The current distribution of trauma centres allowed access time within the Golden Hour for accidents occurring on the Swiss plateau, but the time was more prolonged in the Alps or the Jura. An association existed between mortality and prehospital transport time from the site of an accident to the nearest trauma centre. For each additional 10-minute isochrone, an average increase of 0.4% in mortality was observed. CONCLUSION This work showed an adequate distribution of trauma centres in Switzerland and suggests a positive relationship between transport time to the nearest trauma centre and mortality. The numerous confounding factors not systematically collected in publicly available databases limit the robustness of our results. This study confirms the importance of having a national trauma registry to allow quality analyses to guide public health decisions.
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Affiliation(s)
| | - Clotilde Marmy
- Swiss Federal Institute of Technology (EPFL), Lausanne, Switzerland
| | - Mathieu Pasquier
- Emergency Department, Lausanne University Hospital and University of Lausanne, Switzerland
| | - Tobias Zingg
- Department of Visceral Surgery, Lausanne University Hospital and University of Lausanne, Switzerland
| | - Stéphane Joost
- Swiss Federal Institute of Technology (EPFL), Lausanne, Switzerland
| | - Olivier Hugli
- Emergency Department, Lausanne University Hospital and University of Lausanne, Switzerland
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Darocha T, Hugli O, Kosiński S, Podsiadło P, Caillet-Bois D, Pasquier M. Clinician miscalibration of survival estimate in hypothermic cardiac arrest: HOPE-estimated survival probabilities in extreme cases. Resusc Plus 2021; 7:100139. [PMID: 34223395 PMCID: PMC8244419 DOI: 10.1016/j.resplu.2021.100139] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 05/11/2021] [Accepted: 05/15/2021] [Indexed: 11/25/2022] Open
Abstract
AIM Patients with hypothermic cardiac arrest may survive with an excellent outcome after extracorporeal life support rewarming (ECLSR). The HOPE (Hypothermia Outcome Prediction after ECLS) score is recommended to guide the in-hospital decision on whether or not to initiate ECLSR in patients in cardiac arrest following accidental hypothermia. We aimed to assess the HOPE-estimated survival probabilities for a set of survivors of hypothermic cardiac arrest who had extreme values for the variables included in the HOPE score. METHODS Survivors were identified and selected through a systematic literature review including case reports. We calculated the HOPE score for each patient who presented extraordinary clinical parameters. RESULTS We identified 12 such survivors. The HOPE-estimated survival probability was ≥10% for all (n = 11) patients for whom we were able to calculate the HOPE score. CONCLUSION Our study confirms the robustness of the HOPE score for outliers and thus further confirms its external validity. These cases also confirm that hypothermic cardiac arrest is a fundamentally different entity than normothermic cardiac arrest. Using HOPE for extreme cases may support the proper calibration of a clinician's prognosis and therapeutic decision based on the survival chances of patients with accidental hypothermic cardiac arrest.
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Affiliation(s)
- Tomasz Darocha
- Severe Accidental Hypothermia Center, Department of Anaesthesiology and Intensive Care, Medical University of Silesia, Medykow 14, 40-752 Katowice, Poland
| | - Olivier Hugli
- Emergency Department, Lausanne University Hospital, University of Lausanne, BH 09, CHUV, 1011 Lausanne, Switzerland
| | - Sylweriusz Kosiński
- Faculty of Health Sciences, Jagiellonian University Medical College, Michałowskiego 12, 31-126 Krakow, Poland
| | - Paweł Podsiadło
- Institute of Medical Sciences, Jan Kochanowski University, Al. IX Wieków Kielc 19A, 25-317 Kielce, Poland
| | - David Caillet-Bois
- Department of Emergency Medicine, Lausanne University Hospital, BH 09, 1011 Lausanne, Switzerland
| | - Mathieu Pasquier
- Department of Emergency Medicine, Lausanne University Hospital, BH 09, 1011 Lausanne, Switzerland
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Razafintsalama M, Bah M, Amand G, Vienet-Lègue L, Pietin-Vialle C, Bry-Gauillard H, Pinto M, Pasquier M, Jung C, Levaillant JM, Massin N. P–599 random antral follicle count, performed at any day of the menstrual cycle, demonstrates the same predictive value for ovarian response in in vitro fertilization cycles. Hum Reprod 2021. [DOI: 10.1093/humrep/deab130.598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Study question
Does antral follicle count (AFC) retains its predictive value for ovarian response to stimulation for in vitro fertilization (IVF) throughout the whole menstrual cycle?
Summary answer
AFC is strongly correlated to anti-mullerian hormone (AMH) and highly predictive of good ovarian response whatever the day of cycle the ultrasound is performed.
What is known already
Usually performed in the early follicular phase (at day 2–3 of the menstrual cycle), AFC and AMH are the most accurate markers of ovarian reserve. They are routinely used to predict ovarian response to ovarian stimulation for IVF and eventually to individualize the gonadotropin starting dose.
Study design, size, duration
Retrospective cohort study performed between January, 2017 and December, 2019.
Participants/materials, setting, methods
410 consecutive women aged 20 to 42 years were included. Random AFC (r-AFC) was performed during the fertility workup whatever the day of their menstrual cycle was: early follicular phase i.e. day 1 to day 6 (eFP-AFC), mid follicular phase i.e. day 7 to 12 (mFP-AFC) and luteal phase i.e. day 13 or after (LP-AFC). A second AFC was performed before the start of the stimulation (SD1-AFC). AMH was measured in the early follicular phase.
Main results and the role of chance
Random AFC (r-AFC) was correlated to AMH (r = 0.692; p < 0.001), SD1-AFC (r = 0.756; p < 0.001) and number of oocytes retrieved (r = 0.491; p < 0.001). When regarding AFC depending on the cycle day group, the correlation with AMH was significantly higher for the LP-AFC, (LP-AFC) (r = 0.853) than for the eFP-AFC (r = 0.657; p < 0.001) and for the mFP-AFC (r = 0.668). The correlation with SD1-AFC was similar regardless of the time of performance of r-AFC (r = 0.739, 0.783, 0.733, respectively for eFP, mFP and LP-AFC). Moreover, the ROC analysis showed the same predictive value for good ovarian response (more than 6 oocytes retrieved) for the eFP-AFC, mFP-AFC and LP-AFC (AUC 0.73, 0.75 and 0.84 respectively) as well as for AMH and SD1-AFC (AUC 0.74 and 0.74, respectively).
Limitations, reasons for caution
This is a retrospective analysis, however data were prospectively collected and the method for ultrasound acquisition of AFC was standardized.
Wider implications of the findings: The absence of significant variation of AFC across the menstrual cycle allows to its random performance. Ultrasound performed besides early follicular phase discloses informations on ovaries, the uterus and the endometrium. It is more comfortable and convenient for women and physicians by limiting targeted appointment during menstruation and reiterated examination.
Trial registration number
Not applicable
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Affiliation(s)
- M Razafintsalama
- Intercommunal Hospital- University Paris XII, Gynecology-Obstetrics and Reproductive Medecine-, Creteil- France, France
| | - M Bah
- Intercommunal Hospital- University Paris XII, Gynecology-Obstetrics and Reproductive Medecine-, Creteil- France, France
| | - G Amand
- Intercommunal Hospital- University Paris XII, Gynecology-Obstetrics and Reproductive Medecine-, Creteil- France, France
| | - L Vienet-Lègue
- Intercommunal Hospital- University Paris XII, Gynecology-Obstetrics and Reproductive Medecine-, Creteil- France, France
| | - C Pietin-Vialle
- Intercommunal Hospital- University Paris XII, Gynecology-Obstetrics and Reproductive Medecine-, Creteil- France, France
| | - H Bry-Gauillard
- Intercommunal Hospital- University Paris XII, Gynecology-Obstetrics and Reproductive Medecine-, Creteil- France, France
| | - M Pinto
- Intercommunal Hospital- University Paris XII, Gynecology-Obstetrics and Reproductive Medecine-, Creteil- France, France
| | - M Pasquier
- Intercommunal Hospital- University Paris XII, Gynecology-Obstetrics and Reproductive Medecine-, Creteil- France, France
| | - C Jung
- Intercommunal Hospital- University Paris XII, Clinical Research Center, Creteil- France, France
| | - J M Levaillant
- Hôpital Privé Armand Brillard, Echographie, Nogent-Sur-Marne, France
| | - N Massin
- Intercommunal Hospital- University Paris XII, Gynecology-Obstetrics and Reproductive Medecine-, Creteil- France, France
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Abdennebi I, Pasquier M, Vernet T, Levaillant JM, Massin N. P–730 “Fertility Check Up”: A proposal for assessment of women’s fertility potential. Analysis and evaluation of the first 200 women. Hum Reprod 2021. [DOI: 10.1093/humrep/deab130.729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Study question
Is there an interest in offering a fertility assessment to all women, with or without proven infertility, whatever their personal situation or parental project ?
Summary answer
Assessing the fertility of all women allows us to inform and advise them, in order to optimize their chances to achieve their parenting project.
What is known already
In a society where the age of childbearing is increasing and where women want to be able to postpone their pregnancies and to plan their parenting plan, there is no medical recommendation to assess fertility of women who are single or who do not have proven infertility.
Study design, size, duration
We implemented a new proposal in our reproductive medicine department, the “Fertility Check Up” (FCU), allowing any woman, whatever her personal situation or parental project, to benefit from an evaluation of her fertility, as well as personalized information and advice, to optimize the realization of her life plan.
Participants/materials, setting, methods
The FCU is carried out on female volunteers who do not need to be referred by a doctor. The fertility evaluation is performed by a self-questionnaire and an “all-in-one” ultrasound examination (Fertiliscan) including a complete pelvic ultrasound with a hysterosalpingo-foam-sonography (Hyfosy); this examination allows an anatomical and functional evaluation of the female reproductive system, in one step. Women then benefit from a personalized interview with a fertility specialist.
Main results and the role of chance
In the first year, 200 women aged 24 to 48 years old benefited from this examination, 56% of whom had never attempted to conceive. Anomalies found included: tubal diseases (29%), congenital or acquired uterine anomalies (11,5%), and endometriosis (6,5%). We concluded to a low ovarian reserve for age in 14% of cases. 84% of women say they felt little or no discomfort during the Fertiliscan. A questionnaire was sent to women 6 months after the FCU: among the 85 women with a desire for pregnancy at the time of the FCU, 29.1% obtained a pregnancy, and 36% began ART procedures. Among the women who had no plans for pregnancy, 50% stated that the completion of the FCU had modified their personal or professional plans regarding a possible desire for future pregnancy.
Limitations, reasons for caution
Women are informed that the FCU gives them indications about their theoretical chances of pregnancy, but that there is no way to be sure that a woman will ever bear a child, as 10% of infertilities remain idiopathic.
Wider implications of the findings: The proposal of fertility assessment for women, whether infertile or not, with or without immediate pregnancy plans, allows for information, advice and treatment if necessary. Women are better informed about their own fertility, and can get the best chances to achieve their parental project, with, or ideally without, assisted-reproductive-techniques.
Trial registration number
Not applicable
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Affiliation(s)
- I Abdennebi
- Intercommunal Hospital-University of Creteil, Department of Obstetrics- Gynecology and Reproductive Medecine, CRETEIL, France
| | - M Pasquier
- Intercommunal Hospital-University of Creteil, Department of Obstetrics- Gynecology and Reproductive Medecine, CRETEIL, France
| | - T Vernet
- Intercommunal Hospital-University of Creteil, Department of Obstetrics- Gynecology and Reproductive Medecine, CRETEIL, France
| | - J M Levaillant
- Intercommunal Hospital-University of Creteil, Department of Obstetrics- Gynecology and Reproductive Medecine, CRETEIL, France
| | - N Massin
- Intercommunal Hospital-University of Creteil, Department of Obstetrics- Gynecology and Reproductive Medecine, CRETEIL, France
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Sermondade N, Sonigo C, Pasquier M, Yata-Ahdad N, Fraison E, Grynberg M. O-107 Searching for the optimal number of oocytes to reach a life birth following in vitro fertilization: a systematic review with meta-analysis. Hum Reprod 2021. [DOI: 10.1093/humrep/deab126.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Study question
To investigate the relationship between the number of oocytes and both the live birth rate after fresh embryo transfer and the cumulative live birth rate.
Summary answer
Above a 15-oocyte threshold, live birth rate (LBR) following fresh transfer plateaus, whereas a continuous increase in cumulative live birth rate (CLBR) is observed.
What is known already
Several lines of evidence indicate that number of oocytes represents a key point for in vitro fertilization (IVF) success. However, consensus is lacking regarding the optimal number of oocytes for expecting a live birth. This is a key question because it might impact the way practitioners initiate and adjust COS regimens.
Study design, size, duration
A systematic review and meta-analysis was performed. MEDLINE, EMBASE, and Cochrane Library were searched for studies published between January 01, 2004, and August 31, 2019 using the search terms: “(intracytoplasmic sperm injection or icsi or ivf or in vitro fertilization or fertility preservation)” and “(oocyte and number)” and “(live birth)”.
Participants/materials, setting, methods
Two independent reviewers carried out study selection, quality assessment using the adapted Newcastle-Ottawa Quality Assessment Scales, bias assessment using ROBIN-1 tools, and data extraction according to Cochrane methods. Independent analyses were performed according to the outcome (LBR and CLBR). The mean-weighted threshold of optimal oocyte number was estimated from documented thresholds, followed by a one-stage meta-analysis on articles with documented or estimable relative risks.
Main results and the role of chance
After reviewing 843 records, 64 full-text articles were assessed for eligibility. A total of 36 studies were available for quantitative syntheses. Twenty-one and 18 studies were included in the meta-analyses evaluating the relationship between the number of retrieved oocytes and LBR or CLBR, respectively. Given the limited number of investigations considering mature oocytes, association between the number of metaphase II oocytes and IVF outcomes could not be investigated. Concerning LBR, 7 (35.0%) studies reported a plateau effect, corresponding to a weighted mean of 14.4 oocytes. The pooled dose-response association between the number of oocytes and LBR showed a non-linear relationship, with a plateau beyond 15 oocytes. For CLBR, 4 (19.0%) studies showed a plateau effect, corresponding to a weighted mean of 19.3 oocytes. The meta-analysis of the relationship between the number of oocytes and CLBR found a non-linear relationship, with a continuous increase in CLBR, including for high oocyte yields.
Limitations, reasons for caution
Statistical models show a high degree of deviance, especially for high numbers of oocytes. Further investigations are needed to assess the generalization of those results to frozen mature oocytes, especially in a fertility preservation context, and to evaluate the impact of female age.
Wider implications of the findings
Above a 15-oocyte threshold, LBR following fresh transfer plateaus, suggesting that the freeze-all strategy should probably be performed. In contrast, the continuous increase in CLBR suggests that high numbers of oocytes could be offered to improve the chances of cumulative live births, after evaluating the benefit–risk balance.
Trial registration number
Not applicable
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Affiliation(s)
- N Sermondade
- Hopital TENON, Service de Biologie de la Reproduction - CECOS, PARIS, France
| | - C Sonigo
- Hopital Antoine Béclère, Médecine de la Reproduction et Préservation de la Fertilité, Clamart, France
| | - M Pasquier
- Centre Hospitalier Intercommunal de Créteil, Médecine de la Reproduction, Créteil, France
| | - N Yata-Ahdad
- Centre Hospitalier de Meaux, Médecine de la Reproduction, Meaux, France
| | - E Fraison
- Hospices Civils de Lyon, Médecine de la Reproduction, Lyon, France
| | - M Grynberg
- Hopital Antoine Béclère, Médecine de la Reproduction et Préservation de la Fertilité, Clamart, France
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Mendrala K, Kosiński S, Podsiadło P, Pasquier M, Mazur P, Paal P, Gajniak D, Darocha T. The efficiency of continuous renal replacement therapy for rewarming of patients in accidental hypothermia--An experimental study. Artif Organs 2021; 45:1360-1367. [PMID: 34219241 DOI: 10.1111/aor.14032] [Citation(s) in RCA: 1] [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] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 05/31/2021] [Accepted: 06/25/2021] [Indexed: 11/27/2022]
Abstract
Severe accidental hypothermia carries high mortality and morbidity and is often treated with invasive extracorporeal methods. Continuous veno-venous hemodiafiltration (CVVHDF) is widely available in intensive care units. We sought to provide theoretical basis for CVVHDF use in rewarming of hypothermic patients. CVVHDF system was used in the laboratory setting. Heat balance and transferred heat units were evaluated for the system without using blood. We used 5L of crystalloid solution at the temperature of approximately 25°C, placed in a thermally insulated tank (representing the "central compartment" of a hypothermic patient). Time of warming the central compartment from 24.9 to 30.0°C was assessed with different flow combinations: "blood" (central compartment fluid) 50 or 100 or 150 mL/min, dialysate solution 100 or 1500 mL/h, and substitution fluid 0 or 500 mL/h. The total circulation time was 1535 minutes. There were no differences between heat gain values on the filter depending on blood flow (P = .53) or dialysate flow (P = .2). The mean heating time for "blood" flow rates 50, 100, and 150 mL/min was 113.7 minutes (95% CI, 104.9-122.6 minutes), 83.3 minutes (95% CI, 76.2-90.3 minutes), and 74.7 minutes (95% CI, 62.6-86.9 minutes), respectively (P < .01). The respective median rewarming rate for different "blood" flows was 3.6°C/h (IQR, 3.0-4.2°C/h), 4.8 (IQR, 4.2-5.4°C/h), and 5.4 (IQR, 4.8-6.0°C/h), respectively (P < .01). The dialysate flow did not affect the warming rate. Based on our experimental model, CVVHDF may be used for extracorporeal rewarming, with the rewarming rates increasing achieved with higher blood flow rates.
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Affiliation(s)
- Konrad Mendrala
- Department of Anaesthesiology and Intensive Care, Medical University of Silesia, Katowice, Poland
| | - Sylweriusz Kosiński
- Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland
| | - Paweł Podsiadło
- Institute of Medical Sciences, Jan Kochanowski University, Kielce, Poland
| | - Mathieu Pasquier
- Emergency Department, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Piotr Mazur
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA.,Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland
| | - Peter Paal
- Department of Anaesthesiology and Intensive Care Medicine, Hospitaller Brothers Hospital, Paracelsus Medical University, Salzburg, Austria
| | - Dariusz Gajniak
- Department of Anaesthesiology and Intensive Care, Medical University of Silesia, Katowice, Poland
| | - Tomasz Darocha
- Department of Anaesthesiology and Intensive Care, Medical University of Silesia, Katowice, Poland
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Dunand A, Beysard N, Maudet L, Carron PN, Dami F, Piquilloud L, Caillet-Bois D, Pasquier M. Management of respiratory distress following prehospital implementation of noninvasive ventilation in a physician-staffed emergency medical service: a single-center retrospective study. Scand J Trauma Resusc Emerg Med 2021; 29:85. [PMID: 34187538 PMCID: PMC8240431 DOI: 10.1186/s13049-021-00900-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 06/11/2021] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Noninvasive ventilation (NIV) is recognized as first line ventilatory support for the management of acute pulmonary edema (APE) and chronic obstructive pulmonary disease (COPD) exacerbations. We aimed to study the prehospital management of patients in acute respiratory distress with an indication for NIV and whether they received it or not. METHODS This retrospective study included patients ≥18 years old who were cared for acute respiratory distress in a prehospital setting. Indications for NIV were oxygen saturation (SpO2) <90% and/or respiratory rate (RR) >25/min with a presumptive diagnosis of APE or COPD exacerbation. Study population characteristics, initial and at hospital vital signs, presumptive and definitive diagnosis were analyzed. For patients who received NIV, dyspnea level was evaluated with a dyspnea verbal ordinal scale (D-VOS, 0-10) and arterial blood gas (ABG) values were obtained at hospital arrival. RESULTS Among the 187 consecutive patients included in the study, most (n = 105, 56%) had experienced APE or COPD exacerbation, and 56 (30%) received NIV. In comparison with patients without NIV, those treated with NIV had a higher initial RR (35 ± 8/min vs 29 ± 10/min, p < 0.0001) and a lower SpO2 (79 ± 10 vs 88 ± 11, p < 0.0001). The level of dyspnea was significantly reduced for patients treated with NIV (on-scene D-VOS 8.4 ± 1.7 vs 4.4 ± 1.8 at admission, p < 0.0001). Among the 131 patients not treated with NIV, 41 (31%) had an indication. In the latter group, initial SpO2 was 80 ± 10% in the NIV group versus 86 ± 11% in the non-NIV group (p = 0.0006). NIV was interrupted in 9 (16%) patients due to either discomfort (n = 5), technical problem (n = 2), persistent desaturation (n = 1), or vomiting (n = 1). CONCLUSIONS The results of this study contribute to a better understanding of the prehospital management of patients who present with acute respiratory distress and an indication for NIV. NIV was started on clinically more severe patients, even if predefined criteria to start NIV were present. NIV allows to improve vital signs and D-VOS in those patients. A prospective study could further elucidate why patients with a suspected diagnosis of APE and COPD are not treated with NIV, as well as the clinical impact of the different strategies. TRIAL REGISTRATION The study was approved by our institutional ethical committee ( CER-VD 2020-01363 ).
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Affiliation(s)
- Adeline Dunand
- Faculty of Biology and Medicine, University of Lausanne, Rue du Bugnon 21, 1011, Lausanne, Switzerland.,Department of Emergency Medicine, Lausanne University Hospital, Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Nicolas Beysard
- Department of Emergency Medicine, Lausanne University Hospital, Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Ludovic Maudet
- Department of Emergency Medicine, Lausanne University Hospital, Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Pierre-Nicolas Carron
- Faculty of Biology and Medicine, University of Lausanne, Rue du Bugnon 21, 1011, Lausanne, Switzerland.,Department of Emergency Medicine, Lausanne University Hospital, Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Fabrice Dami
- Faculty of Biology and Medicine, University of Lausanne, Rue du Bugnon 21, 1011, Lausanne, Switzerland.,Department of Emergency Medicine, Lausanne University Hospital, Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Lise Piquilloud
- Faculty of Biology and Medicine, University of Lausanne, Rue du Bugnon 21, 1011, Lausanne, Switzerland.,Adult Intensive Care Unit, Lausanne University Hospital, Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - David Caillet-Bois
- Department of Emergency Medicine, Lausanne University Hospital, Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Mathieu Pasquier
- Faculty of Biology and Medicine, University of Lausanne, Rue du Bugnon 21, 1011, Lausanne, Switzerland. .,Department of Emergency Medicine, Lausanne University Hospital, Rue du Bugnon 46, 1011, Lausanne, Switzerland.
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Eidenbenz D, Techel F, Kottmann A, Rousson V, Carron PN, Albrecht R, Pasquier M. Survival probability in avalanche victims with long burial (≥60 min): A retrospective study. Resuscitation 2021; 166:93-100. [PMID: 34107337 DOI: 10.1016/j.resuscitation.2021.05.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 03/09/2021] [Revised: 05/25/2021] [Accepted: 05/30/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND The survival of completely buried victims in an avalanche mainly depends on burial duration. Knowledge is limited about survival probability after 60 min of complete burial. AIM We aimed to study the survival probability and prehospital characteristics of avalanche victims with long burial durations. METHODS We retrospectively included all completely buried avalanche victims with a burial duration of ≥60 min between 1997 and 2018 in Switzerland. Data were extracted from the registry of the Swiss Institute for Snow and Avalanche Research and the prehospital medical records of the physician-staffed helicopter emergency medical services. Avalanche victims buried for ≥24 h or with an unknown survival status were excluded. Survival probability was estimated by using the non-parametric Ayer-Turnbull method and logistic regression. The primary outcome was survival probability. RESULTS We identified 140 avalanche victims with a burial duration of ≥60 min, of whom 27 (19%) survived. Survival probability shows a slight decrease with increasing burial duration (23% after 60 min, to <6% after 1400 min, p = 0.13). Burial depth was deeper for those who died (100 cm vs 70 cm, p = 0.008). None of the survivors sustained CA during the prehospital phase. CONCLUSIONS The overall survival rate of 19% for completely buried avalanche victims with a long burial duration illustrates the importance of continuing rescue efforts. Avalanche victims in CA after long burial duration without obstructed airway, frozen body or obvious lethal trauma should be considered to be in hypothermic CA, with initiation of cardiopulmonary resuscitation and an evaluation for rewarming with extracorporeal life support.
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Affiliation(s)
- David Eidenbenz
- Department of Emergency Medicine, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 21, BH 09, CHUV, 1011 Lausanne, Switzerland.
| | - Frank Techel
- WSL Institute for Snow and Avalanche Research SLF, Flüelastrasse 11, 7260 Davos-Dorf, Switzerland.
| | - Alexandre Kottmann
- Swiss Air Ambulance - Rega and Emergency Department, Lausanne University Hospital, P.O. Box 1414, 8058 Zürich Airport, Switzerland.
| | - Valentin Rousson
- Center for Primary Care and Public Health (Unisanté), route de Berne 113, 1010 Lausanne, Switzerland.
| | - Pierre-Nicolas Carron
- Department of Emergency Medicine, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 21, BH 09, CHUV, 1011 Lausanne, Switzerland.
| | - Roland Albrecht
- Swiss Air Ambulance - Rega, P.O. Box 1414, 8058 Zürich Airport, Switzerland.
| | - Mathieu Pasquier
- Department of Emergency Medicine, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 21, BH 09, CHUV, 1011 Lausanne, Switzerland.
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Pasquier M, Paal P. Rescue collapse - A hitherto unclassified killer in accidental hypothermia. Resuscitation 2021; 164:142-143. [PMID: 34082031 DOI: 10.1016/j.resuscitation.2021.05.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 05/17/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Mathieu Pasquier
- Department of Emergency Medicine, Lausanne University Hospital and University of Lausanne, BH 09, 1011 Lausanne, Switzerland.
| | - Peter Paal
- Department of Anesthesiology and Intensive Care Medicine, Hospitaller Brothers Hospital, Paracelsus Medical University, Kajetanerplatz 1, 5020 Salzburg, Austria.
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Musi ME, Sheets A, Brugger H, Paal P, Zafren K, Pasquier M. Reply to: Revised Swiss System for clinical staging of accidental hypothermia - At which core temperatures are patients at high risk of cardiac arrest? Resuscitation 2021; 165:186-187. [PMID: 34082033 DOI: 10.1016/j.resuscitation.2021.05.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 05/22/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Martin E Musi
- Department of Emergency Medicine, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA; International Commission for Mountain Emergency Medicine (ICAR MedCom), Zürich, Switzerland.
| | - Alison Sheets
- Department of Emergency Medicine, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA; International Commission for Mountain Emergency Medicine (ICAR MedCom), Zürich, Switzerland; Emergency Medicine, Boulder Community Health, Boulder, Colorado, USA. Technical Rescue Advisor/Faculty, University of Colorado Wilderness and Environmental Medicine Fellowship, Aurora, CO, USA
| | - Hermann Brugger
- Department of Emergency Medicine, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA; International Commission for Mountain Emergency Medicine (ICAR MedCom), Zürich, Switzerland; Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy
| | - Peter Paal
- Department of Emergency Medicine, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA; International Commission for Mountain Emergency Medicine (ICAR MedCom), Zürich, Switzerland; Department of Anaesthesiology and Intensive Care Medicine, Hospitallers Brothers Hospital, Paracelsus Medical University Salzburg. Austrian Board for Mountain Safety, Innsbruck. Austrian Society of Mountain and High Altitude Medicine, Mieming
| | - Ken Zafren
- Department of Emergency Medicine, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA; International Commission for Mountain Emergency Medicine (ICAR MedCom), Zürich, Switzerland; Department of Emergency Medicine, Alaska Native Medical Center Anchorage, Alaska, USA. Department of Emergency Medicine Stanford University Medical Center Stanford, California, USA
| | - Mathieu Pasquier
- Department of Emergency Medicine, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA; International Commission for Mountain Emergency Medicine (ICAR MedCom), Zürich, Switzerland; Emergency Department, Lausanne University Hospital, Lauanne, Switzerland
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Pasquier M, Gordon L, Paal P, Darocha T, Zafren K. Warm Fluid Infusion Is Not an Effective Primary Warming Method in Accidental Hypothermia. Ther Hypothermia Temp Manag 2021; 11:76. [PMID: 33887159 DOI: 10.1089/ther.2021.0006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Mathieu Pasquier
- Department of Emergency Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Les Gordon
- Department of Anaesthesia, University Hospitals Morecambe Bay Trust, Royal Lancaster Infirmary, Lancaster, United Kingdom
| | - Peter Paal
- Department of Anaesthesiology and Intensive Care, Hospitallers Brothers Hospital, Paracelsus Medical University, Salzburg, Austria
| | - Tomasz Darocha
- Severe Accidental Hypothermia Center, Department of Anaesthesiology and Intensive Care, Medical University of Silesia, Katowice, Poland
| | - Ken Zafren
- Department of Emergency Medicine, Stanford University Medical Center, Stanford, California, USA.,Alaska Native Medical Center, Anchorage, Alaska, USA
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Pasquier M, Rousson V. Qualification for Extracorporeal Life Support in Accidental Hypothermia: The HOPE Score. Ann Thorac Surg 2021; 111:1408. [DOI: 10.1016/j.athoracsur.2020.06.146] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 06/27/2020] [Indexed: 11/26/2022]
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Kosiński S, Darocha T, Mendrala K, Pasquier M. Estimation of the survival probabilities in hypothermic cardiac arrest patients with drowning: The HOPE score as a tool to help selecting patients for extracorporeal rewarming. Resuscitation 2021; 162:453-454. [PMID: 33794329 DOI: 10.1016/j.resuscitation.2021.02.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 02/23/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Sylweriusz Kosiński
- Faculty of Health Sciences, Jagiellonian University Medical College, Michałowskiego 12, Kraków, Poland.
| | - Tomasz Darocha
- Department of Anaesthesiology and Intensive Care, Medical University of Silesia, Medyków 16, Katowice, Poland.
| | - Konrad Mendrala
- Department of Anaesthesiology and Intensive Care, Medical University of Silesia, Medyków 16, Katowice, Poland.
| | - Mathieu Pasquier
- Department of Emergency Medicine, Lausanne University Hospital and University of Lausanne, BH09, 1011 Lausanne, Switzerland.
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Musi ME, Sheets A, Zafren K, Brugger H, Paal P, Hölzl N, Pasquier M. Clinical staging of accidental hypothermia: The Revised Swiss System: Recommendation of the International Commission for Mountain Emergency Medicine (ICAR MedCom). Resuscitation 2021; 162:182-187. [PMID: 33675869 DOI: 10.1016/j.resuscitation.2021.02.038] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [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: 11/30/2020] [Revised: 02/12/2021] [Accepted: 02/16/2021] [Indexed: 12/29/2022]
Abstract
Clinical staging of accidental hypothermia is used to guide out-of-hospital treatment and transport decisions. Most clinical systems utilize core temperature, by measurement or estimation, to stage hypothermia, despite the challenge of obtaining accurate field measurements. Recent studies have demonstrated that field estimation of core temperature is imprecise. We propose a revision of the original Swiss Staging system. The revised system uses the risk of cardiac arrest, instead of core temperature, to determine the staging level. Our revised system simplifies assessment by using the level of responsiveness, based on the AVPU scale, and by removing shivering as a stage-defining sign.
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Affiliation(s)
- Martin E Musi
- Department of Emergency Medicine, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA; International Commission for Mountain Emergency Medicine (ICAR MedCom), Zürich, Switzerland.
| | - Alison Sheets
- Department of Emergency Medicine, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA; International Commission for Mountain Emergency Medicine (ICAR MedCom), Zürich, Switzerland; Department of Emergency Medicine, Boulder Community Health, Boulder, CO, USA.
| | - Ken Zafren
- International Commission for Mountain Emergency Medicine (ICAR MedCom), Zürich, Switzerland; Department of Emergency Medicine, Alaska Native Medical Center Anchorage, AK, USA; Department of Emergency Medicine, Stanford University Medical Center, Stanford, CA, USA.
| | - Hermann Brugger
- International Commission for Mountain Emergency Medicine (ICAR MedCom), Zürich, Switzerland; Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy; Medical University Innsbruck, Innsbruck, Austria.
| | - Peter Paal
- International Commission for Mountain Emergency Medicine (ICAR MedCom), Zürich, Switzerland; Department of Anaesthesiology and Intensive Care Medicine, Hospitallers Brothers Hospital, Paracelsus Medical University, Salzburg, Austria.
| | - Natalie Hölzl
- International Commission for Mountain Emergency Medicine (ICAR MedCom), Zürich, Switzerland; Department of Anaesthesiology and Intensive Care Medicine, Allgäu Hospital Group, Klinik Immenstadt, Germany.
| | - Mathieu Pasquier
- International Commission for Mountain Emergency Medicine (ICAR MedCom), Zürich, Switzerland; Department of Emergency Medicine, Lausanne University Hospital, Lausanne, Switzerland.
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Kottmann A, Strapazzon G, Pasquier M, Blancher M, Brugger H. Reply to letter: Adaptation to the 2017 ICAR MEDCOM Avalanche Victim Resuscitation Checklist. Resuscitation 2021; 160:66-67. [PMID: 33476689 DOI: 10.1016/j.resuscitation.2021.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Accepted: 01/05/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Alexandre Kottmann
- Swiss Air Ambulance Rega, Zürich, Switzerland; Emergency Department, Lausanne University Hospital, Lausanne, Switzerland; International Commission for Mountain Emergency Medicine ICAR MEDCOM, Switzerland.
| | - Giacomo Strapazzon
- EURAC Institute of Mountain Emergency Medicine, Bolzano, Italy; International Commission for Mountain Emergency Medicine ICAR MEDCOM, Switzerland
| | - Mathieu Pasquier
- Emergency Department, Lausanne University Hospital, Lausanne, Switzerland; International Commission for Mountain Emergency Medicine ICAR MEDCOM, Switzerland
| | - Marc Blancher
- Emergency Department, University Hospital of Grenoble, France; French Mountain Rescue Association ANMSM, France; International Commission for Mountain Emergency Medicine ICAR MEDCOM, Switzerland
| | - Hermann Brugger
- EURAC Institute of Mountain Emergency Medicine, Bolzano, Italy; International Commission for Mountain Emergency Medicine ICAR MEDCOM, Switzerland
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Abstract
Pasquier, Mathieu, Evelien Cools, Ken Zafren, Pierre-Nicolas Carron, Vincent Frochaux, and Valentin Rousson. Vital signs in accidental hypothermia. High Alt Med Biol. 22: 142-147, 2021. Background: Clinical indicators are used to stage hypothermia and to guide management of hypothermic patients. We sought to better characterize the influence of hypothermia on vital signs, including level of consciousness, by studying cases of patients suffering from accidental hypothermia. Materials and Methods: We retrospectively included patients aged ≥18 years admitted to the hospital with a core temperature below 35°C. We identified the cases from a literature review and from a retrospective case series of hypothermic patients admitted to the hospital between 1994 and 2016. Patients who experienced cardiac arrest, as well as those with potential confounders such as concomitant diseases or intoxications, were excluded. Relationships between core temperature and heart rate, systolic blood pressure, respiratory rate, and level of consciousness were explored via correlations and regression. Results: Of the 305 cases reviewed, 216 met the criteria for inclusion. The mean temperature was 29.7°C ± 4.2°C (range 19.3°C-34.9°C). The relationships between temperature and each of the four vital signs were generally linear and significantly positive, with Spearman correlations for respiratory rate, heart rate, systolic blood pressure, and Glasgow Coma Score (GCS) of 0.29 (p = 0.024), 0.44 (p < 0.001), 0.47 (p < 0.001), and 0.78 (p < 0.001), respectively. Based on linear regression, the mean decrease of a vital sign associated with a 1°C decrease of temperature was estimated to be 0.50 minute-1 for respiratory rate, 2.54 minutes-1 for heart rate, 4.36 mmHg for systolic blood pressure, and 0.88 for GCS. Conclusions: There is a significant positive correlation between core temperature and heart rate, systolic blood pressure, respiratory rate, and GCS. The relationship between vital signs and temperature is generally linear. This knowledge might help clinicians make appropriate decisions when determining whether the clinical condition of a patient should be attributed to hypothermia. This could enhance clinical care and help to guide future research.
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Affiliation(s)
- Mathieu Pasquier
- Emergency Department, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland.,University of Lausanne, Lausanne, Switzerland
| | - Evelien Cools
- Department of Anaesthesiology, University Hospital of Geneva, Geneva, Switzerland
| | - Ken Zafren
- Department of Emergency Medicine, Stanford University Medical Center, Stanford, California, USA
| | - Pierre-Nicolas Carron
- Emergency Department, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland.,University of Lausanne, Lausanne, Switzerland
| | | | - Valentin Rousson
- University of Lausanne, Lausanne, Switzerland.,Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland
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Affiliation(s)
- Mathieu Pasquier
- From Emergency Service, Lausanne University Hospital, Lausanne, Switzerland (M.P.); the Department of Anaesthesiology and Intensive Care, Hospitallers Brothers Hospital, Paracelsus Medical University, Salzburg, Austria (P. Paal); the Faculty of Health Sciences, Jagiellonian University Medical College, Krakow (S.K.), the Department of Emergency Medicine, Jan Kochanowski University, Kielce (P. Podsiadlo), and the Department of Anaesthesiology and Intensive Care, Medical University of Silesia, Katowice (T.D.) - all in Poland; and the Department of Emergency Medicine, University of British Columbia, New Westminster, BC, Canada (D.B.)
| | - Peter Paal
- From Emergency Service, Lausanne University Hospital, Lausanne, Switzerland (M.P.); the Department of Anaesthesiology and Intensive Care, Hospitallers Brothers Hospital, Paracelsus Medical University, Salzburg, Austria (P. Paal); the Faculty of Health Sciences, Jagiellonian University Medical College, Krakow (S.K.), the Department of Emergency Medicine, Jan Kochanowski University, Kielce (P. Podsiadlo), and the Department of Anaesthesiology and Intensive Care, Medical University of Silesia, Katowice (T.D.) - all in Poland; and the Department of Emergency Medicine, University of British Columbia, New Westminster, BC, Canada (D.B.)
| | - Sylweriusz Kosinski
- From Emergency Service, Lausanne University Hospital, Lausanne, Switzerland (M.P.); the Department of Anaesthesiology and Intensive Care, Hospitallers Brothers Hospital, Paracelsus Medical University, Salzburg, Austria (P. Paal); the Faculty of Health Sciences, Jagiellonian University Medical College, Krakow (S.K.), the Department of Emergency Medicine, Jan Kochanowski University, Kielce (P. Podsiadlo), and the Department of Anaesthesiology and Intensive Care, Medical University of Silesia, Katowice (T.D.) - all in Poland; and the Department of Emergency Medicine, University of British Columbia, New Westminster, BC, Canada (D.B.)
| | - Douglas Brown
- From Emergency Service, Lausanne University Hospital, Lausanne, Switzerland (M.P.); the Department of Anaesthesiology and Intensive Care, Hospitallers Brothers Hospital, Paracelsus Medical University, Salzburg, Austria (P. Paal); the Faculty of Health Sciences, Jagiellonian University Medical College, Krakow (S.K.), the Department of Emergency Medicine, Jan Kochanowski University, Kielce (P. Podsiadlo), and the Department of Anaesthesiology and Intensive Care, Medical University of Silesia, Katowice (T.D.) - all in Poland; and the Department of Emergency Medicine, University of British Columbia, New Westminster, BC, Canada (D.B.)
| | - Pawel Podsiadlo
- From Emergency Service, Lausanne University Hospital, Lausanne, Switzerland (M.P.); the Department of Anaesthesiology and Intensive Care, Hospitallers Brothers Hospital, Paracelsus Medical University, Salzburg, Austria (P. Paal); the Faculty of Health Sciences, Jagiellonian University Medical College, Krakow (S.K.), the Department of Emergency Medicine, Jan Kochanowski University, Kielce (P. Podsiadlo), and the Department of Anaesthesiology and Intensive Care, Medical University of Silesia, Katowice (T.D.) - all in Poland; and the Department of Emergency Medicine, University of British Columbia, New Westminster, BC, Canada (D.B.)
| | - Tomasz Darocha
- From Emergency Service, Lausanne University Hospital, Lausanne, Switzerland (M.P.); the Department of Anaesthesiology and Intensive Care, Hospitallers Brothers Hospital, Paracelsus Medical University, Salzburg, Austria (P. Paal); the Faculty of Health Sciences, Jagiellonian University Medical College, Krakow (S.K.), the Department of Emergency Medicine, Jan Kochanowski University, Kielce (P. Podsiadlo), and the Department of Anaesthesiology and Intensive Care, Medical University of Silesia, Katowice (T.D.) - all in Poland; and the Department of Emergency Medicine, University of British Columbia, New Westminster, BC, Canada (D.B.)
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Podsiadło P, Darocha T, Svendsen ØS, Kosiński S, Silfvast T, Blancher M, Sawamoto K, Pasquier M. Outcomes of patients suffering unwitnessed hypothermic cardiac arrest rewarmed with extracorporeal life support: A systematic review. Artif Organs 2020; 45:222-229. [PMID: 32920881 DOI: 10.1111/aor.13818] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [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: 07/20/2020] [Revised: 08/12/2020] [Accepted: 09/03/2020] [Indexed: 12/16/2022]
Abstract
Prolonged cardiac arrest (CA) may lead to neurologic deficit in survivors. Good outcome is especially rare when CA was unwitnessed. However, accidental hypothermia is a very specific cause of CA. Our goal was to describe the outcomes of patients who suffered from unwitnessed hypothermic cardiac arrest (UHCA) supported with Extracorporeal Life Support (ECLS). We included consecutive patients' cohorts identified by systematic literature review concerning patients suffering from UHCA and rewarmed with ECLS. Patients were divided into four subgroups regarding the mechanism of cooling, namely: air exposure; immersion; submersion; and avalanche. A statistical analysis was performed in order to identify the clinical parameters associated with good outcome (survival and absence of neurologic impairment). A total of 221 patients were included into the study. The overall survival rate was 27%. Most of the survivors (83%), had no neurologic deficit. Asystole was the presenting CA rhythm in 48% survivors, of which 79% survived with good neurologic outcome. Variables associated with survival included the following: female gender (P < .001); low core temperature (P = .005); non-asphyxia-related mechanism of cooling (P < .001); pulseless electrical activity as an initial rhythm (P < .001); high blood pH (P < .001); low lactate levels (P = .003); low serum potassium concentration (P < .001); and short resuscitation duration (P = .004). Severely hypothermic patients with unwitnessed CA may survive with good neurologic outcome, including those presenting as asystole. The initial blood pH, potassium, and lactate concentration may help predict outcome in hypothermic CA.
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Affiliation(s)
- Paweł Podsiadło
- Department of Emergency Medicine, Jan Kochanowski University, Kielce, Poland
| | - Tomasz Darocha
- Department of Anaesthesiology and Intensive Care, Medical University of Silesia, Katowice, Poland
| | - Øyvind S Svendsen
- Department of Anaesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway
| | - Sylweriusz Kosiński
- Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland
| | - Tom Silfvast
- Department of Anaesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Marc Blancher
- Department of Emergency Medicine, SAMU 38, University Hospital of Grenoble Alps, Grenoble, France
| | - Keigo Sawamoto
- Department of Emergency Medicine, Sapporo Medical University, Sapporo, Japan
| | - Mathieu Pasquier
- Emergency Department, Lausanne University Hospital, Lausanne, Switzerland
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Vanolli K, Hugli O, Eidenbenz D, Suter MR, Pasquier M. Prehospital Use of Ketamine in Mountain Rescue: A Survey of Emergency Physicians of a Single-Center Alpine Helicopter-Based Emergency Service. Wilderness Environ Med 2020; 31:385-393. [PMID: 32912718 DOI: 10.1016/j.wem.2020.06.004] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 06/01/2020] [Accepted: 06/03/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Although ketamine use in emergency medicine is widespread, studies investigating prehospital use are scarce. Our goal was to assess the self-reported modalities of ketamine use, knowledge of contraindications, and occurrence of adverse events associated with its use by physicians through a prospective online survey. METHODS The survey was administered to physicians working for Air-Glaciers, a Swiss alpine helicopter-based emergency service, and was available between September 24 and November 23, 2018. We enrolled 39 participants (participation rate of 87%) in our study and collected data regarding their characteristics, methods of ketamine use, knowledge of contraindications, and encountered side effects linked to the administration of ketamine. We also included a clinical scenario to investigate an analgesic strategy. RESULTS Ketamine was considered safe and judged irreplaceable by most physicians. The main reason for ketamine use was acute analgesia during painful procedures, such as manipulation of femur fractures. The doses of ketamine administered with or without fentanyl ranged from 0.2 to 0.7 mg·kg-1 intravenously. Most physicians reported using fentanyl and midazolam along with ketamine. The median dose of midazolam was 2 (interquartile range 1-2) mg for a 70-kg adult. Monitoring and oxygen administration were used infrequently. Hallucinations were the most common adverse events. Knowledge of ketamine contraindications was poor. CONCLUSIONS Ketamine use was reported by mountain rescue physicians to be safe and useful for acute analgesia. Most physicians use fentanyl and midazolam along with ketamine. Adverse neuropsychiatric events were rare. Knowledge regarding contraindications to the administration of ketamine should be improved.
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Affiliation(s)
- Katia Vanolli
- Medical School of the University of Lausanne, Lausanne, Switzerland
| | - Olivier Hugli
- Emergency Department, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - David Eidenbenz
- Emergency Department, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Marc R Suter
- Department of Anesthesia, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Mathieu Pasquier
- Emergency Department, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
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Maudet L, Pasquier M, Pantet O, Albrecht R, Carron PN. Prehospital management of burns requiring specialized burn centre evaluation: a single physician-based emergency medical service experience. Scand J Trauma Resusc Emerg Med 2020; 28:84. [PMID: 32819398 PMCID: PMC7439538 DOI: 10.1186/s13049-020-00771-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 07/28/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Emergency medical services regularly encounter severe burns. As standards of care are relatively well-established regarding their hospital management, prehospital care is comparatively poorly defined. The aim of this study was to describe burned patients taken care of by our physician-staffed emergency medical service (PEMS). METHODS All patients directly transported by our PEMS to our burn centre between January 2008 and December 2017 were retrospectively enrolled. We specifically addressed three "burn-related" variables: prehospital and hospital burn size estimations, type and volume of infusion and pain assessment and management. We divided patients into two groups for comparison: TBSA < 20% and ≥ 20%. We a priori defined clinically acceptable limits of agreement in the small and large burn group to be ±5% and ± 10%, respectively. RESULTS We included 86 patients whose median age was 26 years (IQR 12-51). The median prehospital TBSA was 10% (IQR 6-25). The difference between the prehospital and hospital TBSA estimations was outside the limits of agreement at 6.2%. The limits of agreement found in the small and large burn groups were - 5.3, 4.4 and - 10.1, 11, respectively. Crystalloid infusion was reported at a median volume of 0.8 ml/kg/TBSA (IQR 0.3-1.4) during the prehospital phase, which extrapolated over the first 8 h would equal to a median volume of 10.5 ml/kg/TBSA. The median verbal numeric rating scale on scene was 6 (IQR 3-8) and 3 (IQR 2-5) at the hospital (p < 0.001). Systemic analgesia was provided to 61 (71%) patients, predominantly with fentanyl (n = 59; 69%), followed by ketamine (n = 7; 8.1%). The median doses of fentanyl and ketamine were 1.7 mcg/kg (IQR 1-2.6) and 2.1 mg/kg (IQR 0.3-3.2), respectively. CONCLUSIONS We found good agreement in burn size estimations. The quantity of crystalloid infused was higher than the recommended amount, suggesting a potential risk for fluid overload. Most patients benefited from a correct systemic analgesia. These results emphasized the need for dedicated guidelines and decision support aids for the prehospital management of burned patients.
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Affiliation(s)
- Ludovic Maudet
- Faculty of Biology and Medicine, University of Lausanne, Rue du Bugnon 21, CH-1011, Lausanne, Switzerland.
- Department of Emergency Medicine, Lausanne University Hospital, Rue du Bugnon 46, CH-1011, Lausanne, Switzerland.
- Department of Anesthesiology, Lausanne University Hospital, Ru du Bugnon 46, CH-1011, Lausanne, Switzerland.
| | - Mathieu Pasquier
- Faculty of Biology and Medicine, University of Lausanne, Rue du Bugnon 21, CH-1011, Lausanne, Switzerland
- Department of Emergency Medicine, Lausanne University Hospital, Rue du Bugnon 46, CH-1011, Lausanne, Switzerland
| | - Olivier Pantet
- Faculty of Biology and Medicine, University of Lausanne, Rue du Bugnon 21, CH-1011, Lausanne, Switzerland
- Department of Intensive Care Medicine and Burn Centre, Lausanne University Hospital, Rue du Bugnon 46, CH-1011, Lausanne, Switzerland
| | - Roland Albrecht
- Rega - Swiss Air-Rescue, Rega Centre, PO Box 1414, CH-8058, Zurich, Switzerland
| | - Pierre-Nicolas Carron
- Faculty of Biology and Medicine, University of Lausanne, Rue du Bugnon 21, CH-1011, Lausanne, Switzerland
- Department of Emergency Medicine, Lausanne University Hospital, Rue du Bugnon 46, CH-1011, Lausanne, Switzerland
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Ageron FX, Sarasin F, Pasquier M, Carron PN. [Emergency department : COVID-19 crisis and organizational aspects]. Rev Med Suisse 2020; 16:924-929. [PMID: 32374538] [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] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Emergency departments are on the front line in the management of COVID-19 cases, from screening to the initial management of the most severe cases. The clinical presentation of COVID-19 range from non-specific symptoms to adult acute respiratory distress syndrome (ARDS). Diagnosis is based on PCR from a nasopharyngeal swab and emergency treatment rely on oxygen therapy. Patient's orientation (home, hospitalization, admission in intensive care unit) is a central aspect of emergency management. The shift from a strategy of systematic recognition of potential cases to the one of epidemic mitigation required hospital emergency medicine services to implement crisis management measures, to guarantee admission and hospitalization capacity.
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Affiliation(s)
| | - François Sarasin
- (pour l'équipe des cadres du SU), Service des urgences, HUG, 1205 Genève
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