MEESSI-AHF score to estimate short-term prognosis of acute heart failure patients in the Emergency Department: a prospective and multicenter study.

BACKGROUND: The assessment of acute heart failure (AHF) prognosis is primordial in emergency setting. Although AHF management is exhaustively codified using mortality predictors, there is currently no recommended scoring system for assessing prognosis. The European Society of Cardiology (ESC) recommends a comprehensive assessment of global AHF prognosis, considering in-hospital mortality, early rehospitalization rates and the length of hospital stay. OBJECTIVE: We aimed to prospectively evaluate the performance of the Multiple Estimation of risk based on the Emergency department Spanish Score In patients with AHF (MEESSI-AHF) score in estimating short prognosis according to the ESC guidelines. DESIGN, SETTINGS AND PATIENTS: A multicenter study was conducted between November 2020, and June 2021. Adult patients who presented to eleven French hospitals for AHF were prospectively included. OUTCOME MEASURES AND ANALYSIS: According to MEESSI-AHF score, patients were stratified in four categories corresponding to mortality risk: low-, intermediate-, high- and very high-risk groups. The primary outcome was the number of days alive and out of the hospital during the 30-day period following admission to the Emergency Department (ED). RESULTS: In total, 390 patients were included. The number of days alive and out of the hospital decreased significatively with increasing MEESSI-AHF risk groups, ranging from 21.2 days (20.3-22.3 days) for the low-risk, 20 days (19.3-20.5 days) for intermediate risk,18.6 days (17.6-19.6 days) for the high-risk and 17.9 days (16.9-18.9 days) very high-risk category. CONCLUSION: Among patients admitted to ED for an episode of AHF, the MEESSI-AHF score estimates with good performance the number of days alive and out of the hospital.

Impact of laryngeal tube use on chest compression fraction during out-of-hospital cardiac arrest. A prospective alternate month study.

AIM: Supraglottic devices are thought to allow efficient ventilation and continuous chest compressions during cardiac arrest. Therefore, the use of supraglottic devices could increase the chest compression fraction (CCF), a critical determinant of patient survival. The aim of this study was to assess the CCF in out-of-hospital cardiac arrest (OHCA) patients ventilated with a supraglottic device. METHODS: We conducted an open prospective multicenter study with temporal clusters. OHCA patients treated by emergency nurses received either intermittent chest compressions with bag-valve mask ventilations (30:2 rhythm; BVM group); or continuous chest compressions with asynchronous ventilations by laryngeal tube (LT group). The primary endpoint was the CCF assessed using an accelerometer connected to the defibrillator. We also investigated the ease of use of the laryngeal tube. RESULTS: Eighty-two patients were included (41 in each group); 68% were male and the median age was 68 (54-80) years. Patients and cardiac arrest characteristics did not differ between groups. The CCF was 75% (68-79%) in the LT group and 59% (51-68%) in the BVM group (p<0.01). LT insertion failed in nine out of 40 cases (23%). The median time of LT insertion was 26s (11-56 s). CCF was significantly lower when LT insertion failed (58% (48-74%) vs. 76% (72-80%) when LT insertion succeeded; p=0.01). CONCLUSION: The use of the LT during OHCA increases the CCF when compared to standard BVM ventilation. However, the impact of LT use on mortality remains unclear.