Exhaled carbon monoxide is correlated with ischemia reperfusion injuries during ex vivo lung perfusion in pigs.

Measurement of exhaled carbon monoxide (eCO) might help in the selection of lung grafts during ex vivo lung perfusion (EVLP) since its endogenous production is increased under ischemia reperfusion. The objective of this study was to measure eCO variations depending on the extent of lung ischemia reperfusion injuries. Using a porcine model and a laser spectrometer instrument, eCO was measured during EVLP. eCO was compared after 30 min (D0) or 24 h (D1) of cold ischemia. The ability of eCO to distinguish lungs deemed suitable for transplantation was evaluated. Six lungs were studied at D0 and compared to six lungs studied at D1. eCO was systematically higher on D1 (1.35 ± 0.26 ppmv versus 0.95 ± 0.31 ppmv, p = 0.01). The best threshold concentration for eCO to select lungs was 0.86 ppmv (area under the receiver operating characteristic curve: 0.65 [95% confidence interval: 0.34-0.97], p = 0.40). These results show that eCO varies during EVLP. The interpretation of this variation and the role of eCO as a biomarker of ischemia reperfusion injuries during EVLP should be tested in further clinical studies.

Post-conditioning with Cyclosporine A after a 24-hour cold ischemia in ex vivo reperfused pig lungs.

OBJECTIVE: To evaluate the effects of 1 and 5 µM of Cyclosporine A (CsA), administered 24 hours after a cold ischemic period, in an ex vivo reperfused pig lung model. METHODS: The experiments were performed in 15 pigs. Each pair of lungs was surgically separated. Extracorporeal perfusion and mechanical ventilation were started after a cold ischemia of 2 hours for one lung and 24 hours for the contralateral. We constituted three groups (n = 5 each): two groups for which the lung underwent a 24-hour ischemia received either 1 or 5 µM of CsA at the time of reperfusion, and a control group without CsA. For each group, lungs undergoing a 2-hour ischemia did not receive CsA. RESULTS: Reperfusion with either CsA increased the PO2 levels in a dose dependent manner, and reduced concentrations of the receptor for advanced glycation endproducts, compared to the control. The pulmonary arterial pressure, the capillary pressure, and the pulmonary vascular resistances were not increased, even with 5 µM of CsA. No significant change was shown on cytokines levels. DISCUSSION: Postconditioning with CsA improves lung function, after a 24-hour cold ischemic period. Either 1 or 5 µM seemed to be safe regarding the pulmonary vascular pressures and resistances.

Characteristics and management of acute ST-segment elevation myocardial infarctions occurring in ski resorts in the French Alps: Impact of an acute coronary care network.

BACKGROUND: Compliance with guidelines for the management of ST-segment elevation myocardial infarction (STEMI) may be difficult in hard-to-access areas. AIMS: to analyse the characteristics, management and outcome of STEMIs occurring at altitude in the French Alps and managed by mobile medical emergency units. METHODS: From January 2006 to December 2008, from the prospective RESURCOR registry, 114 patients with a STEMI of less than 12 hours' duration, occurring in a ski resort or at high altitude and managed by the RESURCOR care system, were identified. Baseline characteristics, treatments and in-hospital outcomes were analysed. RESULTS: Ninety-three per cent of patients were men; the mean age was 57 years. STEMIs occurred during or less than 1 hour after physical activity in 76.3% of cases (mainly during or after alpine/cross-country skiing). Killip class greater or equal to 2 and cardiac arrest were observed in 35% and 7.9% of cases, respectively. Fifty-two (45.6%) patients underwent thrombolysis and 62 (54.4%) had percutaneous coronary intervention (PCI). Median delays were: first call to treatment, 82 min (17-230 min); symptoms to treatment, 165 min (52-770 min). All delays were significantly longer for PCI than for thrombolysis. First call to treatment delay was less than 120 min in 98.1% of patients who underwent thrombolysis and in 51.6% who had PCI (P<0.0001). In-hospital survival was 96.5%. CONCLUSION: Altitude STEMIs happen mainly during sporting activities. Clinical presentation is often severe, but an emergency coronary care network allows rapid reperfusion. These findings emphasize the need for an efficient network for STEMI management in geographically difficult-to-access areas.

[Factors associated with delay in calling Emergency Medical Services ("15") for patients with ST-elevation myocardial infarction in southern Isère]. / Facteurs associés au délai d'appel au centre 15 du service d'aide médicale urgente chez les patients ayant un syndrome coronaire aigu avec sus-décalage du segment ST dans le sud du département de l'Isère.

BACKGROUND: Time until revascularization is an important prognostic factor for patients with ST-elevation myocardial infarction. The objective of this study was to investigate the factors associated with patients' delay in calling for emergency medical services (SAMU, "15" in France). METHODS: We analyzed the original data of a permanent prospective register of patients receiving care from mobile intensive care units staffed by emergency physicians and dispatched by SAMU in southern Isère (France), from October 1, 2002, through December 31, 2004. RESULTS: Of the 380 patients analyzed, 71% were men and 15% had a history of coronary disease. The median age was 60 years for men and 72 for women. The median time from symptom onset to calling SAMU was 63 minutes (interquartile range, 27 to 144). In the univariate analyses, the time to the call was higher for women (90 v 58, p<0.01) and increased with age (p<0.01) and prior calls to a physician or nurse (115 v 45, p<0.001). In the multivariable analysis, factors independently associated with delay in calling SAMU included female gender, age of 55-64 years, prior calls to a physician or nurse, and onset of pain during the weekend or at night. The media call delay did not differ for patients with and without a history of coronary disease. CONCLUSION: The subpopulations of patients characterized by the factors associated with delayed calls should be the target of programs to stress the importance of calling SAMU quickly, regardless of the time of day; the effectiveness of these programs should be evaluated by randomized studies before they enter general use.