Relation between chest compression rate and depth: the ENFONCE Study.

INTRODUCTION: Chest compressions are the cornerstone of cardiopulmonary resuscitation. The recent International Liaison Committee on Resuscitation guidelines recommend increasing the rate and the depth of chest compressions, to 100-120/min and 5-6 cm, based on theoretical arguments and observational studies. We hypothesized that an increased chest compressions rate could decrease chest compressions depth. METHODS: Operators were asked to perform continuous chest compressions on a mannequin. Chest compressions rate and depth were collected. The ratio of chest compressions compliance to the guidelines, that is rate 100-120/min and depth 5-6 cm, was calculated. RESULTS: In total 951 sequences of chest compressions were studied. Median chest compressions rate: 114 (104-130)/min. Median chest compressions depth: 4.5 (3.4-5.3) cm. Correlation between rate and depth: low (R2 = 0.12). Chest compressions in compliance with the recommended rate: 434 (46%). Rate >120/min in 285 (30%) cases and <100/min in 223 (23%) cases. Chest compressions in compliance with the recommended depth: 286 (30%). Depth >6 cm in 50 (5%) cases and <5 cm in 621 (65%) cases. Finally, chest compressions were in compliance with the guidelines for both rate and depth in 141 (15%) cases. The ratio of chest compressions in compliance with the recommended depth significantly decreased with the increase of the rate: 40% for a rate <100/min, 32% for a rate in the target (100-120/min) and 18% for a rate >100/min (P < 0.0001). DISCUSSION: The ratio of chest compressions in compliance with the recommended rate and depth was as low as 15%. The rate of chest compressions in compliance with the recommended depth significantly decreased when the chest compressions rate increased. To reach both recommended rate and depth seems illusive.

Prevention of hypothermia in trauma victims - the HYPOTRAUM 2 study.

INTRODUCTION: Hypothermia is common in trauma patients. It contributes to increasing mortality rate. Hypothermia is multifactorial, favoured by exposure to cold, severity of the patient's state and interventions such as infusion of fluids at room temperature. AIM: To demonstrate that specific management of hypothermia (or of the risk of hypothermia) increases the number of trauma patients arriving at the hospital with a temperature >35°C. DESIGN: This is a prospective, multicentre, open-label, pragmatic, cluster randomized clinical trial of an expected 1,200 trauma patients included by 12 out-of-hospital mobile intensive care units (MICU). Trauma patients are included in a prehospital setting if they present at least one of the following criteria known to be associated with an increased incidence of hypothermia: ambient temperature <18°C, Glasgow coma scale <15, systolic arterial blood pressure <100 mm Hg or body temperature <35°C. Patients are randomized, by cluster, to receive a conventional management or 'interventional' nursing management associating: continuous epitympanic temperature monitoring, early installation in the heated ambulance (temperature target >30°C controlled by infrared thermometer), protection by a survival blanket, and use of heated solutes (temperature objective >35°C controlled by infrared thermometer). The primary end point is the prevalence of hypothermia on arrival at the hospital. The hypothesis tested is a reduction from 20% to 13% in the prevalence of hypothermia. Secondary end points are to evaluate the interaction between the effectiveness of the measures taken and: (1) the severity of the patients assessed by the Revised Trauma Score; (2) the meteorological conditions when they are managed; (3) the time of care; and (4) therapeutic interventions. DISCUSSION: This trial will assess the effectiveness of an invasive, out-of-hospital, temperature management on the onset of hypothermia in moderate to severe trauma patients. IMPACT: Specific management of hypothermia is expected to decrease hypothermia in trauma patients.

Young children are the main victims of fast food induced obesity in Brazil.

INTRODUCTION: Obesity and overweight strongly contribute to increasing cardiovascular morbidity and mortality, and are becoming a worldwide health issue. The prevalence of obesity has increased dramatically in Latin America. Child obesity is a major issue. Fast food is strongly suspected of contributing to this epidemic of obesity, although there is a lack of evidence. METHODS: We studied the correlation between the number of McDonald restaurants and overweight and obesity prevalence by region stratified by gender and age. Data on prevalences were obtained within national studies conducted by the Brazilian Ministry of Health. Three age sub-groups were analyzed: 5 to 9-year-olds, 10 to 19-year-olds and over 19-year-olds. RESULTS: There was a very strong positive correlation between overweight rates and the number of McDonald restaurants for both males and females between 5 and 9 years old (R2 respectively = 0.92 and 0.84) and a strong positive correlation for females between 10 and 19 years old (R2 = 0.68). There was a very strong positive correlation between obesity rates and the number of McDonald restaurants for males between 5 and 9 years old (R2 = 0.95). This positive correlation was strong for both males and females between 10 and 19 years old (R2 respectively = 0.77 and 0.63). Other correlations were not significant. CONCLUSION: A strong correlation between the prevalence of overweight and obesity and the number of McDonald restaurants was found for Brazilian children and was most important within the group of youngest children. These results should be taken into consideration by education and prevention campaigns.

Decision to deploy coronary reperfusion is not affected by the volume of ST-segment elevation myocardial infarction patients managed by prehospital emergency medical teams.

OBJECTIVE: Mortality in patients with ST-segment elevation myocardial infarction (STEMI) has been associated with the volume of activity of percutaneous coronary intervention (PCI) facilities. This observational study investigated whether the coronary reperfusion-decision rate is associated with the volume of activity in a prehospital emergency setting. METHODS: Prospectively collected data for the period 2003-2013 were extracted from a regional registry of all STEMI patients handled by eight dispatch centers (SAMUs) in and around Paris [41 mobile ICU (MICUs)]. A possible association between volume of activity (number of STEMIs) and coronary reperfusion-decision rate, and subsidiarily between volume of activity and choice of technique (fibrinolysis vs. primary PCI), were investigated. Explanatory factors (patient age, sex, delay between pain onset and first medical contact, and access to a PCI facility) were analyzed in a multivariate analysis. RESULTS: Overall, 18 162 patients; male/female 3.5/1; median age 62 (52-72) years were included in the analysis. The median number of STEMIs per MICU was 339 (IQ 220-508) and that of reperfusion-decisions was 94% (91-95). There was no association between the decision rate and the number of STEMIs (P = 0.1). However, the decision rate was associated with age, sex, delay, and access to a PCI facility (P < 0.0001) in a highly significant way. Fibrinolysis was a more frequent option for low-volume (remoter PCI facilities) than high-volume MICUs (30 vs. 16%). CONCLUSION: The decision of coronary reperfusion in a prehospital emergency setting depended on patient characteristics, delay between pain onset and first medical contact, and access to a PCI facility, but not on volume of activity. Promoting fibrinolysis use in underserved areas might help increase the reperfusion-decision rate.

Evolution of ST-Elevation Acute Myocardial Infarction Prevalence by Gender Assessed Age Pyramid Analysis-The Piramyd Study.

INTRODUCTION: Recent studies reported a decrease in the incidence of acute myocardial infarction. This favorable evolution does not extend to young women. The interaction between gender, risk factors and myocardial infarction incidence remains controversial. OBJECTIVE: To compare the evolution of the age pyramid of patients with ST-elevation myocardial infarction (STEMI) according to gender. METHODS: Data from patients with STEMI managed in pre-hospital settings prospectively collected in the greater Paris area. Evolution of patient demographics and risk factors was investigated. RESULTS: 28,249 patients with STEMI were included in the registry between 2002 and 2014, 21,883 (77%) males and 6,366 (23%) females. The sex ratio did not significantly vary over the study period (p = 0.4). Median patient age was 60.1 years (51.1⁻73.0) and was significantly different between males and females, respectively 57.9 (50.0⁻68.3) vs. 72.9 years (58.3⁻82.2) (p = 0.0004). The median age of males significantly (p = 0.0044) increased from 57.6 (50.1⁻70.0) in 2002 to 58.1 years (50.5⁻67.8) in 2014. The median age of females significantly (p = 0.0006) decreased from 73.7 (57.9⁻81.8) to 69.6 years (57.0⁻82.4). The median gap between the age of men and women significantly (p = 0.0002) decreased, from 16.1 to 11.5 years. Prevalence of risk factors was unchanged or decreased except for hypertension which significantly increased in males. The rate of STEMI without reported risk factors increased in both males and females. CONCLUSION: The age of STEMI onset significantly decreased in females, whereas it significantly increased in males. The prevalence of risk factors decreased in males, whereas no significant variation was found in females.