Improving EMS response times for out-of-hospital cardiac arrest in urban areas using drone-like vertical take-off and landing air ambulances: An international, simulation-based cohort study.

BACKGROUND: Advances in vertical take-off and landing (VTOL) technologies may enable drone-like crewed air ambulances to rapidly respond to out-of-hospital cardiac arrest (OHCA) in urban areas. We estimated the impact of incorporating VTOL air ambulances on OHCA response intervals in two large urban centres in France and Canada. METHODS: We included adult OHCAs occurring between Jan. 2017-Dec. 2018 within Greater Paris in France and Metro Vancouver in Canada. Both regions utilize tiered OHCA response with basic (BLS)- and advanced life support (ALS)-capable units. We simulated incorporating 1-2 ALS-capable VTOL air ambulances dedicated to OHCA response in each study region, and computed time intervals from call reception by emergency medical services (EMS) to arrival of the: (1) first ALS unit ("call-to-ALS arrival interval"); and (2) first EMS unit ("call-to-first EMS arrival interval"). RESULTS: There were 6,217 OHCAs included during the study period (3,760 in Greater Paris and 2,457 in Metro Vancouver). Historical median call-to-ALS arrival intervals were 21 min [IQR 16-29] in Greater Paris and 12 min [IQR 9-17] in Metro Vancouver, while median call-to-first EMS arrival intervals were 11 min [IQR 8-14] and 7 min [IQR 5-8] respectively. Incorporating 1-2 VTOL air ambulances improved median call-to-ALS arrival intervals to 7-9 min and call-to-first EMS arrival intervals to 6-8 min in both study regions (all P < 0.001). CONCLUSION: VTOL air ambulances dedicated to OHCA response may improve EMS response intervals, with substantial improvements in ALS response metrics.

Acute intramural hematoma of the aorta complicated by spinal cord ischemia.

We present an unusual case of spinal cord ischemia from an acute type B intramural hematoma that was successfully treated with blood pressure elevation and drainage of cerebral spinal fluid.

The role of intraoperative magnetic resonance imaging in glioma surgery.

For patients with gliomas, the goal of surgery is to maximize the extent of tumor resection while avoiding injury to functional tissue. The hope is to improve patients' survival and maintain the highest quality of life as possible. However, because of the infiltrative nature of gliomas these two goals often oppose each other so a compromise must be met. Many tools have been developed to help with this challenge of glioma surgery. Over the past two decades, intraoperative-magnetic resonance imaging (iMRI) has emerged as an increasingly important modality to enhance surgical safety while providing the surgeon with updated information to guide their resection. Here the authors review the studies that demonstrate a positive correlation between extent of resection (EOR) and overall survival (OS), although the data is clearer in patients with low-grade gliomas (LGG) and still somewhat controversial in those with higher-grade tumors. We will then review some of the studies that support the role of iMRI and how it has impacted glioma surgery by increasing the EOR. The value of iMRI usage in regards to overall patient outcome can be extrapolated through its effect on EOR. Overall, available data support the safe use of iMRI and as an effective adjunct in glioma surgery.

Cytotoxic edema: mechanisms of pathological cell swelling.

Cerebral edema is caused by a variety of pathological conditions that affect the brain. It is associated with two separate pathophysiological processes with distinct molecular and physiological antecedents: those related to cytotoxic (cellular) edema of neurons and astrocytes, and those related to transcapillary flux of Na+ and other ions, water, and serum macromolecules. In this review, the authors focus exclusively on the first of these two processes. Cytotoxic edema results from unchecked or uncompensated influx of cations, mainly Na+, through cation channels. The authors review the different cation channels that have been implicated in the formation of cytotoxic edema of astrocytes and neurons in different pathological states. A better understanding of these molecular mechanisms holds the promise of improved treatments of cerebral edema and of the secondary injury produced by this pathological process.