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1.
Int J Artif Organs ; 43(2): 87-93, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31509049

RESUMO

INTRODUCTION: Continuous renal replacement therapy is not presently recommended in the treatment of life-threatening hyperkalemia. There are no specific recommendations in hemodialysis to treat hyperkalemia. We hypothesized an in vitro model may provide valuable information on the usefulness of continuous renal replacement therapy to treat severe hyperkalemia. METHODS: A potassium-free solute was used instead of diluted blood for continuous renal replacement therapy with a simulated blood flowrate set at 200 mL/min. The mode of elimination included continuous filtration, continuous dialysis, and continuous diafiltration using a flowrate of 4000 mL/min for continuous filtration and continuous dialysis modes, and a ratio of 2500/1500 in the continuous diafiltration mode. RESULTS: The mean initial potassium in the central compartment was 10.1 ± 0.4 mmol/L. The clearances in the continuous diafiltration, continuous filtration, and continuous dialysis were 3.4 ± 0.5, 3.6 ± 0.1, and 3.7 ± 0.1 L/h, respectively, not significantly different. Continuous dialysis resulted in the lowest workload for staff. Increasing the continuous dialysis flowrates from 2000 to 8000 mL/h increased clearance from 2.3 ± 0.3 to 6.2 ± 0.8 L/h. The delays in decreasing the potassium concentration to 5.5 mmol/L dropped from 120 to 45 min, respectively. Potassium eliminated in the first hour increased from 18 to 38 mmol that compared favorably with hemodialysis. Decrease in simulated blood flowrate from 200 to 50 mL/min moderately but significantly decreased the clearance from 3.7 to 3.0 L/h. CONCLUSION: Hyperkalemia is efficiently treated by continuous renal replacement therapy using the dialysis mode. Caution is needed to prevent the onset of severe hypokalemia within 40 min after initiation of the session.

2.
Am J Emerg Med ; 2019 Dec 04.
Artigo em Inglês | MEDLINE | ID: mdl-31836349

RESUMO

CONTEXT: In the prehospital setting, early identification of septic shock (SS) with high risk of mortality aims to initiate early treatments and to decide delivery unit (emergency department (ED) or intensive care unit (ICU)). In this context, there is a need for a prognostic measure of severity and death in order to early detect patients with a higher risk of pejorative evolution. In this study, we describe the association between prehospital shock index (SI) and mortality at day 28 of patients with SS initially cared for in the prehospital setting by a mobile intensive care unit (MICU). METHODS: Patients with SS cared for by a MICU between January 2016 and May 2019 were retrospectively analyzed. Using propensity score, the association between SI and mortality was assessed by Odd Ratio (OR) with 95 percent confidence interval [95 CI]. RESULTS: One-hundred and fourteen patients among which 78 males (68%) were analysed. The mean age was 71 ± 14 years old. SS was mainly associated with pulmonary (55%), digestive (20%) or urinary (11%) infection. Overall mortality reached 33% (n = 38) at day 28. Median SI [interquartile range] differed between alive and deceased patients: 0.73 [0.61-1.00] vs 0.80 [0.66-1.10], p < 0.001*). After adjusting for confounding factors, the OR of SI > 0.9 was 1.17 [1.03-1.32]. CONCLUSION: In this study, we report an association between prehospital SI and mortality of patients with prehospital SS. A SI > 0.9 is a readily available tool correlated with increased mortality of patients with SS initially cared for in the prehospital setting.

3.
Eur Heart J ; 2019 Oct 31.
Artigo em Inglês | MEDLINE | ID: mdl-31670793

RESUMO

AIMS: Out-of-hospital cardiac arrest (OHCA) without return of spontaneous circulation (ROSC) despite conventional resuscitation is common and has poor outcomes. Adding extracorporeal membrane oxygenation (ECMO) to cardiopulmonary resuscitation (extracorporeal-CPR) is increasingly used in an attempt to improve outcomes. METHODS AND RESULTS: We analysed a prospective registry of 13 191 OHCAs in the Paris region from May 2011 to January 2018. We compared survival at hospital discharge with and without extracorporeal-CPR and identified factors associated with survival in patients given extracorporeal-CPR. Survival was 8% in 525 patients given extracorporeal-CPR and 9% in 12 666 patients given conventional-CPR (P = 0.91). By adjusted multivariate analysis, extracorporeal-CPR was not associated with hospital survival [odds ratio (OR), 1.3; 95% confidence interval (95% CI), 0.8-2.1; P = 0.24]. By conditional logistic regression with matching on a propensity score (including age, sex, occurrence at home, bystander CPR, initial rhythm, collapse-to-CPR time, duration of resuscitation, and ROSC), similar results were found (OR, 0.8; 95% CI, 0.5-1.3; P = 0.41). In the extracorporeal-CPR group, factors associated with hospital survival were initial shockable rhythm (OR, 3.9; 95% CI, 1.5-10.3; P = 0.005), transient ROSC before ECMO (OR, 2.3; 95% CI, 1.1-4.7; P = 0.03), and prehospital ECMO implantation (OR, 2.9; 95% CI, 1.5-5.9; P = 0.002). CONCLUSIONS: In a population-based registry, 4% of OHCAs were treated with extracorporeal-CPR, which was not associated with increased hospital survival. Early ECMO implantation may improve outcomes. The initial rhythm and ROSC may help select patients for extracorporeal-CPR.

4.
Turk J Anaesthesiol Reanim ; 47(5): 407-413, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31572993

RESUMO

Objective: Cardiac arrest (CA) resuscitation is associated with an 'ischaemia-reperfusion' syndrome characterised by lactic acidosis as assessed by lactate and base deficit (BD). Both biomarkers are usually measured in patients suffering from refractory CA (RCA) subjected to extracorporeal life support (ECLS) to evaluate tissue reperfusion. However, their prognostic value has never been compared. The aim of the present study was to compare the prognostic value of both biomarkers measured at 0 and 3 h after the initiation of ECLS in patients with RCA on mortality. Methods: Patients who were admitted to the intensive care unit with RCA were consecutively included in the study. Results: Sixty-six patients were included. Lactate correlated with BD (R2=0.44, p<0.001). An area under the curve of 0.72 (95% confidence interval (CI) 0.59-0.84) was found for lactate and of 0.60 (95% CI 0.46-0.73) for BD. Using multivariable logistic regression, lactate (odds ratio (OR) 1.22, 95% CI 1.03-1.48) remained associated with mortality on day 28, but not BD (OR 0.99, 95% CI 0.86-1.14). Conclusion: We report a difference in the prognostic value of lactate and BD on mortality. Three hours from the initiation of ECLS in patients with RCA, lactate should be preferred to BD to predict the efficiency of ECLS.

5.
Intensive Care Med ; 45(9): 1231-1240, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31418059

RESUMO

PURPOSE: The majority of terrorist acts are carried out by explosion or shooting. The objective of this study was first, to describe the management implemented to treat a large number of casualties and their flow together with the injuries observed, and second, to compare these resources according to the mechanism of trauma. METHODS: This retrospective cohort study collected medical data from all casualties of the attacks on November 13th 2015 in Paris, France, with physical injuries, who arrived alive at any hospital within the first 24 h after the events. Casualties were divided into two groups: explosion injuries and gunshot wounds. RESULTS: 337 casualties were admitted to hospital, 286 (85%) from gunshot wounds and 51 (15%) from explosions. Gunshot casualties had more severe injuries and required more in-hospital resources than explosion casualties. Emergency surgery was required in 181 (54%) casualties and was more frequent for gunshot wounds than explosion injuries (57% vs. 35%, p < 0·01). The types of main surgery needed and their delay following hospital admission were as follows: orthopedic [n = 107 (57%); median 744 min]; general [n = 27 (15%); 90 min]; vascular [n = 19 (10%); median 53 min]; thoracic [n = 19 (10%); 646 min]; and neurosurgery [n = 4 (2%); 198 min]. CONCLUSION: The resources required to deal with a terrorist attack vary according to the mechanism of trauma. Our study provides a template to estimate the proportion of various types of surgical resources needed overall, as well as their time frame in a terrorist multisite and multitype attack. FUNDING: Assistance Publique-Hôpitaux de Paris.

6.
Turk J Anaesthesiol Reanim ; 47(4): 334-341, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31380515

RESUMO

Objective: The outcome of sepsis relies on the early diagnosis and implementation of appropriate treatments. For management of out-of-hospital patients with sepsis, prehospital emergency services, named Service d'Aide Médicale d'Urgence (SAMU) in France, dispatch to the scene an emergency mobile team (EMT) or a mobile intensive care unit (MICU) based on the patient's severity. Therefore, patients are admitted to the emergency department (ED) or to the intensive care unit (ICU). The impact of MICU intervention on patient's prognosis remains unclear. The aim of the present study was to describe the impact of MICU intervention on mortality on day 28 (D28) of patients with sepsis. Methods: We performed a retrospective study on patients with sepsis managed by prehospital teams, MICU or EMT, before admission to the ED or ICU. The primary outcome was mortality on D28. Results: The SAMU received 30,642 calls during the study period with 140 patients with suspected sepsis. The suspected origin of sepsis was mainly pulmonary for 78 (55%) patients. Thirteen (9%) patients died on D28, 12 in the ED and 1 in the ICU. Two patients were admitted to the hospital by a MICU. After adjusting for confounding factors, the relative risk of mortality on D28 for patients admitted to the hospital by a MICU was 0.40. Conclusion: We describe an association between MICU intervention and mortality on D28. MICU intervention for out-of-hospital patients with sepsis is associated with 60% reduced mortality on D28. Larger studies are needed to confirm the impact of the intervention of MICU on mortality of patients with sepsis.

7.
Turk J Anaesthesiol Reanim ; 47(1): 48-54, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31276111

RESUMO

Objective: During cardiac arrest (CA) resuscitation, an 'ischaemia-reperfusion' syndrome occurs leading to multiorgan failure reflected by an increase in blood lactate. Blood lactate is a diagnosis and prognosis biomarker in extracorporeal life support (ECLS), but its kinetic appears more informative to assess a patient's outcome. The aim of the present study was to describe the prognostic value of blood lactate and lactate clearance (LC) 3 (H3) and 6 h (H6) after the initiation of ECLS in the treatment of refractory CA. Methods: Patients admitted to the intensive care unit for refractory CA were included. Lactate measurements were performed at the initiation of ECLS (H0) and at H3 and H6 upon the initiation of ECLS. LC was measured from 0 to 3 h (LC03), 0 to 6 h (LC06) and 3 to 6 h (LC36). The primary endpoint was in-hospital mortality within 28 days. Results: Sixty-six patients were enrolled in the study. Lactate levels were higher in deceased patients. Increased mortality was observed with increasing levels of lactate at H3 and H6 and with decreasing LC03. Using logistic regression, an association was observed between mortality and lactate at H3 with an odds ratio (OR) of 1.21 (95% confidence interval (CI) 1.05-1.42); LC03, OR of 0.93 (95% CI 0.87-0.99) and LC06, OR of 0.96 (95% CI 0.92-0.99). Conclusion: Blood lactate and LC within the first 3 h of ECLS in refractory CA are associated with mortality. LC is a more relevant parameter than blood lactate, taking into account both the production and elimination of lactate. We suggest to preferentially use LC to assess the patient's outcome.

8.
Turk J Anaesthesiol Reanim ; 47(2): 134-141, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31080955

RESUMO

Objective: Extracorporeal Life Support (ECLS) can help to improve the outcome of refractory cardiac arrest (CA). ECLS allows to maintain blood pressure and tissue perfusion until the cause of CA is treated. The aim of the present study was to describe the mean blood pressure (MBP) during the first 24 h of ECLS for out-of-hospital CA (OHCA). Methods: We performed a retrospective analysis of consecutive refractory OHCA requiring ECLS admitted to the intensive care unit. MBP was examined after starting ECLS (H0) and every 6 h during the first 24 h (H6, H12, H18 and H24). Results: Forty patients were analysed. MBP significantly differs between survivors and non-survivors since 6 h: 77 vs 44 mm Hg (p=0.002), 51 vs 87 mm Hg at H12 (p=0.008), 57 vs 75 mm Hg at H18 (p=0.015) and 79 vs 53 mm Hg at H24 (p=0.004), whereas no difference was observed at H0: 69 vs 55 mm Hg (p=0.06). An MBP lower than 65 mm Hg since 6 h is associated with a poor outcome (sensitivity and specificity of death of 87% and 66% at H6, 80% and 75% at H12, 100% and 75% at H18 and 70% and 80% at H24, respectively). Conclusion: Despite high levels of catecholamine, the inability to maintain MBP higher than 60 mm Hg after starting ECLS for OHCA is associated with a poor outcome.

9.
Resuscitation ; 138: 222-232, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30885824

RESUMO

BACKGROUND: Early prognostication is a major challenge after out-of-hospital cardiac arrest (OHCA). AIMS: We hypothesized that a genome-wide analysis of blood gene expression could offer new prognostic tools and lines of research. METHODS: Sixty-nine patients were enrolled from an ancillary study of the clinical trial NCT00999583 that tested the effect of erythropoietin (EPO) after OHCA. Blood samples were collected in comatose survivors of OHCA at hospital admission and 1 and 3 days after resuscitation. Gene expression profiles were analyzed (Illumina HumanHT-12 V4 BeadChip; >34,000 genes). Patients were classified into two categories representing neurological favorable outcome (cerebral performance category [CPC] = 1-2) vs unfavorable outcome (CPC > 2) at Day 60 after OHCA. Differential and functional enrichment analyses were performed to compare transcriptomic profiles between these two categories. RESULTS: Among the 69 enrolled patients, 33 and 36 patients were treated or not by EPO, respectively. Among them, 42% had a favorable neurological outcome in both groups. EPO did not affect the transcriptomic response at Day-0 and 1 after OHCA. In contrast, 76 transcripts differed at Day-0 between patients with unfavorable vs favorable neurological outcome. This signature persisted at Day-1 after OHCA. Functional enrichment analysis revealed a down-regulation of adaptive immunity with concomitant up-regulation of innate immunity and inflammation in patients with unfavorable vs favorable neurological outcome. The transcription of many genes of the HLA family was decreased in patients with unfavorable vs favorable neurological outcome. Concomitantly, neutrophil activation and inflammation were observed. Up-stream regulators analysis showed the implication of numerous factors involved in cell cycle and damages. A logistic regression including a set of genes allowed a reliable prediction of the clinical outcomes (specificity = 88%; Hit Rate = 83%). CONCLUSIONS: A transcriptomic signature involving a counterbalance between adaptive and innate immune responses is able to predict neurological outcome very early after hospital admission after OHCA. This deserves confirmation in a larger population.

10.
Am J Emerg Med ; 37(10): 1860-1863, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30638630

RESUMO

BACKGROUND: Mechanical ventilation can cause deleterious effects on the lung and thus alter patient's prognosis. The aim of this study was to describe the characteristics of prehospital mechanical ventilation in patients with septic shock requiring mechanical ventilation in the prehospital setting. METHODS: Patients with septic shock subjected to pre-hospital intubation and mechanical ventilation by a mobile intensive care unit were consecutively included and retrospectively analysed. Septic shock was defined according to the international sepsis-3 consensus conference. Patient's characteristics, interventions, prehospital ventilatory parameters and outcome were retrieved from medical records. The association between the tidal volume indexed on ideal body weight (VTIBW) and mortality at day 28 was evaluated. RESULTS: Fifty-nine patients were included. Septic shock was mainly associated with pulmonary (64%) infection. Mean pre-hospital VTIBW was 7 ±â€¯1 ml.kg-1 in the overall population. Mortality reached 42%. The AUC of VTIBW was 0.83 [0.72-0.94]. Using logistic regression model including: age, prehospital mean blood pressure, volume infused in the prehospital setting, FiO2 and length of stay in the intensive care unit, the association with mortality remained significant for VTIBW (OR adjusted [CI95] = 4.11 [1.89-10.98]), VTIBW >8 ml·kg-1 (OR adjusted [CI95] = 8.29 [2.35-34.98]) and VTIBW <8 ml·kg-1 (OR adjusted [CI95] = 0.12 [0.03-0.43]). CONCLUSION: In this retrospective study, we observed an association between mortality at day 28 and prehospital VTIBW in pre-hospital mechanically ventilated patients with septic shock. A VTIBW <8 ml·kg-1 was associated with a decrease and a VTIBW >8 ml·kg-1 with an increase in mortality.

12.
Am J Emerg Med ; 37(1): 56-60, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-29709397

RESUMO

OBJECTIVE: Mechanical ventilation can help improve the prognosis of septic shock. While adequate delivery of oxygen to the tissue is crucial, hyperoxemia may be deleterious. Invasive out-of-hospital ventilation is often promptly performed in life-threatening emergencies. We propose to determine whether the arterial oxygen pressure (PaO2) at the intensive care unit (ICU) admission is associated with mortality in patients with septic shock subjected to pre-hospital mechanical ventilation. METHODS: We performed a monocentric retrospective observational study on 77 patients. PaO2 was measured at ICU admission. The primary outcome was mortality at day 28 (D28). RESULTS: Forty-nine (64%) patients were included. The mean PaO2 at ICU admission was 153 ±â€¯77 and 202 ±â€¯82 mm Hg for alive and deceased patients respectively. Mortality concerned 18% of patients for PaO2 < 100, 25% for 100 < PaO2 < 150 and 57% for a PaO2 > 150 mm Hg. PaO2 was significantly associated with mortality at D28 (p = 0.04). Using propensity score analysis including SOFA score, pre-hospital duration, lactate, and prehospital fluid volume expansion, association with mortality at D28 only remained for PaO2 > 150 mm Hg (p = 0.02, OR [CI95] = 1.59 [1.20-2.10]). CONCLUSIONS: In this study, we report a significant association between hyperoxemia at ICU admission and mortality in patients with septic shock subjected to pre-hospital invasive mechanical ventilation. The early adjustment of the PaO2 should be considered for these patients to avoid the toxic effects of hyperoxemia. However, blood gas analysis is hard to get in a prehospital setting. Consequently, alternative and feasible measures are needed, such as pulse oximetry, to improve the management of pre-hospital invasive ventilation.


Assuntos
Serviços Médicos de Emergência , Ventilação não Invasiva , Oximetria/métodos , Choque Séptico/terapia , Adulto , Idoso , Gasometria , Feminino , Mortalidade Hospitalar , Humanos , Unidades de Terapia Intensiva , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Pressão Parcial , Prognóstico , Pontuação de Propensão , Estudos Retrospectivos , Choque Séptico/mortalidade , Choque Séptico/fisiopatologia
13.
Am J Emerg Med ; 37(4): 664-671, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30001815

RESUMO

OBJECTIVES: The early identification of septic shock patients at high risk of poor outcome is essential to early initiate optimal treatments and to decide on hospital admission. Biomarkers are often used to evaluate the severity. In prehospital settings, the availability of biomarkers, such as lactate, is restricted. In this context, clinical tools such as skin mottling score (SMS) and capillary refill time (CRT) are more suitable. In this study, we describe prehospital SMS and CRT's ability to predict mortality of patients with septic shock initially cared in the prehospital setting by a mobile intensive care unit. METHODS: Patients with septic shock who received prehospital medical care admitted to the intensive care unit were retrospectively analyzed. RESULTS: Sixty-three patients were included. The origin of sepsis was mainly pulmonary (67%). Overall mortality reached 36%. No significant difference was observed in the duration of prehospital medical care between alive and deceased patients. Mean prehospital value of SMS was 3 ±â€¯2 and mean prehospital value of CRT was 5 ±â€¯1 s. A significant association was found between mortality and prehospital SMS (p = 0.02, OR[CI95] = 1.50 [1.08-2.15]) and prehospital CRT (p = 0.04, OR[CI95] = 1.53 [1.04-2.37]). After adjusting for confounding factors using propensity score, the relative risk of death was 6.58 for SMS > 2 and 2.03 for CRT > 4 s. CONCLUSION: In this study, we report an association between prehospital SMS and CRT, and mortality of patients with septic shock. SMS and CRT are simple tools that could be used to optimize the triage and to decide early intensive care admission.


Assuntos
Cuidados Críticos/métodos , Microcirculação , Choque Séptico/diagnóstico , Choque Séptico/fisiopatologia , Pele/patologia , Idoso , Idoso de 80 Anos ou mais , Serviços Médicos de Emergência , Feminino , França , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , Pontuação de Propensão , Estudos Retrospectivos , Índice de Gravidade de Doença , Choque Séptico/mortalidade , Triagem
16.
Resuscitation ; 130: 44-48, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-29738799

RESUMO

Extracorporeal CPR is a second line treatment for refractory cardiac arrest, as written in the latest International Guidelines. Optimal timing, patient selection, location and method of implementation vary across the world. The objective here is to present an international consensus on the pillars of an ECPR program. The major aspect the group agrees on in that ECPR should be implemented within 60 minutes of collapse. With this in mind, the program should be built according to local resources knowing that the optimal team will require pre-established specific roles with personnel dedicated to resuscitation and others to ECPR.


Assuntos
Reanimação Cardiopulmonar , Oxigenação por Membrana Extracorpórea , Cooperação Internacional , Parada Cardíaca Extra-Hospitalar , Equipe de Assistência ao Paciente , Reanimação Cardiopulmonar/métodos , Reanimação Cardiopulmonar/normas , Consenso , Oxigenação por Membrana Extracorpórea/métodos , Oxigenação por Membrana Extracorpórea/normas , Humanos , Parada Cardíaca Extra-Hospitalar/mortalidade , Parada Cardíaca Extra-Hospitalar/terapia , Equipe de Assistência ao Paciente/organização & administração , Equipe de Assistência ao Paciente/normas , Seleção de Pacientes , Taxa de Sobrevida , Tempo para o Tratamento/normas
17.
Crit Care Med ; 46(6): e523-e529, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29543597

RESUMO

OBJECTIVES: To investigate the magnitude of lactic acidosis in response to cyanide poisoning compared with the secondary response caused by cardiovascular shock. DESIGN: Retrospective case-control observational study. SETTING: University Hospital of Assistance Publique - Hôpitaux de Paris. SUBJECTS: Patients admitted for suspicion of cyanide poisoning or drug overdose. Medical charts provided by Assistance Publique - Hôpitaux de Paris of patients between January 1988 and December 2015. INTERVENTION: None. MEASUREMENTS AND MAIN RESULTS: Twelve cyanide poisoned patients were matched to 48 controls by age, sex, systolic blood pressure, catecholamine administration, and outcome at discharge from ICU. Extracted data included age, sex, vital signs, symptoms, biochemical parameters, toxicological analysis, treatment, and outcome. Non-parametric tests were used. Multivariable analysis was used to adjust for confounders causing hyperlactacidemia. The median blood lactate concentration was significantly greater in the cyanide group (15.6 mmol/L) compared to the control group (4.1 mmol/L; p = 0.0003). Similarly, blood lactate concentration greater than or equal to 8 mmol/l was observed in 83% of the cyanide cases versus 27% of the matched controls. Multivariate analysis conferred hyperlactacidemia as the lone factor which significantly predicted cyanide poisoning at an odds of 73.0 (5.7-936.1). Moreover, blood cyanide level significantly correlated with the increase of blood lactate (p = 0.0033). CONCLUSIONS: This study supports the hypothesis lactic acidosis primarily results from the direct toxicity of cyanide.


Assuntos
Acidose Láctica/induzido quimicamente , Cianetos/envenenamento , Acidose Láctica/etiologia , Adolescente , Adulto , Idoso , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Choque Cardiogênico/complicações , Adulto Jovem
19.
Resuscitation ; 126: 154-159, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-29253646

RESUMO

PURPOSE: Extracorporeal cardiopulmonary resuscitation (ECPR) is a second line treatment for refractory cardiac arrest (R-OHCA). Timing of ECPR before performing coronary angiography (CAG) is still debated. The aim of the study was to describe the clinical and angiographic characteristics of the largest cohort of out-of-hospital cardiac arrest (OHCA) patients undergoing ECPR. METHODS: All refractory OHCA patients with ECPR managed by the prehospital mobile intensive care unit (MoICU of the SAMU) in Paris (France) were prospectively included from October 2014 to December 2016. RESULTS: Among 74 patients included over the period, 54 patients had coronary artery disease (CAD). There is a trend toward the CAD patients being older but it did not meet statistical significance (55.3 ±â€¯11.8 vs. 50.6 ±â€¯12.8, p = 0,14). Patients were more frequently men and smokers (p = 0.03 for both). The proportion of initial shockable rhythm tended to be higher in patients with CAD (71% vs. 55%). The rate of 1-, 2-, and 3-vessel disease were 43%, 35% and 22% respectively. The Syntax Score was 18 ±â€¯9 and the lesions in each epicardial vessel were mainly proximal. Percutaneous coronary intervention was performed ad hoc in 49 patients (91%). Complete revascularization was performed in 64%. Inhospital death was numerically lower (65% vs. 75%) in patients with CAD, especially in patients with initial shockable rhythm. CONCLUSION: In 74 refractory OHCA patients treated with ECPR implanted by a prehospital mobile intensive care unit, the rate of CAD was high (54/74) especially in patients with shockable rhythm. The majority of patients presented with double or triple vessel disease and proximal lesions. The severity and extension of CAD may explain the refractory nature of the cardiac arrest.


Assuntos
Reanimação Cardiopulmonar/métodos , Doença da Artéria Coronariana/terapia , Oxigenação por Membrana Extracorpórea/métodos , Parada Cardíaca Extra-Hospitalar/terapia , Adulto , Idoso , Reanimação Cardiopulmonar/mortalidade , Comorbidade , Angiografia Coronária , Doença da Artéria Coronariana/complicações , Doença da Artéria Coronariana/diagnóstico por imagem , Serviços Médicos de Emergência/métodos , Oxigenação por Membrana Extracorpórea/mortalidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Parada Cardíaca Extra-Hospitalar/complicações , Parada Cardíaca Extra-Hospitalar/mortalidade , Estudos Prospectivos , Tempo para o Tratamento
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