Refractory cardiac arrest in a rural area: mechanical chest compression during helicopter transport.

BACKGROUND: Out-of-hospital refractory cardiac arrest patients can be transported to a hospital for extracorporeal life support (ECLS), which can be either therapeutic or performed for organ donation. Early initiation is of vital importance and the main limitation when considering ECLS. This explains that all reported series of cardiac arrest patients referred for ECLS were urban ones. We report a series of rural out-of-hospital non-heart-beating patients transported by helicopter. METHODS: This observational study was performed in two rural districts in France. Data on patients with pre-hospital criteria for ECLS who were transported to the hospital by helicopter, maintained by mechanical chest compression, were recorded over a 2-year period. RESULTS: During the study period, 27 patients were referred for ECLS, of which 14 for therapeutic ECLS and 13 for organ preservation. The median transport distance was 37 km (25th and 75th percentiles: 31-58; range 25 to 94 km). Among the therapeutic ECLS patients, one survived to discharge from the hospital. Liver and kidneys were retrieved in another patient after brain death was ascertained. In the 13 patients referred for organ donation, four were excluded for medical reasons; 18 kidneys were retrieved in nine patients, of which six kidneys were successfully transplanted. CONCLUSION: In this preliminary study, we report the feasibility and the interest of helicopter transport of refractory cardiac arrest patients maintained by mechanical chest compression. Patients with refractory cardiac arrest occurring in rural areas, even at distance from a referral centre, can be candidates for ECLS.

[Family environment and dental health disparities among urban children in Burkina Faso]. / Environnement familial et disparités de santé dentaire des enfants en milieu urbain au Burkina Faso.

BACKGROUND: Dental caries is the most common multifactorial disease in children and has substantial negative impact on daily life. In sub-Saharan Africa, few data are available on the relationship between dental caries and the social and family environment of children. The objectives of the present study were firstly to assess the level of prevalence and severity of dental caries of children in Ouagadougou, the capital city of Burkina Faso and secondly to determine whether or not individual factors, family and living conditions are linked with dental health disparities within the population. METHODS: Interview and clinical data were obtained from a household-based cross-sectional survey. A two-stage stratified sampling technique was applied in four areas of Ouagadougou representing different stages of urbanization. RESULTS: The final study population included 1606 children aged 6-12 years. For the overall group the total caries prevalence rate was 48.2%. Results showed that the dental health status of the mother, social integration of the householder and socioeconomic level of the household were associated with the dental health of children. Disparities in dental health were prominent; poor dental health was relatively frequent in children from households poorly integrated into social networks with rather acceptable standard in terms of material wealth. CONCLUSION: Our study showed that individual factors as well as family-related and environmental factors had an influence on their caries experience. The rapidly changing lifestyle affects oral health and the burden of oral diseases is expected to increase initially in people of upper classes and later in disadvantaged people. Disease prevention focussing on common risk factors of chronic diseases should be enhanced. In addition, the accessibility of quality fluoride products (e.g. toothpaste, salt, water) should be facilitated as soon as possible.