Publications by authors named "Lionel Lamhaut"

101 Publications

Biological markers and follow-up after discharge home of patients with COVID-19 pneumonia.

Emergencias 2021 Jun;33(3):181-186

SAMU 78, Versailles Hospital, Le Chesnay, Francia.

Background: The time lapse between onset of symptoms and a call to an emergency dispatch center (pain-to-call time) is a critical prognostic factor in patients with chest pain. It is therefore important to identify factors related to delays in calling for help.

Objectives: To analyze whether age, gender, or time of day influence the pain-to-call delay in patients with acute STsegment elevation myocardial infarction (STEMI).

Material And Methods: Data were extracted from a prospective registry of STEMI cases managed by 39 mobile intensive care ambulance teams before hospital arrival within 24 hours of onset in our region, the greater metropolitan area of Paris, France. We analyzed the relation between pain-to-call time and the following factors: age, gender, and the time of day when symptoms appeared. We also assessed the influence of pain-to-call time on the rate of prehospital decisions to implement reperfusion therapy.

Results: A total of 24 662 consecutive patients were included; 19 291 (78%) were men and 4371 (22%) were women. The median age was 61 (interquartile range, 52-73) years (men, 59 [51-69] years; women, 73 [59-83] years; P .0001). The median pain-to-call time was 60 (24-164) minutes (men, 55 [23-150] minutes; women, 79 [31-220] minutes; P .0001). The delay varied by time of day from a median of 40 (17-101) minutes in men between 5 pm and 6 pm to 149 (43-377) minutes in women between 2 am and 3 am. The delay was longer in women regardless of time of day and increased significantly with age in both men and women (P .001). A longer pain-to-call time was significantly associated with a lower rate of implementation of myocardial reperfusion (P .001).

Conclusion: Pain-to-call delays were longer in women and older patients, especially at night. These age and gender differences identify groups that would benefit most from health education interventions.
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June 2021

Reply to: Prognostic Value of Signs of Life in Refractory Out-of-Hospital Cardiac Arrest.

Resuscitation 2021 May 4. Epub 2021 May 4.

Univ. Grenoble Alpes/CNRS/TIMC-IMAG UMR 5525, Grenoble, France; Quality of Care Unit, CIC 1406, INSERM, Grenoble Alpes University Hospital, Grenoble, France.

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http://dx.doi.org/10.1016/j.resuscitation.2021.04.017DOI Listing
May 2021

A new hybrid technique for extracorporeal cardiopulmonary resuscitation for use by nonsurgeons.

Emergencias 2021 Abr;33(2):156-157

SAMU de Paris-ICU, Necker University Hospital, París Francia. René Descartes University, París, Francia.

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March 2021

Temporal Trends of Out-of-Hospital Cardiac Arrests Without Resuscitation Attempt by Emergency Medical Services.

Circ Cardiovasc Qual Outcomes 2021 Mar 12;14(3):e006626. Epub 2021 Mar 12.

European Georges Pompidou Hospital, Cardiology Department, Paris, France (V.W., N.K., A.S., E.M., X.J.).

Background: Significant improvements in survival from out-of-hospital cardiac arrest (OHCA) have been reported; however, these are based only on data from OHCA in whom resuscitation is initiated by emergency medical services (EMS). We aimed to assess the characteristics and temporal trends of OHCA without resuscitation attempt by EMS.

Methods: Prospective population-based study between 2011 and 2016 in the Greater Paris area (6.7 million inhabitants). All cases of OHCA were included in collaboration with EMS units, 48 different hospitals, and forensic units.

Results: Among 15 207 OHCA (mean age 70.7±16.9 years, 61.6% male), 5486 (36.1%) had no resuscitation attempt by EMS. Factors that were independently associated with increase in likelihood of no resuscitation attempt included: age of patients (odds ratio, 1.06 per year [95% CI, 1.05-1.06], <0.001), female sex (odds ratio, 1.21 [95% CI, 1.10-1.32], =0.002), OHCA at home location (odds ratio, 3.38 [95%CI, 2.86-4.01], <0.001), and absence of bystander (odds ratio, 1.94 [95% CI, 1.74-2.16], <0.001). Overall, the annual number of OHCA increased by 9.1% (from 2923 to 3189, =0.028). This increase was related to an increase of the annual number of OHCA without resuscitation attempt by EMS by 26.3% (from 993 to 1253, =0.012), while the annual number of OHCA with resuscitation attempt by EMS did not significantly change (from 1930 to 1936, =0.416). Considering only cases with resuscitation attempt, survival rate at hospital discharge increased (from 7.3% to 9.5%, =0.02). However, when considering all OHCA, survival improvement did not reach statistical significance (from 4.8% to 5.7%, =0.17).

Conclusions: We demonstrated an increase of the total number of OHCA related to an increase of the number of OHCA without resuscitation attempt by EMS. This increasing proportion of OHCA without resuscitation attempt attenuates improvement in survival rates achieved in EMS-treated patients.
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http://dx.doi.org/10.1161/CIRCOUTCOMES.120.006626DOI Listing
March 2021

Extracorporeal Cardiopulmonary Resuscitation in Adults. Interim Guideline Consensus Statement From the Extracorporeal Life Support Organization.

ASAIO J 2021 03;67(3):221-228

From the The Alfred Hospital, Melbourne, Australia.

Disclaimer: Veno-arterial extracorporeal membrane oxygenation (ECMO) is increasingly being deployed for selected patients in cardiac arrest who do not attain a native circulation with conventional CPR (ECPR). This ELSO guideline is intended to be a practical guide to implementing ECPR and the early management following establishment of ECMO support. Where a paucity of high-quality evidence exists, a consensus has been reached amongst the authors to provide guidance to the clinician. This guideline will be updated as further evidence in this field becomes available.
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http://dx.doi.org/10.1097/MAT.0000000000001344DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7984716PMC
March 2021

The cardiac arrest centre for the treatment of sudden cardiac arrest due to presumed cardiac cause: aims, function, and structure: position paper of the ACVC association of the ESC, EAPCI, EHRA, ERC, EUSEM, and ESICM.

Eur Heart J Acute Cardiovasc Care 2020 Nov 7. Epub 2020 Nov 7.

Department of Intensive Care Medicine, University Hospital of Antwerp, Antwerp, Belgium.

Approximately 10% of patients resuscitated from out-of-hospital cardiac arrest (OHCA) survive to hospital discharge. Improved management to improve outcomes are required, and it is proposed that such patients should be preferentially treated in cardiac arrest centres (CACs). The minimum requirements of therapy modalities for the CAC are 24/7 availability of an on-site coronary angiography laboratory, an emergency department, an intensive care unit, imaging facilities, such as echocardiography, computed tomography, and magnetic resonance imaging, and a protocol outlining transfer of selected patients to CACs with additional resources (OHCA hub hospitals). These hub hospitals are regularly treating a high volume of patients and offer further treatment modalities. This consensus document describes the aims, the minimal requirements for therapeutic modalities and expertise, and the structure, of a CAC. It represents a consensus among the major European medical associations and societies involved in the treatment of OHCA patients.
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http://dx.doi.org/10.1093/ehjacc/zuaa024DOI Listing
November 2020

Prognostic value of signs of life throughout cardiopulmonary resuscitation for refractory out-of-hospital cardiac arrest.

Resuscitation 2021 May 18;162:163-170. Epub 2021 Feb 18.

University Grenoble Alpes/CNRS/TIMC-IMAG UMR 5525, Grenoble, France; Quality of Care Unit, CIC 1406, INSERM, Grenoble Alpes University Hospital, Grenoble, France.

Purpose: Prognostication of refractory out-of-hospital cardiac arrest (OHCA) is essential for selecting the population that may benefit from extracorporeal cardiopulmonary resuscitation (ECPR). We aimed to examine the prognostic value of signs of life before or throughout conventional CPR for individuals undergoing ECPR for refractory OHCA.

Methods: Pooling the original data from three cohort studies, we estimated the prevalence of signs of life, for individuals with refractory OHCA resuscitated with ECPR. We performed multivariable logistic regression to examine the independent associations between the occurrence of signs of life and 30-day survival with a CPC score ≤ 2.

Results: The analytical sample consisted of 434 ECPR recipients. The prevalence of any sign of life was 61%, including pupillary light reaction (48%), gasping (32%), or increased level of consciousness (13%). Thirty-day survival with favorable neurological outcome was 15% (63/434). In multivariable analysis, the adjusted odds ratios of 30-day survival with favorable neurological outcome were 7.35 (95% confidence interval [CI], 2.71-19.97), 5.86 (95% CI, 2.28-15.06), 4.79 (95% CI, 2.16-10.63), and 1.75 (95% CI, 0.95-3.21) for any sign of life, pupillary light reaction, increased level of consciousness, and gasping, respectively.

Conclusion: The assessment of signs of life before or throughout CPR substantially improves the accuracy of a multivariable prognostic model in predicting 30-day survival with favorable neurological outcome. The lack of any sign of life might obviate the provision of ECPR for patients without shockable cardiac rhythm.
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http://dx.doi.org/10.1016/j.resuscitation.2021.02.022DOI Listing
May 2021

Sudden Cardiac Arrest in Young Women.

Circulation 2021 Feb 15;143(7):758-760. Epub 2021 Feb 15.

University of Paris, Paris-Cardiovascular Research Center, Institut National de la Santé et de la Recherche Médicale, France (O.W., A.S., N.T., N.K., F.D., V.W., L.L., K.W., O.V., A.C., X.J., E.M.).

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http://dx.doi.org/10.1161/CIRCULATIONAHA.120.052219DOI Listing
February 2021

Is caspofungin efficient to treat invasive candidiasis requiring continuous veno-venous hemofiltration? A case report.

Therapie 2020 Dec 15. Epub 2020 Dec 15.

Adult polyvalent intensive care unit. department of anesthesiology-SAMU de Paris, Assistance Publique-Hôpitaux de Paris, university hospital Necker, 75015 Paris, France. Electronic address:

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http://dx.doi.org/10.1016/j.therap.2020.12.013DOI Listing
December 2020

The cardiac arrest centre for the treatment of sudden cardiac arrest due to presumed cardiac cause - aims, function and structure: Position paper of the Association for Acute CardioVascular Care of the European Society of Cardiology (AVCV), European Association of Percutaneous Coronary Interventions (EAPCI), European Heart Rhythm Association (EHRA), European Resuscitation Council (ERC), European Society for Emergency Medicine (EUSEM) and European Society of Intensive Care Medicine (ESICM).

Eur Heart J Acute Cardiovasc Care 2020 Nov;9(4_suppl):S193-S202

Department of Cardiology, Rigshospitalet and Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.

Approximately 10% of patients resuscitated from out-of-hospital cardiac arrest survive to hospital discharge. Improved management to improve outcomes is required, and it is proposed that such patients should be preferentially treated in cardiac arrest centres. The minimum requirements of therapy modalities for the cardiac arrest centre are 24/7 availability of an on-site coronary angiography laboratory, an emergency department, an intensive care unit, imaging facilities such as echocardiography, computed tomography and magnetic resonance imaging, and a protocol outlining transfer of selected patients to cardiac arrest centres with additional resources (out-of-hospital cardiac arrest hub hospitals). These hub hospitals are regularly treating a high volume of patients and offer further treatment modalities. This consensus document describes the aims, the minimal requirements for therapeutic modalities and expertise, and the structure, of a cardiac arrest centre. It represents a consensus among the major European medical associations and societies involved in the treatment of out-of-hospital cardiac arrest patients.
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http://dx.doi.org/10.1177/2048872620963492DOI Listing
November 2020

Elimination of fluconazole during continuous renal replacement therapy. An in vitro assessment.

Int J Artif Organs 2020 Nov 21:391398820976144. Epub 2020 Nov 21.

Department of Anesthesiology and Intensive Care Medicine, SAMU de Paris, Adult Intensive Care Unit, Necker Hospital, Paris, France.

Introduction: Continuous renal replacement therapy (CRRT) efficiently eliminates fluconazole. However, the routes of elimination were not clarified. Adsorption of fluconazole by filters is a pending question. We studied the elimination of fluconazole in a model mimicking a session of CRRT in humans using the NeckEpur model. Two filters were studied.

Methods: The AV1000-polysulfone filter with the Multifiltrate Pro. Fresenius and the ST150-polyacrylonitrile filter with the Prismaflex. Baxter-Gambro were studied. Continuous filtration used a flowrate of 2.5 L/h in post-dilution only. Session were made in duplicate. Routes of elimination were assessed using the NeckEpur model.

Results: The mean measured initial fluconazole concentration (mean ± SD) for the four sessions in the central compartment (CC) was 14.9 ± 0.2 mg/L. The amount eliminated from the CC at the end of 6 h-session at a 2.5 L/h filtration flowrate for the AV1000-polysulfone and the ST150-polyacrylonitrile filters were 90%-93% and 96%-94%, respectively; the clearances from the central compartment (CC) were 2.5-2.6 and 2.4-2.3 L/h, respectively. The means of the instantaneous sieving coefficient were 0.94%-0.91% and 0.99%-0.91%, respectively. The percentages of the amount eliminated from the CC by filtration/adsorption were 100/0%-95/5% and 100/0%-100/0%, respectively.

Conclusion: Neither the ST150-polyacrylonitrile nor the AV1000-polysulfone filters result in any significant adsorption of fluconazole.
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http://dx.doi.org/10.1177/0391398820976144DOI Listing
November 2020

Alteration of the pharmacokinetics of aminoglycosides by adsorption in a filter during continuous renal replacement therapy. An in vitro assessment.

Therapie 2020 Oct 29. Epub 2020 Oct 29.

Department anesthesia and reanimation, adult intensive care unit, Necker hospital, 75015 Paris, France; University of Paris, 75006 Paris, France.

Objectives: Filters used in continuous renal replacement therapy (CRRT) induce elimination by filtration, dialysis, and adsorption. The worldwide used ST150® filter adsorbs cytokines. However, adsorption is a non-specific process which might alter the pharmacokinetics of drugs. Pharmacodynamic/pharmacokinetic relationship of aminoglycosides evidences the importance of the peak concentration at the first dose. We hypothesize an in vitro study may clarify the routes of elimination of aminoglycosides using the ST150® filter.

Methods: Prismaflex® and the STX150® filter, Baxter-Gambro were used. The diafiltration mode combined flowrates of dialysis and filtration at 2.5/1.5L/h, respectively, over 6h. One ionic solute was used in the different compartments. Pharmacokinetic analyses were performed using the NeckEpur® software.

Results: Percentages of gentamicin, tobramycin, and amikacin eliminated from the central compartment were 97±1, 95±3, and 94±6, %, respectively. The clearances were 8.4±2.3, 5.4±5, and 4.2±0.4L/h, respectively. The contributions of dialysis, filtration, and adsorption for gentamicin, tobramycin, and amikacin were 34.3±2.1, 0±0, and 67.7±2.1; 51.1±1.6, 6.3±3.1, and 46.3±2.0, and 37.8±6.3, 46.3±2.0, and 16.0±5.7%, respectively. Among physico-chemical properties, the rate of adsorption linearly and inversely correlated with the polar surface area of aminoglycosides (Y=-0.44X+161.7; R=0.9993).

Discussion: Using the ST150® filter, dialysis, filtration, and adsorption play a role depending on the chemical structure of aminoglycosides. In the diafiltration mode, elimination of gentamicin and tobramycin by filtration is not detected or weak, respectively. Adsorption should be considered as a potential adverse effect of CRRT. Polar surface area of drugs is a physico-chemical parameter which should be considered regarding adsorption of drugs in filters. The risk needs to be systematically assessed.
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http://dx.doi.org/10.1016/j.therap.2020.10.005DOI Listing
October 2020

Rationale and Strategies for Development of an Optimal Bundle of Management for Cardiac Arrest.

Crit Care Explor 2020 Oct 15;2(10):e0214. Epub 2020 Oct 15.

University of Texas Southwestern Medical Center, Dallas, TX.

Objectives: To construct a highly detailed yet practical, attainable roadmap for enhancing the likelihood of neurologically intact survival following sudden cardiac arrest.

Design Setting And Patients: Population-based outcomes following out-of-hospital cardiac arrest were collated for 10 U.S. counties in Alaska, California, Florida, Ohio, Minnesota, Utah, and Washington. The 10 identified emergency medical services systems were those that had recently reported significant improvements in neurologically intact survival after introducing a more comprehensive approach involving citizens, hospitals, and evolving strategies for incorporating technology-based, highly choreographed care and training. Detailed inventories of in-common elements were collated from the ten 9-1-1 agencies and assimilated. For reference, combined averaged outcomes for out-of-hospital cardiac arrest occurring January 1, 2017, to February 28, 2018, were compared with concurrent U.S. outcomes reported by the well-established Cardiac Arrest Registry to Enhance Survival.

Interventions: Most commonly, interventions and components from the ten 9-1-1 systems consistently included extensive public cardiopulmonary resuscitation training, 9-1-1 system-connected smart phone applications, expedited dispatcher procedures, cardiopulmonary resuscitation quality monitoring, mechanical cardiopulmonary resuscitation, devices for enhancing negative intrathoracic pressure regulation, extracorporeal membrane oxygenation protocols, body temperature management procedures, rapid cardiac angiography, and intensive involvement of medical directors, operational and quality assurance officers, and training staff.

Measurements And Main Results: Compared with Cardiac Arrest Registry to Enhance Survival ( = 78,704), the cohorts from the 10 emergency medical services agencies examined ( = 2,911) demonstrated significantly increased likelihoods of return of spontaneous circulation (mean 37.4% vs 31.5%; < 0.001) and neurologically favorable hospital discharge, particularly after witnessed collapses involving bystander cardiopulmonary resuscitation and shockable cardiac rhythms (mean 10.7% vs 8.4%; < 0.001; and 41.6% vs 29.2%; < 0.001, respectively).

Conclusions: The likelihood of neurologically favorable survival following out-of-hospital cardiac arrest can improve substantially in communities that conscientiously and meticulously introduce a well-sequenced, highly choreographed, system-wide portfolio of both traditional and nonconventional approaches to training, technologies, and physiologic management. The commonalities found in the analyzed systems create a compelling case that other communities can also improve out-of-hospital cardiac arrest outcomes significantly by conscientiously exploring and adopting similar bundles of system organization and care.
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http://dx.doi.org/10.1097/CCE.0000000000000214DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7566870PMC
October 2020

Impact of Coronary Lesion Stability on the Benefit of Emergent Percutaneous Coronary Intervention After Sudden Cardiac Arrest.

Circ Cardiovasc Interv 2020 09 8;13(9):e009181. Epub 2020 Sep 8.

Université de Paris, PARCC, INSERM, F-75015 Paris, France (L.P., E.M., O.V., F.D., F.B., L.L., P.B., W.B., A.C., X.J., N.K.).

Background: Conflicting data exist regarding the benefit of urgent coronary angiogram and percutaneous coronary intervention (PCI) after sudden cardiac arrest, particularly in the absence of ST-segment elevation. We hypothesized that the type of lesions treated (stable versus unstable) influences the benefit derived from PCI.

Methods: Data were taken between May 2011 and 2014 from a prospective registry enrolling all sudden cardiac arrest in Paris and suburbs (6.7 million inhabitants). Patients undergoing emergent coronary angiogram were included. Decision to perform PCI was left to the discretion of local teams. We assessed the impact of emergent PCI on survival at discharge according to whether the treated lesion was angiographically unstable or stable, and we investigated the predictive factors for unstable coronary lesions.

Results: Among 9265 sudden cardiac arrests occurring during the study period, 1078 underwent emergent coronary angiogram (median age: 59.6 years, 78.3% males): 463 (42.9%) had an unstable lesion, 253 (23.5%) only stable lesions, and 362 (33.6%) no significant lesions. Emergent PCI was performed in 478 patients (91.4% of unstable and 21.7% of stable lesions). At discharge, PCI of unstable lesions was associated with twice-higher survival rate compared with untreated unstable lesions (47.9% versus 25.6%, =0.013), while stable lesions PCI did not improve survival (25.5% versus 26.3%, =1.00). After adjustment, PCI of unstable coronary lesions was independently associated with improved survival (odds ratio, 2.09 [95% CI, 1.42-3.09], <0.001), contrary to PCI of stable lesions (odds ratio, 0.92 [95% CI. 0.44-1.87], =0.824). Angina, initial shockable rhythm, ST-segment elevation, and absence of known coronary artery disease were independent predictors of unstable lesions.

Conclusions: Emergent PCI of unstable lesions is associated with improved survival after sudden cardiac arrest, contrary to PCI of stable lesions. Accordingly, early PCI should only be performed in patients with unstable lesions. Four factors (chest pain, ST-elevation, absence of coronary artery disease history, and shockable initial rhythm) could help identify patients with unstable lesions who would, therefore, benefit from emergent coronary angiogram.
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http://dx.doi.org/10.1161/CIRCINTERVENTIONS.119.009181DOI Listing
September 2020

Current Work in Extracorporeal Cardiopulmonary Resuscitation.

Crit Care Clin 2020 Oct;36(4):723-735

SAMU de Paris, Necker Hospital, 149 Rue de Sevres, Paris 75015, France.

The use of extracorporeal cardiopulmonary resuscitation (ECPR) to resuscitate patients with refractory out-of-hospital cardiac arrest is increasing in the United States and the developed world. This approach to treatment is appealing, because it can restore prearrest levels of perfusion to the brain and vital organs while the cause of the arrest is addressed. In this article, the authors highlight current ECPR program development and discuss controversies.
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http://dx.doi.org/10.1016/j.ccc.2020.07.004DOI Listing
October 2020

Life-threatening and major cardiac events during long-distance races: updates from the prospective RACE PARIS registry with a systematic review and meta-analysis.

Eur J Prev Cardiol 2020 Jul 27:2047487320943001. Epub 2020 Jul 27.

Sorbonne Université, ACTION Study Group, Pitié Salpêtrière Hospital (AP-HP), France.

Aims: Limited data exist regarding the incidence and aetiology of life-threatening events such as major cardiac events or exertional heat stroke during long-distance races. We aimed to provide an updated incidence, etiology and prognosis of life-threatening events during long-distance races.

Methods: The prospective RACE PARIS registry recorded all life-threatening events/fatal events occurring during 46 marathons, half-marathons and other long-distance races in the Paris area between 2006 and 2016, comprising 1,073,722 runners. Event characteristics were determined by review of medical records and interviews with survivors.

Results: The incidence of life-threatening events, exertional heat stroke and major cardiac events was 3.35 per 100,000, 1.02 per 100,000 and 2.33 per 100,000, respectively, including 18 sudden cardiac arrests (1.67 per 100,000). The main aetiology of sudden cardiac arrest was myocardial ischaemia (11/18), due to acute coronary thrombosis (6/11), stable atherosclerotic coronary artery disease (2/11), coronary dissection (1/11), anomalous connection (1/11) or myocardial bridging (1/11). A third of participants with ischaemia-related major cardiac events presented with pre-race clinical symptoms. Major cardiac events were more frequent in the case of a high pollution index (6.78 per 100,000 vs. 2.07 per 100,000, odds ratio 3.27, 95% confidence interval 1.12-9.54). Case fatality was low (0.19 per 100,000). Similarly, we report in a meta-analysis of eight long-distance race registries comprising 16,223,866 runners a low incidence of long-distance race-related sudden cardiac arrest (0.82 per 100,000) and fatality (0.39 per 100,000). Death following sudden cardiac arrest was strongly associated with initial asystole or pulseless rhythm.

Conclusion: Long-distance race-related life-threatening events remain rare although serious events. Better information for runners on the risk of pre-race clinical symptoms, outside air pollution and temperature may reduce their incidence.
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http://dx.doi.org/10.1177/2047487320943001DOI Listing
July 2020

In-Depth Extracorporeal Cardiopulmonary Resuscitation in Adult Out-of-Hospital Cardiac Arrest.

J Am Heart Assoc 2020 05 6;9(10):e016521. Epub 2020 May 6.

Istituto Anestesiologia e Rianimazione Università Cattolica del Sacro Cuore - Policlinico Universitario Agostino Gemelli - IRCCS Rome Italy.

The use of extracorporeal cardiopulmonary resuscitation (E-CPR) for the treatment of patients with out-of-hospital cardiac arrest who do not respond to conventional cardiopulmonary resuscitation CPR) has increased significantly in the past 10 years, in response to case reports and observational studies reporting encouraging results. However, no randomized controlled trials comparing E-CPR with conventional CPR have been published to date. The evidence from systematic reviews of the available observational studies is conflicting. The inclusion criteria for published E-CPR studies are variable, but most commonly include witnessed arrest, immediate bystander CPR, an initial shockable rhythm, and an estimated time from CPR start to establishment of E-CPR (low-flow time) of <60 minutes. A shorter low-flow time has been consistently associated with improved survival. In an effort to reduce low-flow times, commencement of E-CPR in the prehospital setting has been reported and is currently under investigation. The provision of an E-CPR service, whether hospital based or prehospital, carries considerable cost and technical challenges. Despite increased adoption, many questions remain as to which patients will derive the most benefit from E-CPR, when and where to implement E-CPR, optimal post-arrest E-CPR care, and whether this complex invasive intervention is cost-effective. Results of ongoing trials are awaited to determine whether E-CPR improves survival when compared with conventional CPR.
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http://dx.doi.org/10.1161/JAHA.120.016521DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7660839PMC
May 2020

Diafiltration flowrate is a determinant of the extent of adsorption of amikacin in renal replacement therapy using the ST150-AN69 filter: An in vitro study.

Int J Artif Organs 2020 Dec 1;43(12):758-766. Epub 2020 May 1.

Department of Anesthesiology an Intensive Care Medicine, Adult Intensive Care Unit, SAMU de Paris, Necker Hospital, Paris, France.

Introduction: In continuous renal replacement therapy, conduction and convection are controlled allowing prescribing dosage regimen improving survival. In contrast, adsorption is an uncontrolled property altering drug disposition. Whether adsorption depends on flowrates is unknown. We hypothesized an in vitro model may provide information in conditions mimicking continuous renal replacement therapy in humans.

Methods: ST150-AN69 filter and Prismaflex dialyzer, Baxter-Gambro were used. Simulated blood flowrate was set at 200 mL/min. The flowrates in the filtration (continuous filtration), dialysis (continuous dialysis), and diafiltration (continuous diafiltration) were 1500, 2500, and 4000 mL/h, respectively. Routes of elimination were assessed using NeckEpur analysis.

Results: The percentages of the total amount eliminated by continuous filtration, continuous dialysis, and continuous diafiltration were 82%, 86%, and 94%, respectively. Elimination by effluents and adsorption accounted for 42% ± 7% and 58% ± 5%, 57% ± 7% and 43% ± 6%, and 84% ± 6% and 16% ± 6% of amikacin elimination, respectively. There was a linear regression between flowrates and amikacin clearance: Y = 0.6 X ± 1.7 (R = 0.9782). Conversely, there was a linear inverse correlation between the magnitude of amikacin adsorption and flowrate: Y = -16.9 X ± 84.1 (R = 0.9976).

Conclusion: Low flowrates resulted in predominant elimination by adsorption, accounting for 58% of the elimination of amikacin from the central compartment in the continuous filtration mode at 1500 mL/h of flowrate. Thereafter, the greater the flowrate, the lower the adsorption of amikacin in a linear manner. Flowrate is a major determinant of adsorption of amikacin. There was an about 17% decrease in the rate of adsorption per increase in the flowrate of 1 L/min.
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http://dx.doi.org/10.1177/0391398820911928DOI Listing
December 2020

Toxicological Analysis Unveiling the Low Rate of Self-Reporting of Addictive/Recreative Substances in Acute Severe Drug Overdose Cases.

Turk J Anaesthesiol Reanim 2020 Apr 22;48(2):148-155. Epub 2019 Oct 22.

University Paris Diderot, Paris, France.

Objective: Toxicological analysis (TA) is advised when assessing the prognosis and the treatment of drug overdose patients. Apart from this use, the value of TA has remained unclear. This study aimed at defining the value of TA regarding the toxicological diagnosis in severe overdose cases that involved addictive or recreational drugs (ARDs) that were used either alone or in combination with medicinal drugs.

Methods: The patients who were enrolled in the study had been admitted to our intensive care unit for the treatment of poisoning. TA was performed using advanced technologies such as mass spectrometry of blood/urine on admission. An occurrence indicated the supposed ingestion of a defined substance. Patients were included in a group depending on the combination of the occurrences of supposed ingested drugs (SID) and the results of the 1) TA: SID+, TA+; 2) SID+, not searched by TA; 3) SID-, TA+.

Results: There were 224 occurrences of 90 substances in 70 patients. ARDs were present in 30 patients (43%). ARD accounted for 24 occurrences in the SID+, TA+ group, 10 occurrences in the SID+, not searched group and 196 occurrences in the SID-, TA+ group. In the SID+, TA+ group, 9 occurrences (69%) of ethanol were confirmed by TA. Ingestion of ethanol was invalidated in 4 occurrences (31%). In the patients who denied ethanol ingestion, TA confirmed the non-ingestion of ethanol using 30 blood measures (81%). Ethanol was involved in 57% of the patients, being the lone substance in only 1 case.

Conclusion: In drug overdose instances that result in organ failure(s) and involve ARDs, self-reporting is of limited value in assessing the patients' exposure to ARD. Multiple consumptions expose patients to unexpected drug interactions.
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http://dx.doi.org/10.5152/TJAR.2019.28003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7101186PMC
April 2020

Are we correctly treating invasive candidiasis under continuous renal replacement therapy with echinocandins? Preliminary in vitro assessment.

Anaesth Crit Care Pain Med 2021 02 3;40(1):100640. Epub 2020 Apr 3.

Adult Intensive Care Unit, Department of Anaesthesiology-SAMU de Paris, University hospital Necker, Assistance publique-Hôpitaux de Paris, 149-161, rue de Sèvres, 75015 Paris, France; Department of Pharmacy, hôpital Necker, Assistance publique-Hôpitaux de Paris, 149, rue de Sèvres, 75015 Paris, France.

There is major concern regarding the pharmacokinetics of drugs under continuous renal replacement therapy (CRRT), including anti-infectious agents and more especially antifungal agents. From a regulatory viewpoint, only dialysis and filtration are considered meanwhile there is growing evidence that adsorption may also significantly alter the pharmacokinetics of anti-infectious agents. Adsorption results from a complex drug-filter interaction and might be considered an unexpected adverse effect induced by CRRT. Measurement of total plasma concentrations instead of the unbound, free, active concentrations in in vitro as well as in clinical studies hides this major adverse effect, which may jeopardise the therapeutic effect and even result in treatment failure. Noteworthy, minimal inhibitory concentrations (MIC) of anti-infectious agents are performed using solid and liquid medium without proteins testing only the antimicrobial activity of the free fraction of drugs. In a new in vitro model using crystalloid solution instead of blood, we report data supporting the assumption that the assessment of the disposition of the free fraction of caspofungin and micafungin unveils adverse effects of ST150® filter, which might eventually result in non-detectable drug concentrations and treatment failure. From a technical viewpoint, we conclude the measurement of the free fraction of drugs that largely bound to plasma proteins, including caspofungin and micafungin, should be considered instead of total plasma concentrations to assess all effects induced by filters used in CRRT.
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http://dx.doi.org/10.1016/j.accpm.2020.01.007DOI Listing
February 2021

EMERGEncy versus delayed coronary angiogram in survivors of out-of-hospital cardiac arrest with no obvious non-cardiac cause of arrest: Design of the EMERGE trial.

Am Heart J 2020 04 17;222:131-138. Epub 2020 Jan 17.

Cardiology Department, European Hospital Georges Pompidou, Assistance Publique- Hôpitaux de Paris, Paris Descartes University, Sudden Cardiac Death Expert Center, INSERM U 971, Paris, France. Electronic address:

Background: In adults, the most common cause of out-of-hospital cardiac arrests (OHCA) is acute coronary artery occlusion. If an immediate coronary angiogram (CAG) is recommended for survivors presenting a ST segment elevation on the electrocardiogram (ECG) performed after resuscitation, there is still a debate regarding the best strategy in patients without ST segment elevation.

Hypothesis: Performing an immediate CAG after an OHCA without ST segment elevation on the post-resuscitation ECG and no obvious non-cardiac cause of arrest could lead to a better 180-day survival rate with no or minimal neurological sequel as compared with a delayed CAG performed 48 to 96 hours after the arrest.

Design: The EMERGE trial is a prospective national, randomized, open and parallel group trial, in which 970 survivors of OHCA will be randomized (1:1) to either immediate (as soon as possible after return of spontaneous circulation) or delayed (48 to 96 h) CAG. Participants will be OHCA patients with no ST segment elevation on the post resuscitation ECG and no obvious non-cardiac cause of arrest. The primary endpoint of the study is the 180-day survival rate with no or minimal neurological sequel corresponding to Cerebral Performance Category (CPC) 1 or 2. The secondary endpoints are: occurrence of shock during the first 48 hours, ventricular tachycardia and/or fibrillation during the first 48 hours, change in left ventricular ejection fraction between baseline and 180 days assessed by echocardiogram, neurological status evaluated by the CPC score at intensive care unit (ICU) discharge and day 90 neurological status assessed by the Glasgow Outcome Scale Extended score (GOSE) at 90 and 180 days, overall survival rate, and hospital length of stay.

Summary: The EMERGE trial is a prospective, multicenter, randomized, controlled trial that will assess the 180-day survival rate with no or minimal neurologic sequel in patients resuscitated from an OHCA without ST segment elevation and who will be managed with either immediate or delayed CAG.
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http://dx.doi.org/10.1016/j.ahj.2020.01.006DOI Listing
April 2020

Does Pharmacokinetics in the Central Compartment Evidence Routes of Elimination During Continuous Renal Replacement Therapy in Ex Vivo Model?

Crit Care Med 2020 02;48(2):e163-e164

Assistance Publique-Hôpitaux de Paris, Département d'Anesthésie et de Réanimation, Adult Intensive Care Unit, Centre hospitalo-universitaire Necker-Enfants Malades, 149 rue de Sèvres, Université Paris Descartes, 75015 Paris, France, and EA7323 Evaluation of therapeutics and pharmacology in perinatality and pediatrics-Hôpitaux Universitaires Cochin-Broca-Hôtel Dieu, Site Tarnier, Université Paris Descartes, 75006 Paris, France Laboratoire de Biochimie, Hôpital Universitaire Necker-Enfants malades, Assistance Publique-Hôpitaux de Paris (AP-HP), 75015 Paris, France, and Unité de Technologies Chimiques et Biologiques pour la Santé (UTCBS), CNRS UMR8258 - U1022, Faculté de Pharmacie Paris Descartes, Université Paris Descartes, 75006 Paris, France Assistance Publique-Hôpitaux de Paris, Département d'Anesthésie et de Réanimation, Adult Intensive Care Unit, Centre hospitalo-universitaire Necker-Enfants Malades, 149 rue de Sèvres, Université Paris Descartes, 75015 Paris, France.

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http://dx.doi.org/10.1097/CCM.0000000000004036DOI Listing
February 2020

Low rates of immediate coronary angiography among young adults resuscitated from sudden cardiac arrest.

Resuscitation 2020 02 16;147:34-42. Epub 2019 Dec 16.

AP-HP, European Georges Pompidou Hospital, Cardiology Department, Paris, France; Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, Paris, France; Paris University, Paris, France; Groupe Parisien Universitaire de Rythmologie (G.P.U.R.), France. Electronic address:

Aim: Coronary artery disease (CAD) has recently been emphasized as a major cause of sudden cardiac arrest (SCA) in young adults. We aim to assess the rate of immediate coronary angiography performance in young patients resuscitated from SCA.

Methods: From May 2011 to May 2017, all cases of out-of-hospital SCA aged 18-40 years alive at hospital admission were prospectively included in 48 hospitals of the Great Paris area. Cardiovascular causes of SCA were centrally adjudicated, and management including immediate coronary angiography performance was assessed.

Results: Out of 3579 SCA admitted alive, 409 (11.4%) patients were under 40 years of age (32.3 ± 6.2 years, 69.7% males), with 244 patients having a definite cause identified. Among those, CAD accounted for 72 (29.5%) cases, of which 64 (88.9%) were acute coronary syndromes. The rate of immediate coronary angiography was only 41.7% compared to 65.1% among those ≥40-years (P < 0.001). During the study period, while the rate of immediate coronary angiography increased from 60.5% to 70.3% (P < 0.001) in patients aged ≥40 years, the rate in patients aged less than 40 years remained stable (43.5% to 45.3%, P = 0.795). Patients younger than 40 years were significantly less likely to undergo immediate coronary angiography (OR = 0.34, 95% CI: 0.25-0.47), although early angiography was associated with survival at hospital discharge (OR = 2.68, 95% CI: 1.21-6.00).

Conclusion: CAD is the first cause of SCA in young adults aged less than 40 years. The observed low rates of immediate coronary angiography suggest a missed opportunity for early intervention.
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http://dx.doi.org/10.1016/j.resuscitation.2019.12.005DOI Listing
February 2020

Temporal trends in the use of targeted temperature management after cardiac arrest and association with outcome: insights from the Paris Sudden Death Expertise Centre.

Crit Care 2019 Dec 3;23(1):391. Epub 2019 Dec 3.

Université de Paris, INSERM, Paris Cardiovascular Research Centre, Paris, France.

Purpose: Recent doubts regarding the efficacy may have resulted in a loss of interest for targeted temperature management (TTM) in comatose cardiac arrest (CA) patients, with uncertain consequences on outcome. We aimed to identify a change in TTM use and to assess the relationship between this change and neurological outcome.

Methods: We used Utstein data prospectively collected in the Sudden Death Expertise Center (SDEC) registry (capturing CA data from all secondary and tertiary hospitals located in the Great Paris area, France) between May 2011 and December 2017. All cases of non-traumatic OHCA patients with stable return of spontaneous circulation (ROSC) were included. After adjustment for potential confounders, we assessed the relationship between changes over time in the use of TTM and neurological recovery at discharge using the Cerebral Performance Categories (CPC) scale.

Results: Between May 2011 and December 2017, 3925 patients were retained in the analysis, of whom 1847 (47%) received TTM. The rate of good neurological outcome at discharge (CPC 1 or 2) was higher in TTM patients as compared with no TTM (33% vs 15%, P < 0.001). Gender, age, and location of CA did not change over the years. Bystander CPR increased from 55% in 2011 to 73% in 2017 (P < 0.001) and patients with a no-flow time longer than 3 min decreased from 53 to 38% (P < 0.001). The use of TTM decreased from 55% in 2011 to 37% in 2017 (P < 0.001). Meanwhile, the rate of patients with good neurological recovery remained stable (19 to 23%, P = 0.76). After adjustment, year of CA occurrence was not associated with outcome.

Conclusions: We report a progressive decrease in the use of TTM in post-cardiac arrest patients over the recent years. During this period, neurological outcome remained stable, despite an increase in bystander-initiated resuscitation and a decrease in "no flow" duration.
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http://dx.doi.org/10.1186/s13054-019-2677-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6892202PMC
December 2019

Can we still die from acute myocardial infarction in 2020? Reflex mobile cardiac assistance unit or local team for ECMO implantation?

Arch Cardiovasc Dis 2019 Dec 7;112(12):733-737. Epub 2019 Nov 7.

Department of cardiology, centre hospitalier Annecy-Genevois, 74370 Metz-Tessy, France.

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http://dx.doi.org/10.1016/j.acvd.2019.10.003DOI Listing
December 2019

Extracorporeal cardiopulmonary resuscitation in out-of-hospital cardiac arrest: a registry study.

Eur Heart J 2020 06;41(21):1961-1971

Paris Cardiovascular Research Center (PARCC), INSERM Unit 970, 56 rue Leblanc, 75787 Paris, France.

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.
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http://dx.doi.org/10.1093/eurheartj/ehz753DOI Listing
June 2020

Continuous renal replacement therapy in the treatment of severe hyperkalemia: An in vitro study.

Int J Artif Organs 2020 Feb 11;43(2):87-93. Epub 2019 Sep 11.

Département d'Anesthésie et de Réanimation, Adult Intensive Care Unit, Hôpital Universitaire Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France.

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.
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http://dx.doi.org/10.1177/0391398819865748DOI Listing
February 2020

Does occurrence during sports affect sudden cardiac arrest survival?

Resuscitation 2019 08 22;141:121-127. Epub 2019 Jun 22.

Paris-Sudden Death Expertise Center (Paris-SDEC), INSERM Unit 970, Paris Cardiovascular Research Center, Paris, France; Paris Descartes University, Paris, France; Cardiology Department, European Hospital Georges Pompidou, Paris, France. Electronic address:

Objectives: A higher survival rate was observed in Sudden Cardiac Arrest (SCA) occurring during sports activities, although the underlying mechanisms remain unclear. We tested the hypothesis that better initial management, rather than sports per se, may account for the observed better outcomes during sports activities.

Methods: Data was taken between May 2011 and March 2016 from a prospective ongoing registry that includes all SCA in Paris and suburbs (6.7 million inhabitants). Sports-related SCA (i.e. SCA occurring during sport activities or within one hour of cessation of the activity) were identified.

Results: Over the study period, 13,400 SCA occurred, of which 154 were sports-related (median age: 51.2 years, 96.1% males). At discharge, sports activity was associated with an 8-times higher survival rate (39.7% vs. 5.1%, P < 0.001). Logistic regression showed that after considering potential confounders, including age, gender, SCA location, witness presence, time to response, and initial shockable rhythm, occurrence of SCA during sports was associated with a higher survival rate (OR 1.77, 95% CI 1.14-2.74, P = 0.01). However, after further adjustment for initial basic life support, i.e. bystander CPR and AED use, there was no association between sports setting and survival at hospital discharge (OR 1.43, 95% CI 0.91-2.23, P = 0.12).

Conclusion: Sports-related SCA is a rare event, with an 8-times higher survival rate compared to non-sports-related SCA. Better initial management, including bystander CPR and AED use, rather than sports per se, mainly accounts this difference. This highlights the major importance of population education to basic life support in improving SCA outcome.
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http://dx.doi.org/10.1016/j.resuscitation.2019.06.277DOI Listing
August 2019

Early recurrent arrhythmias after out-of-hospital cardiac arrest associated with obstructive coronary artery disease: Analysis of the PROCAT registry.

Resuscitation 2019 08 8;141:81-87. Epub 2019 Jun 8.

Medical Intensive Care Unit, Cochin Hospital (APHP), Paris, France; Paris Descartes University, Sorbonne Paris Cité-Medical School, Paris, France; INSERM U970 (team 4), Paris Cardiovascular Research Centre, Paris, France.

Objective: After out-of-hospital cardiac arrest (OHCA) associated with obstructive coronary artery disease (CAD), the risk of recurrence during the early period is unclear and the indication for anti-arrhythmic treatment is debated. We assessed the incidence and predisposing factors for severe cardiac arrhythmias in this population.

Design: Retrospective study in a cardiac arrest center.

Settings: The primary endpoint was the occurrence of major cardiac arrhythmias from hospital admission to intensive care unit (ICU) discharge in patients admitted after an OHCA associated with obstructive CAD. A major arrhythmia was defined as any arrhythmic event (auricular or ventricular) associated with cardiac arrest recurrence and/or severe arterial hypotension. Secondary outcomes were time from ICU admission to arrhythmia occurrence and all-cause in-ICU mortality. Risk factors for recurrence of a major arrhythmia were assessed using multivariate analysis.

Patients: We included all consecutive OHCA patients resuscitated from ventricular fibrillation (VF) or pulseless ventricular tachycardia (VT) as initial rhythm associated with obstructive CAD, and who had a successful primary percutaneous coronary intervention.

Intervention: None.

Measurements And Main Results: Among 256 patients, a major arrhythmia occurred in 29 (11.3%), within the first 24 h in 79.3% of cases and were mostly VF (44.8%). Mortality rate was significantly increased in patients with major arrhythmia recurrence (69% vs 41%; p = 0.006). Factor significantly associated with recurrence of severe arrhythmia was male gender (OR 0.32 [0.12-0.92]; p = 0.034). Treatment with prophylactic anti-arrhythmic in the ICU was not associated with a change in the risk of recurrence (OR 0.85 [0.21-3.65], p = 0.82).

Conclusion: An early recurrence of major arrhythmia was observed in more than 10% of post-cardiac arrest patients. These events happened mostly within the first 24 h. The interest of prophylactic anti-arrhythmic treatment remains to be evaluated in this population.
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http://dx.doi.org/10.1016/j.resuscitation.2019.05.034DOI Listing
August 2019

Hemodynamic efficiency of hemodialysis treatment with high cut-off membrane during the early period of post-resuscitation shock: The HYPERDIA trial.

Resuscitation 2019 07 8;140:170-177. Epub 2019 Apr 8.

Medical Intensive Care Unit, Cochin University Hospital, APHP, Paris, France; Paris Descartes University, Sorbonne Paris Cité-Medical School, Paris, France; Sudden Death Expertise Centre, INSERM U970 (team 4), Paris Cardiovascular Research Centre, Paris, France. Electronic address:

Background: After resuscitation of cardiac arrest (CA), an acute circulatory failure occurs in about 50% of cases, which shares many characteristics with septic shock. Most frequently, supportive treatments are poorly efficient to prevent multiple organ failure and death. We evaluated whether an early plasma removal of inflammatory mediators using high cut-off continuous veno-venous hemodialysis (HCO-CVVHD) could improve hemodynamic status and outcome of these patients.

Patients And Methods: We performed a randomized open-label trial. Patients with post-cardiac arrest shock (defined as requirement of norepinephrine or epinephrine infusion > 1 mg/h) were included. The experimental group received 2 distinct sessions of HCO-CVVHD during the first 48 h following ICU admission. The control group received continuous veno-venous hemofiltration (CVVH) with standard membranes if needed. The primary endpoint was the delay to shock resolution asssessed by the length of catecholamine infusion. Number of vasopressors-free days at day 28, arterial blood pressure measures every 6-hours, daily fluid balance and mortality (ICU and day-28) were evaluated as secondary endpoints.

Results: 35 patients were included: 17 (median age 68.4, 59% male) in the HCO-CVVHD group and 18 (median age 66.3, 83% male) in the control group. Baseline characteristics did not differ between the two groups. Day-28 mortality rate was 64.7% and 72.2% in the HCO-CVVHD and control group, respectively (p = 0.72). Probability of vasopressors discontinuation over time was similar in the two groups (p for logrank test = 0.67). Number of day-28 catecholamine-free days was 25.1 [0, 26.5] and 24.5 [0, 26.2] in the HCO-CVVHD and control group, respectively (p = 0.65). No difference was observed regarding the daily-dose of vasopressors, arterial pressure profile and fluid balance.

Conclusion: In cardiac arrest patients, HCO-CVVHD did not decrease the lenght of post-resuscitation shock and had no significant effect on hemodynamic profile.

Registration: NCT00780299.
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http://dx.doi.org/10.1016/j.resuscitation.2019.03.045DOI Listing
July 2019