Publications by authors named "Mathieu Pasquier"

103 Publications

Accidental Hypothermia: 2021 Update.

Int J Environ Res Public Health 2022 Jan 3;19(1). Epub 2022 Jan 3.

International Commission for Mountain Emergency Medicine (ICAR MedCom), 8302 Kloten, Switzerland.

Accidental hypothermia is an unintentional drop of core temperature below 35 °C. Annually, thousands die of primary hypothermia and an unknown number die of secondary hypothermia worldwide. Hypothermia can be expected in emergency patients in the prehospital phase. Injured and intoxicated patients cool quickly even in subtropical regions. Preventive measures are important to avoid hypothermia or cooling in ill or injured patients. Diagnosis and assessment of the risk of cardiac arrest are based on clinical signs and core temperature measurement when available. Hypothermic patients with risk factors for imminent cardiac arrest (temperature < 30 °C in young and healthy patients and <32 °C in elderly persons, or patients with multiple comorbidities), ventricular dysrhythmias, or systolic blood pressure < 90 mmHg) and hypothermic patients who are already in cardiac arrest, should be transferred directly to an extracorporeal life support (ECLS) centre. If a hypothermic patient arrests, continuous cardiopulmonary resuscitation (CPR) should be performed. In hypothermic patients, the chances of survival and good neurological outcome are higher than for normothermic patients for witnessed, unwitnessed and asystolic cardiac arrest. Mechanical CPR devices should be used for prolonged rescue, if available. In severely hypothermic patients in cardiac arrest, if continuous or mechanical CPR is not possible, intermittent CPR should be used. Rewarming can be accomplished by passive and active techniques. Most often, passive and active external techniques are used. Only in patients with refractory hypothermia or cardiac arrest are internal rewarming techniques required. ECLS rewarming should be performed with extracorporeal membrane oxygenation (ECMO). A post-resuscitation care bundle should complement treatment.
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http://dx.doi.org/10.3390/ijerph19010501DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8744717PMC
January 2022

Prehospital Use of Ultrathin Reflective Foils.

Wilderness Environ Med 2022 Jan 5. Epub 2022 Jan 5.

Department of Emergency Medicine Stanford University Medical Center, Stanford, California Department of Emergency Medicine, Alaska Native Medical Center, Anchorage, Alaska. Electronic address:

Ultrathin reflective foils (URFs) are widely used to protect patients from heat loss, but there is no clear evidence that they are effective. We review the physics of thermal insulation by URFs and discuss their clinical applications. A conventional view is that the high reflectivity of the metallic side of the URF is responsible for thermal protection. In most circumstances, the heat radiated from a well-clothed body is minimal and the reflecting properties of a URF are relatively insignificant. The reflection of radiant heat can be impaired by condensation and freezing of the moisture on the inner surface and by a tight fit of the URF against the outermost layer of insulation. The protection by thermal insulating materials depends mostly on the ability to trap air and increases with the number of covering layers. A URF as a single layer may be useful in low wind conditions and moderate ambient temperature, but in cold and windy conditions a URF probably best serves as a waterproof outer covering. When a URF is used to protect against hypothermia in a wilderness emergency, it does not matter whether the gold or silver side is facing outward.
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http://dx.doi.org/10.1016/j.wem.2021.11.006DOI Listing
January 2022

The use of Foley catheter tamponade for bleeding control in penetrating injuries.

Scand J Trauma Resusc Emerg Med 2021 Dec 4;29(1):165. Epub 2021 Dec 4.

Department of Emergency Medicine, Lausanne University Hospital, 1011, Lausanne, Switzerland.

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http://dx.doi.org/10.1186/s13049-021-00975-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8642887PMC
December 2021

Hypothermia Outcome Prediction after Extracorporeal Life Support for Hypothermic Cardiac Arrest Patients: Assessing the Performance of the HOPE Score in Case Reports from the Literature.

Int J Environ Res Public Health 2021 11 12;18(22). Epub 2021 Nov 12.

Department of Emergency Medicine, Lausanne University Hospital and University of Lausanne, 1011 Lausanne, Switzerland.

: The hypothermia outcome prediction after extracorporeal life support (ECLS) score, or HOPE score, provides an estimate of the survival probability in hypothermic cardiac arrest patients undergoing ECLS rewarming. The aim of this study was to assess the performance of the HOPE score in case reports from the literature. : Cases were identified through a systematic review of the literature. We included cases of hypothermic cardiac arrest patients rewarmed with ECLS and not included in the HOPE derivation and validation studies. We calculated the survival probability of each patient according to the HOPE score. : A total of 70 patients were included. Most of them (62/70 = 89%) survived. The discrimination using the HOPE score was good (Area Under the Receiver Operating Characteristic Curve = 0.78). The calibration was poor, with HOPE survival probabilities averaging 54%. Using a HOPE survival probability threshold of at least 10% as a decision criterion for rewarming a patient would have resulted in only five false positives and a single false negative, i.e., 64 (or 91%) correct decisions. : In this highly selected sample, the HOPE score still had a good practical performance. The selection bias most likely explains the poor calibration found in the present study, with survivors being more often described in the literature than non-survivors. Our finding underscores the importance of working with a representative sample of patients when deriving and validating a score, as was the case in the HOPE studies that included only consecutive patients in order to minimize the risk of publication bias and lower the risk of overly optimistic outcomes.
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http://dx.doi.org/10.3390/ijerph182211896DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8622062PMC
November 2021

Higher pre-hospital anaesthesia case volumes result in lower mortality rates: implications for mass casualty care.

Br J Anaesth 2022 Feb 15;128(2):e89-e92. Epub 2021 Nov 15.

Emergency Department, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland.

Senior physicians with a higher pre-hospital anaesthesia case volume have higher first-pass tracheal intubation success rates, shorter on-site times, and lower patient mortality rates than physicians with lower case volumes. A senior physician's skill set includes the basics of management of airway and breathing (ventilating and oxygenating the patient), circulation, disability (anaesthesia), and environment (especially maintaining core temperature). Technical rescue skills may be required to care for patients requiring pre-hospital airway management especially in hazardous environments, such as road traffic accidents, chemical incidents, terror attacks or warfare, and natural disasters. Additional important tactical skills in mass casualty situations include patient triage, prioritising, allocating resources, and making transport decisions.
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http://dx.doi.org/10.1016/j.bja.2021.10.022DOI Listing
February 2022

Resuscitation of an Unconscious Victim of Accidental Hypothermia in 1805.

Wilderness Environ Med 2021 Dec 5;32(4):548-553. Epub 2021 Oct 5.

International Commission for Mountain Emergency Medicine (ICAR MedCom), Zürich, Switzerland; Department of Emergency Medicine, Alaska Native Medical Center, Anchorage, Alaska; Department of Emergency Medicine, Stanford University Medical Center, Stanford, California. Electronic address:

In 1805, W.D., a 16-y-old boy, became hypothermic after he was left alone on a grounded boat in Leith Harbour, near Edinburgh, Scotland. He was brought to his own house and resuscitated with warm blankets, smelling salts, and massage by Dr. George Kellie. W.D. made an uneventful recovery. We discuss the pathophysiology and treatment of accidental hypothermia, contrasting treatment in 1805 with treatment today. W.D. was hypothermic when found by passersby. Although he appeared dead, he was rewarmed with help from Dr. Kellie and his assistants over 200 y ago using simple methods. One concept that has not changed is the critical importance of attempting resuscitation, even if it seems to be futile. Don't give up!
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http://dx.doi.org/10.1016/j.wem.2021.08.007DOI Listing
December 2021

Prognosis of Hypothermic Patients Undergoing ECLS Rewarming-Do Alterations in Biochemical Parameters Matter?

Int J Environ Res Public Health 2021 09 16;18(18). Epub 2021 Sep 16.

Department of Anaesthesiology and Intensive Care, Medical University of Silesia, 40-055 Katowice, Poland.

Background: While ECLS is a highly invasive procedure, the identification of patients with a potentially good prognosis is of high importance. The aim of this study was to analyse changes in the acid-base balance parameters and lactate kinetics during the early stages of ECLS rewarming to determine predictors of clinical outcome.

Methods: This single-centre retrospective study was conducted at the Severe Hypothermia Treatment Centre at John Paul II Hospital in Krakow, Poland. Patients ≥18 years old who had a core temperature (Tc) < 30 °C and were rewarmed with ECLS between December 2013 and August 2018 were included. Acid-base balance parameters were measured at ECLS implantation, at Tc 30 °C, and at 2 and 4 h after Tc 30 °C. The alteration in blood lactate kinetics was calculated as the percent change in serum lactate concentration relative to the baseline.

Results: We included 50 patients, of which 36 (72%) were in cardiac arrest. The mean age was 56 ± 15 years old, and the mean Tc was 24.5 ± 12.6 °C. Twenty-one patients (42%) died. Lactate concentrations in the survivors group were significantly lower than in the non-survivors at all time points. In the survivors group, the mean lactate concentration decreased -2.42 ± 4.49 mmol/L from time of ECLS implantation until 4 h after reaching Tc 30 °C, while in the non-survivors' group ( = 0.024), it increased 1.44 ± 6.41 mmol/L.

Conclusions: Our results indicate that high lactate concentration is associated with a poor prognosis for hypothermic patients undergoing ECLS rewarming. A decreased value of lactate kinetics at 4 h after reaching 30 °C is also associated with a poor prognosis.
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http://dx.doi.org/10.3390/ijerph18189764DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8468166PMC
September 2021

The Efficacy of Renal Replacement Therapy for Rewarming of Patients in Severe Accidental Hypothermia-Systematic Review of the Literature.

Int J Environ Res Public Health 2021 09 13;18(18). Epub 2021 Sep 13.

Department of Anesthesiology and Intensive Care, Medical University of Silesia, Medykow 14, 40-752 Katowice, Poland.

Background: Renal replacement therapy (RRT) can be used to rewarm patients in deep hypothermia. However, there is still no clear evidence for the effectiveness of RRT in this group of patients. This systematic review aims to summarize the rewarming rates during RRT in patients in severe hypothermia, below or equal to 32 °C.

Methods: This systematic review was registered in the PROSPERO International Prospective Register of Systematic Reviews (identifier CRD42021232821). We searched Embase, Medline, and Cochrane databases using the keywords hypothermia, renal replacement therapy, hemodialysis, hemofiltration, hemodiafiltration, and their abbreviations. The search included only articles in English with no time limit, up until 30 June 2021.

Results: From the 795 revised articles, 18 studies including 21 patients, were selected for the final assessment and data extraction. The mean rate of rewarming calculated for all studies combined was 1.9 °C/h (95% CI 1.5-2.3) and did not differ between continuous (2.0 °C/h; 95% CI 0.9-3.0) and intermittent (1.9 °C/h; 95% CI 1.5-2.3) methods ( > 0.9).

Conclusions: Based on the reviewed literature, it is currently not possible to provide high-quality recommendations for RRT use in specific groups of patients in accidental hypothermia. While RRT appears to be a viable rewarming strategy, the choice of rewarming method should always be determined by the specific clinical circumstances, the available resources, and the current resuscitation guidelines.
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http://dx.doi.org/10.3390/ijerph18189638DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8467292PMC
September 2021

Quality Indicators for Avalanche Victim Management and Rescue.

Int J Environ Res Public Health 2021 09 11;18(18). Epub 2021 Sep 11.

International Commission for Mountain Emergency Medicine (ICAR MedCom), 8058 Zürich, Switzerland.

Decisions in the management and rescue of avalanche victims are complex and must be made in difficult, sometimes dangerous, environments. Our goal was to identify indicators for quality measurement in the management and rescue of avalanche victims. The International Commission for Mountain Emergency Medicine (ICAR MedCom) convened a group of internal and external experts. We used brainstorming and a five-round modified nominal group technique to identify the most relevant quality indicators (QIs) according to the National Quality Forum Measure Evaluation Criteria. Using a consensus process, we identified a set of 23 QIs to measure the quality of the management and rescue of avalanche victims. These QIs may be a valuable tool for continuous quality improvement. They allow objective feedback to rescuers regarding clinical performance and identify areas that should be the foci of further quality improvement efforts in avalanche rescue.
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http://dx.doi.org/10.3390/ijerph18189570DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8464975PMC
September 2021

Modelling transport time to trauma centres and 30-day mortality in road accidents in Switzerland: an exploratory study.

Swiss Med Wkly 2021 09 1;151(35-36). Epub 2021 Sep 1.

Emergency Department, Lausanne University Hospital and University of Lausanne, Switzerland.

Background: Rapid access to a trauma centre for severely injured road accident victims, conceptualised as the Golden Hour, links access time to definitive treatment within 1 hour of trauma with reduced risks of morbidity and mortality. Access times have not been studied in Switzerland. The aim of this work was to model the transport time by ambulance of seriously injured road traffic accident victims to one of the 12 trauma centres in Switzerland and to investigate whether this time influenced mortality.

Methods: Isochronous travel curves in 10-minute increments were modelled around each of the 12 Swiss trauma centres to assess travel times at the Swiss national level, based on the shortest travel time from the location of a serious road accident to the nearest trauma centre. We used the national database of the Federal Roads Office, which provided the geolocation of these accidents occurring between 2011 and 2017. The association between mortality and transport time to the nearest trauma centre was then analysed.

Results: The current distribution of trauma centres allowed access time within the Golden Hour for accidents occurring on the Swiss plateau, but the time was more prolonged in the Alps or the Jura. An association existed between mortality and prehospital transport time from the site of an accident to the nearest trauma centre. For each additional 10-minute isochrone, an average increase of 0.4% in mortality was observed.

Conclusion: This work showed an adequate distribution of trauma centres in Switzerland and suggests a positive relationship between transport time to the nearest trauma centre and mortality. The numerous confounding factors not systematically collected in publicly available databases limit the robustness of our results. This study confirms the importance of having a national trauma registry to allow quality analyses to guide public health decisions.
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http://dx.doi.org/10.4414/SMW.2021.w30007DOI Listing
September 2021

Crevasse accidents in the Swiss Alps Epidemiology and mortality of 405 victims of crevasse accidents from 2010 to 2020.

Injury 2022 Jan 12;53(1):183-189. Epub 2021 Aug 12.

Swiss Air-Ambulance, Rega (Rettungsflugwacht/Garde Aérienne), Zurich, Switzerland; Department of Anaesthesiology and Intensive Care Medicine, Cantonal Hospital St. Gallen, St. Gallen, Switzerland; Department of Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Air Zermatt, Emergency Medical Service, Zermatt, Switzerland. Electronic address:

Introduction: The clinical spectrum of injuries in crevasse accidents can range from benign to life-threatening, even including death. To date, little is known about incidence and causes.

Methods: We retrospectively analyzed mountain rescue missions that included crevasse accidents and took place in Switzerland from 2010 to 2020. Demographic and epidemiological data were collected. Injury severity was graded according to the National Advisory Committee for Aeronautics (NACA) score. Winter season was defined as December to May, and summer season as June to November.

Results: A total of 321 victims of crevasse falls were included in the study. The median age of victims was 41.2 years (interqauartile range [IQR] 31.3 to 51.6), with 82% (n=260) being male and 59% (n=186) foreigners. The typical altitude range at which rescue missions were performed was between 3000 and 3499m (44% of all cases). The median depth of the fall was 15 meters (IQR 8 to 20) during the winter season compared to 8 meters (IQR 5 to 10) during the summer, p<0.001. Overall mortality was 6.5%. The NACA score was ≥4 for 9.4% (n=30) of the victims. 55% (n=177) had a NACA score of 0 or 1. There was a significant positive correlation between the depth of fall and the injury severity (Pearson`s correlation r=0.35, 95%- confidence interval: 0.18 to 0.51), p<0.001.

Conclusion: More than half of victims fallen into a crevasse are uninjured or sustain mild injury. Life-threathening injuries were found in about 10% of victims and the crevasse fall was fatal in 6.5% of cases. Injury severity positively correlates with the depth of fall, which is higher during winter season.
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http://dx.doi.org/10.1016/j.injury.2021.08.010DOI Listing
January 2022

Extracorporeal Life Support in Accidental Hypothermia with Cardiac Arrest-A Narrative Review.

ASAIO J 2021 Jul 8. Epub 2021 Jul 8.

From the Deparment of Respiratory Medicine, Allergology and Sleep Medicine, Paracelsus Medical University, Nuremberg, Germany Department of Anesthesiology and Intensive Care, Severe Accidental Hypothermia Center, Medical University of Silesia, Katowice, Poland Department of Anesthesiology and Intensive Care Medicine, Hospitallers Brothers Hospital, Paracelsus Medical University, Salzburg, Austria Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy Department of Emergency Medicine, Jan Kochanowski University, Kielce, Poland Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland Department of Medical Rescue, Poznan University of Medical Sciences, Poznan, Poland Departmentf Cardiac Surgery and Transplantology, Poznan University of Medical Sciences, Poznan, Poland Emergency Department, Lausanne University Hospital, Lausanne, Switzerland.

Severely hypothermic patients, especially suffering cardiac arrest, require highly specialized treatment. The most common problems affecting the recognition and treatment seem to be awareness, logistics, and proper planning. In severe hypothermia, pathophysiologic changes occur in the cardiovascular system leading to dysrhythmias, decreased cardiac output, decreased central nervous system electrical activity, cold diuresis, and noncardiogenic pulmonary edema. Cardiac arrest, multiple organ dysfunction, and refractory vasoplegia are indicative of profound hypothermia. The aim of these narrative reviews is to describe the peculiar pathophysiology of patients suffering cardiac arrest from accidental hypothermia. We describe the good chances of neurologic recovery in certain circumstances, even in patients presenting with unwitnessed cardiac arrest, asystole, and the absence of bystander cardiopulmonary resuscitation. Guidance on patient selection, prognostication, and treatment, including extracorporeal life support, is given.
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http://dx.doi.org/10.1097/MAT.0000000000001518DOI Listing
July 2021

Clinician miscalibration of survival estimate in hypothermic cardiac arrest: HOPE-estimated survival probabilities in extreme cases.

Resusc Plus 2021 Sep 26;7:100139. Epub 2021 May 26.

Department of Emergency Medicine, Lausanne University Hospital, BH 09, 1011 Lausanne, Switzerland.

Aim: Patients with hypothermic cardiac arrest may survive with an excellent outcome after extracorporeal life support rewarming (ECLSR). The HOPE (Hypothermia Outcome Prediction after ECLS) score is recommended to guide the in-hospital decision on whether or not to initiate ECLSR in patients in cardiac arrest following accidental hypothermia. We aimed to assess the HOPE-estimated survival probabilities for a set of survivors of hypothermic cardiac arrest who had extreme values for the variables included in the HOPE score.

Methods: Survivors were identified and selected through a systematic literature review including case reports. We calculated the HOPE score for each patient who presented extraordinary clinical parameters.

Results: We identified 12 such survivors. The HOPE-estimated survival probability was ≥10% for all (n = 11) patients for whom we were able to calculate the HOPE score.

Conclusion: Our study confirms the robustness of the HOPE score for outliers and thus further confirms its external validity. These cases also confirm that hypothermic cardiac arrest is a fundamentally different entity than normothermic cardiac arrest. Using HOPE for extreme cases may support the proper calibration of a clinician's prognosis and therapeutic decision based on the survival chances of patients with accidental hypothermic cardiac arrest.
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http://dx.doi.org/10.1016/j.resplu.2021.100139DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8244419PMC
September 2021

The efficiency of continuous renal replacement therapy for rewarming of patients in accidental hypothermia--An experimental study.

Artif Organs 2021 Nov 14;45(11):1360-1367. Epub 2021 Jul 14.

Department of Anaesthesiology and Intensive Care, Medical University of Silesia, Katowice, Poland.

Severe accidental hypothermia carries high mortality and morbidity and is often treated with invasive extracorporeal methods. Continuous veno-venous hemodiafiltration (CVVHDF) is widely available in intensive care units. We sought to provide theoretical basis for CVVHDF use in rewarming of hypothermic patients. CVVHDF system was used in the laboratory setting. Heat balance and transferred heat units were evaluated for the system without using blood. We used 5L of crystalloid solution at the temperature of approximately 25°C, placed in a thermally insulated tank (representing the "central compartment" of a hypothermic patient). Time of warming the central compartment from 24.9 to 30.0°C was assessed with different flow combinations: "blood" (central compartment fluid) 50 or 100 or 150 mL/min, dialysate solution 100 or 1500 mL/h, and substitution fluid 0 or 500 mL/h. The total circulation time was 1535 minutes. There were no differences between heat gain values on the filter depending on blood flow (P = .53) or dialysate flow (P = .2). The mean heating time for "blood" flow rates 50, 100, and 150 mL/min was 113.7 minutes (95% CI, 104.9-122.6 minutes), 83.3 minutes (95% CI, 76.2-90.3 minutes), and 74.7 minutes (95% CI, 62.6-86.9 minutes), respectively (P < .01). The respective median rewarming rate for different "blood" flows was 3.6°C/h (IQR, 3.0-4.2°C/h), 4.8 (IQR, 4.2-5.4°C/h), and 5.4 (IQR, 4.8-6.0°C/h), respectively (P < .01). The dialysate flow did not affect the warming rate. Based on our experimental model, CVVHDF may be used for extracorporeal rewarming, with the rewarming rates increasing achieved with higher blood flow rates.
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http://dx.doi.org/10.1111/aor.14032DOI Listing
November 2021

Management of respiratory distress following prehospital implementation of noninvasive ventilation in a physician-staffed emergency medical service: a single-center retrospective study.

Scand J Trauma Resusc Emerg Med 2021 Jun 29;29(1):85. Epub 2021 Jun 29.

Faculty of Biology and Medicine, University of Lausanne, Rue du Bugnon 21, 1011, Lausanne, Switzerland.

Background: Noninvasive ventilation (NIV) is recognized as first line ventilatory support for the management of acute pulmonary edema (APE) and chronic obstructive pulmonary disease (COPD) exacerbations. We aimed to study the prehospital management of patients in acute respiratory distress with an indication for NIV and whether they received it or not.

Methods: This retrospective study included patients ≥18 years old who were cared for acute respiratory distress in a prehospital setting. Indications for NIV were oxygen saturation (SpO) <90% and/or respiratory rate (RR) >25/min with a presumptive diagnosis of APE or COPD exacerbation. Study population characteristics, initial and at hospital vital signs, presumptive and definitive diagnosis were analyzed. For patients who received NIV, dyspnea level was evaluated with a dyspnea verbal ordinal scale (D-VOS, 0-10) and arterial blood gas (ABG) values were obtained at hospital arrival.

Results: Among the 187 consecutive patients included in the study, most (n = 105, 56%) had experienced APE or COPD exacerbation, and 56 (30%) received NIV. In comparison with patients without NIV, those treated with NIV had a higher initial RR (35 ± 8/min vs 29 ± 10/min, p < 0.0001) and a lower SpO (79 ± 10 vs 88 ± 11, p < 0.0001). The level of dyspnea was significantly reduced for patients treated with NIV (on-scene D-VOS 8.4 ± 1.7 vs 4.4 ± 1.8 at admission, p < 0.0001). Among the 131 patients not treated with NIV, 41 (31%) had an indication. In the latter group, initial SpO was 80 ± 10% in the NIV group versus 86 ± 11% in the non-NIV group (p = 0.0006). NIV was interrupted in 9 (16%) patients due to either discomfort (n = 5), technical problem (n = 2), persistent desaturation (n = 1), or vomiting (n = 1).

Conclusions: The results of this study contribute to a better understanding of the prehospital management of patients who present with acute respiratory distress and an indication for NIV. NIV was started on clinically more severe patients, even if predefined criteria to start NIV were present. NIV allows to improve vital signs and D-VOS in those patients. A prospective study could further elucidate why patients with a suspected diagnosis of APE and COPD are not treated with NIV, as well as the clinical impact of the different strategies.

Trial Registration: The study was approved by our institutional ethical committee ( CER-VD 2020-01363 ).
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http://dx.doi.org/10.1186/s13049-021-00900-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8240431PMC
June 2021

Survival probability in avalanche victims with long burial (≥60 min): A retrospective study.

Resuscitation 2021 09 6;166:93-100. Epub 2021 Jun 6.

Department of Emergency Medicine, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 21, BH 09, CHUV, 1011 Lausanne, Switzerland. Electronic address:

Background: The survival of completely buried victims in an avalanche mainly depends on burial duration. Knowledge is limited about survival probability after 60 min of complete burial.

Aim: We aimed to study the survival probability and prehospital characteristics of avalanche victims with long burial durations.

Methods: We retrospectively included all completely buried avalanche victims with a burial duration of ≥60 min between 1997 and 2018 in Switzerland. Data were extracted from the registry of the Swiss Institute for Snow and Avalanche Research and the prehospital medical records of the physician-staffed helicopter emergency medical services. Avalanche victims buried for ≥24 h or with an unknown survival status were excluded. Survival probability was estimated by using the non-parametric Ayer-Turnbull method and logistic regression. The primary outcome was survival probability.

Results: We identified 140 avalanche victims with a burial duration of ≥60 min, of whom 27 (19%) survived. Survival probability shows a slight decrease with increasing burial duration (23% after 60 min, to <6% after 1400 min, p = 0.13). Burial depth was deeper for those who died (100 cm vs 70 cm, p = 0.008). None of the survivors sustained CA during the prehospital phase.

Conclusions: The overall survival rate of 19% for completely buried avalanche victims with a long burial duration illustrates the importance of continuing rescue efforts. Avalanche victims in CA after long burial duration without obstructed airway, frozen body or obvious lethal trauma should be considered to be in hypothermic CA, with initiation of cardiopulmonary resuscitation and an evaluation for rewarming with extracorporeal life support.
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http://dx.doi.org/10.1016/j.resuscitation.2021.05.030DOI Listing
September 2021

Reply to: Revised Swiss System for clinical staging of accidental hypothermia - At which core temperatures are patients at high risk of cardiac arrest?

Resuscitation 2021 08 31;165:186-187. Epub 2021 May 31.

Department of Emergency Medicine, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA; International Commission for Mountain Emergency Medicine (ICAR MedCom), Zürich, Switzerland; Emergency Department, Lausanne University Hospital, Lauanne, Switzerland.

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http://dx.doi.org/10.1016/j.resuscitation.2021.05.014DOI Listing
August 2021

Rescue collapse - A hitherto unclassified killer in accidental hypothermia.

Resuscitation 2021 07 1;164:142-143. Epub 2021 Jun 1.

Department of Anesthesiology and Intensive Care Medicine, Hospitaller Brothers Hospital, Paracelsus Medical University, Kajetanerplatz 1, 5020 Salzburg, Austria. Electronic address:

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http://dx.doi.org/10.1016/j.resuscitation.2021.05.011DOI Listing
July 2021

Warm Fluid Infusion Is Not an Effective Primary Warming Method in Accidental Hypothermia.

Ther Hypothermia Temp Manag 2021 Jun 21;11(2):76. Epub 2021 Apr 21.

Department of Emergency Medicine, Stanford University Medical Center, Stanford, California, USA.

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http://dx.doi.org/10.1089/ther.2021.0006DOI Listing
June 2021

Estimation of the survival probabilities in hypothermic cardiac arrest patients with drowning: The HOPE score as a tool to help selecting patients for extracorporeal rewarming.

Resuscitation 2021 05 29;162:453-454. Epub 2021 Mar 29.

Department of Emergency Medicine, Lausanne University Hospital and University of Lausanne, BH09, 1011 Lausanne, Switzerland. Electronic address:

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http://dx.doi.org/10.1016/j.resuscitation.2021.02.043DOI Listing
May 2021

Clinical staging of accidental hypothermia: The Revised Swiss System: Recommendation of the International Commission for Mountain Emergency Medicine (ICAR MedCom).

Resuscitation 2021 05 3;162:182-187. Epub 2021 Mar 3.

International Commission for Mountain Emergency Medicine (ICAR MedCom), Zürich, Switzerland; Department of Emergency Medicine, Lausanne University Hospital, Lausanne, Switzerland. Electronic address:

Clinical staging of accidental hypothermia is used to guide out-of-hospital treatment and transport decisions. Most clinical systems utilize core temperature, by measurement or estimation, to stage hypothermia, despite the challenge of obtaining accurate field measurements. Recent studies have demonstrated that field estimation of core temperature is imprecise. We propose a revision of the original Swiss Staging system. The revised system uses the risk of cardiac arrest, instead of core temperature, to determine the staging level. Our revised system simplifies assessment by using the level of responsiveness, based on the AVPU scale, and by removing shivering as a stage-defining sign.
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http://dx.doi.org/10.1016/j.resuscitation.2021.02.038DOI Listing
May 2021

Vital Signs in Accidental Hypothermia.

High Alt Med Biol 2021 Jun 22;22(2):142-147. Epub 2020 Dec 22.

University of Lausanne, Lausanne, Switzerland.

Pasquier, Mathieu, Evelien Cools, Ken Zafren, Pierre-Nicolas Carron, Vincent Frochaux, and Valentin Rousson. Vital signs in accidental hypothermia. . 22: 142-147, 2021. Clinical indicators are used to stage hypothermia and to guide management of hypothermic patients. We sought to better characterize the influence of hypothermia on vital signs, including level of consciousness, by studying cases of patients suffering from accidental hypothermia. We retrospectively included patients aged ≥18 years admitted to the hospital with a core temperature below 35°C. We identified the cases from a literature review and from a retrospective case series of hypothermic patients admitted to the hospital between 1994 and 2016. Patients who experienced cardiac arrest, as well as those with potential confounders such as concomitant diseases or intoxications, were excluded. Relationships between core temperature and heart rate, systolic blood pressure, respiratory rate, and level of consciousness were explored via correlations and regression. Of the 305 cases reviewed, 216 met the criteria for inclusion. The mean temperature was 29.7°C ± 4.2°C (range 19.3°C-34.9°C). The relationships between temperature and each of the four vital signs were generally linear and significantly positive, with Spearman correlations for respiratory rate, heart rate, systolic blood pressure, and Glasgow Coma Score (GCS) of 0.29 ( = 0.024), 0.44 ( < 0.001), 0.47 ( < 0.001), and 0.78 ( < 0.001), respectively. Based on linear regression, the mean decrease of a vital sign associated with a 1°C decrease of temperature was estimated to be 0.50 minute for respiratory rate, 2.54 minutes for heart rate, 4.36 mmHg for systolic blood pressure, and 0.88 for GCS. There is a significant positive correlation between core temperature and heart rate, systolic blood pressure, respiratory rate, and GCS. The relationship between vital signs and temperature is generally linear. This knowledge might help clinicians make appropriate decisions when determining whether the clinical condition of a patient should be attributed to hypothermia. This could enhance clinical care and help to guide future research.
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http://dx.doi.org/10.1089/ham.2020.0179DOI Listing
June 2021

Reply to letter: Adaptation to the 2017 ICAR MEDCOM Avalanche Victim Resuscitation Checklist.

Resuscitation 2021 03 18;160:66-67. Epub 2021 Jan 18.

EURAC Institute of Mountain Emergency Medicine, Bolzano, Italy; International Commission for Mountain Emergency Medicine ICAR MEDCOM, Switzerland.

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http://dx.doi.org/10.1016/j.resuscitation.2021.01.005DOI Listing
March 2021

Esophageal Temperature Measurement.

N Engl J Med 2020 Oct;383(16):e93

From Emergency Service, Lausanne University Hospital, Lausanne, Switzerland (M.P.); the Department of Anaesthesiology and Intensive Care, Hospitallers Brothers Hospital, Paracelsus Medical University, Salzburg, Austria (P. Paal); the Faculty of Health Sciences, Jagiellonian University Medical College, Krakow (S.K.), the Department of Emergency Medicine, Jan Kochanowski University, Kielce (P. Podsiadlo), and the Department of Anaesthesiology and Intensive Care, Medical University of Silesia, Katowice (T.D.) - all in Poland; and the Department of Emergency Medicine, University of British Columbia, New Westminster, BC, Canada (D.B.).

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http://dx.doi.org/10.1056/NEJMvcm1900481DOI Listing
October 2020

Qualification for Extracorporeal Life Support in Accidental Hypothermia: The HOPE Score.

Ann Thorac Surg 2021 04 25;111(4):1408. Epub 2020 Sep 25.

Center of Primary Care and Public Health, University of Lausanne, Lausanne, Switzerland.

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http://dx.doi.org/10.1016/j.athoracsur.2020.06.146DOI Listing
April 2021

Outcomes of patients suffering unwitnessed hypothermic cardiac arrest rewarmed with extracorporeal life support: A systematic review.

Artif Organs 2021 Mar 8;45(3):222-229. Epub 2020 Oct 8.

Emergency Department, Lausanne University Hospital, Lausanne, Switzerland.

Prolonged cardiac arrest (CA) may lead to neurologic deficit in survivors. Good outcome is especially rare when CA was unwitnessed. However, accidental hypothermia is a very specific cause of CA. Our goal was to describe the outcomes of patients who suffered from unwitnessed hypothermic cardiac arrest (UHCA) supported with Extracorporeal Life Support (ECLS). We included consecutive patients' cohorts identified by systematic literature review concerning patients suffering from UHCA and rewarmed with ECLS. Patients were divided into four subgroups regarding the mechanism of cooling, namely: air exposure; immersion; submersion; and avalanche. A statistical analysis was performed in order to identify the clinical parameters associated with good outcome (survival and absence of neurologic impairment). A total of 221 patients were included into the study. The overall survival rate was 27%. Most of the survivors (83%), had no neurologic deficit. Asystole was the presenting CA rhythm in 48% survivors, of which 79% survived with good neurologic outcome. Variables associated with survival included the following: female gender (P < .001); low core temperature (P = .005); non-asphyxia-related mechanism of cooling (P < .001); pulseless electrical activity as an initial rhythm (P < .001); high blood pH (P < .001); low lactate levels (P = .003); low serum potassium concentration (P < .001); and short resuscitation duration (P = .004). Severely hypothermic patients with unwitnessed CA may survive with good neurologic outcome, including those presenting as asystole. The initial blood pH, potassium, and lactate concentration may help predict outcome in hypothermic CA.
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http://dx.doi.org/10.1111/aor.13818DOI Listing
March 2021

Prehospital Use of Ketamine in Mountain Rescue: A Survey of Emergency Physicians of a Single-Center Alpine Helicopter-Based Emergency Service.

Wilderness Environ Med 2020 Dec 8;31(4):385-393. Epub 2020 Sep 8.

Emergency Department, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland. Electronic address:

Introduction: Although ketamine use in emergency medicine is widespread, studies investigating prehospital use are scarce. Our goal was to assess the self-reported modalities of ketamine use, knowledge of contraindications, and occurrence of adverse events associated with its use by physicians through a prospective online survey.

Methods: The survey was administered to physicians working for Air-Glaciers, a Swiss alpine helicopter-based emergency service, and was available between September 24 and November 23, 2018. We enrolled 39 participants (participation rate of 87%) in our study and collected data regarding their characteristics, methods of ketamine use, knowledge of contraindications, and encountered side effects linked to the administration of ketamine. We also included a clinical scenario to investigate an analgesic strategy.

Results: Ketamine was considered safe and judged irreplaceable by most physicians. The main reason for ketamine use was acute analgesia during painful procedures, such as manipulation of femur fractures. The doses of ketamine administered with or without fentanyl ranged from 0.2 to 0.7 mg·kg intravenously. Most physicians reported using fentanyl and midazolam along with ketamine. The median dose of midazolam was 2 (interquartile range 1-2) mg for a 70-kg adult. Monitoring and oxygen administration were used infrequently. Hallucinations were the most common adverse events. Knowledge of ketamine contraindications was poor.

Conclusions: Ketamine use was reported by mountain rescue physicians to be safe and useful for acute analgesia. Most physicians use fentanyl and midazolam along with ketamine. Adverse neuropsychiatric events were rare. Knowledge regarding contraindications to the administration of ketamine should be improved.
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http://dx.doi.org/10.1016/j.wem.2020.06.004DOI Listing
December 2020

Prehospital management of burns requiring specialized burn centre evaluation: a single physician-based emergency medical service experience.

Scand J Trauma Resusc Emerg Med 2020 Aug 20;28(1):84. Epub 2020 Aug 20.

Faculty of Biology and Medicine, University of Lausanne, Rue du Bugnon 21, CH-1011, Lausanne, Switzerland.

Background: Emergency medical services regularly encounter severe burns. As standards of care are relatively well-established regarding their hospital management, prehospital care is comparatively poorly defined. The aim of this study was to describe burned patients taken care of by our physician-staffed emergency medical service (PEMS).

Methods: All patients directly transported by our PEMS to our burn centre between January 2008 and December 2017 were retrospectively enrolled. We specifically addressed three "burn-related" variables: prehospital and hospital burn size estimations, type and volume of infusion and pain assessment and management. We divided patients into two groups for comparison: TBSA < 20% and ≥ 20%. We a priori defined clinically acceptable limits of agreement in the small and large burn group to be ±5% and ± 10%, respectively.

Results: We included 86 patients whose median age was 26 years (IQR 12-51). The median prehospital TBSA was 10% (IQR 6-25). The difference between the prehospital and hospital TBSA estimations was outside the limits of agreement at 6.2%. The limits of agreement found in the small and large burn groups were - 5.3, 4.4 and - 10.1, 11, respectively. Crystalloid infusion was reported at a median volume of 0.8 ml/kg/TBSA (IQR 0.3-1.4) during the prehospital phase, which extrapolated over the first 8 h would equal to a median volume of 10.5 ml/kg/TBSA. The median verbal numeric rating scale on scene was 6 (IQR 3-8) and 3 (IQR 2-5) at the hospital (p < 0.001). Systemic analgesia was provided to 61 (71%) patients, predominantly with fentanyl (n = 59; 69%), followed by ketamine (n = 7; 8.1%). The median doses of fentanyl and ketamine were 1.7 mcg/kg (IQR 1-2.6) and 2.1 mg/kg (IQR 0.3-3.2), respectively.

Conclusions: We found good agreement in burn size estimations. The quantity of crystalloid infused was higher than the recommended amount, suggesting a potential risk for fluid overload. Most patients benefited from a correct systemic analgesia. These results emphasized the need for dedicated guidelines and decision support aids for the prehospital management of burned patients.
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http://dx.doi.org/10.1186/s13049-020-00771-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7439538PMC
August 2020

Comment on: Cardiac Arrest Secondary to Accidental Hypothermia: Who Should We Resuscitate?

Air Med J 2020 May - Jun;39(3):156. Epub 2020 Jan 6.

Severe Accidental Hypothermia Center, Department of Anaesthesiology and Intensive Care, Medical University of Silesia, Katowice, Poland.

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http://dx.doi.org/10.1016/j.amj.2019.12.004DOI Listing
August 2020

[Emergency department : COVID-19 crisis and organizational aspects].

Rev Med Suisse 2020 May;16(692):924-929

Service des urgences, CHUV, 1011 Lausanne.

Emergency departments are on the front line in the management of COVID-19 cases, from screening to the initial management of the most severe cases. The clinical presentation of COVID-19 range from non-specific symptoms to adult acute respiratory distress syndrome (ARDS). Diagnosis is based on PCR from a nasopharyngeal swab and emergency treatment rely on oxygen therapy. Patient's orientation (home, hospitalization, admission in intensive care unit) is a central aspect of emergency management. The shift from a strategy of systematic recognition of potential cases to the one of epidemic mitigation required hospital emergency medicine services to implement crisis management measures, to guarantee admission and hospitalization capacity.
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May 2020
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