E. Wiel’s research while affiliated with University of Lille and other places

Introduction and objectives: In out-of-hospital cardiac arrest, early recognition, calling for emergency medical assistance, and early cardiopulmonary resuscitation are acknowledged to be the three most important components in the chain of survival. However, bystander basic life support (BLS) initiation rates remain low. The objective of the present study was to evaluate the association between bystander BLS and survival after an out-of-hospital cardiac arrest (OHCA). Methods: We conducted a retrospective cohort study of all patients with OHCA with a medical etiology treated by a mobile intensive care unit (MICU) in France from July 2011 to September 2021, as recorded in the French National OHCA Registry (RéAC). Cases in which the bystander was an on-duty fire fighter, paramedic, or emergency physician were excluded. We assessed the characteristics of patients who received bystander BLS vs. those who did not. The two classes of patient were then matched 1:1, using a propensity score. Conditional logistic regression was then used to probe the putative association between bystander BLS and survival. Results: During the study, 52,303 patients were included; BLS was provided by a bystander in 29,412 of these cases (56.2%). The 30-day survival rates were 7.6% in the BLS group and 2.5% in the no-BLS group (p < 0.001). After matching, bystander BLS was associated with a greater 30-day survival rate (odds ratio (OR) [95% confidence interval (CI)] = 1.77 [1.58-1.98]). Bystander BLS was also associated with greater short-term survival (alive on hospital admission; OR [95%CI] = 1.29 [1.23-1.36]). Conclusions: The provision of bystander BLS was associated with a 77% greater likelihood of 30-day survival after OHCA. Given than only one in two OHCA bystanders provides BLS, a greater focus on life saving training for laypeople is essential.

Background Epinephrine effectiveness and safety are still questioned. It is well known that the effect of epinephrine varies depending on patients’ rhythm and time to injection. Objective We aimed to assess the association between epinephrine use during out-of-hospital cardiac arrest (OHCA) care and patient 30-day (D30) survival. Methods Between 2011 and 2017, 27,008 OHCA patients were included from the French OHCA registry. We adjusted populations using a time-dependent propensity score matching. Analyses were stratified according to patient's first rhythm. After matching, 2837 pairs of patients with a shockable rhythm were created and 20,950 with a nonshockable rhythm. Results Whatever the patient's rhythm (shockable or nonshockable), epinephrine use was associated with less D30 survival (odds ratio [OR] 0.508; 95% confidence interval [CI] 0.440–0.586] and OR 0.645; 95% CI 0.549–0.759, respectively). In shockable rhythms, on all outcomes, epinephrine use was deleterious. In nonshockable rhythms, no difference was observed regarding return of spontaneous circulation and survival at hospital admission. However, epinephrine use was associated with worse neurological prognosis (OR 0.646; 95% CI 0.549–0.759). Conclusions In shockable and nonshockable rhythms, epinephrine does not seem to have any benefit on D30 survival. These results underscore the need to perform further studies to define the optimal conditions for using epinephrine in patients with OHCA.

Riassunto La sindrome coronarica acuta (SCA) è costituita da manifestazioni cliniche, elettrocardiografiche e biologiche legate alla rottura di una placca di ateroma che ha indotto la formazione di un trombo che limita il flusso sanguigno nella rete arteriosa coronarica. Le SCA sono classificate come SCA con elevazione (o sopraslivellamento) del tratto ST (STEMI o SCA ST +) e come SCA senza elevazione del tratto ST (NSTEMI o SCA non-ST +). Nelle STEMI, il trombo è costituito principalmente da fibrina che causa un’occlusione coronarica acuta totale responsabile di una necrosi completa del tessuto miocardico entro sei ore, mentre, nelle NSTEMI, è piuttosto di tipo piastrinico e non ostruisce completamente il lume arterioso. Il dolore toracico è il segno di riferimento più comune. Il fattore tempo è l’elemento chiave nella gestione delle SCA. Il ruolo dei servizi di assistenza medica di emergenza (Samu), dei servizi mobili di emergenza e di rianimazione (Smur) e del 118 è essenziale, dal momento che consentono un trattamento rapido. L’elettrocardiogramma (ECG) a 18 derivazioni (6 derivazioni standard e 12 derivazioni precordiali V1-V9 e V3r, V4r, VE) è l’esame da realizzare prioritariamente. Permette di distinguere le STEMI dalle NSTEMI. Indipendentemente dal tipo di SCA, il trattamento include l’assunzione di farmaci antipiastrinici, fluidificanti del sangue, ansiolitici e antidolorifici. Nelle NSTEMI, la valutazione dei marker biologici della sofferenza miocardica (troponina) può consentire l’orientamento diagnostico e terapeutico a partire dalla fase preospedaliera. L’apporto recente di nuove e potenti molecole antiaggreganti piastriniche e anticoagulanti ha modificato le strategie decisionali e la gestione della SCA preospedaliera, in modo da garantire una riperfusione ottimale e il più velocemente possibile.

Background: Oligo-analgesia is common in the emergency department (ED). This study aimed at reporting, when initiated by triage nurse, the superior efficacy of inhaled methoxyflurane plus standard of care (m-SoC) analgesia versus placebo plus SoC (p-SoC) for moderate-to-severe trauma-related pain in the hospital ED. Methods: A randomised, double-blind, placebo-controlled trial was conducted at eight EDs. Adults with pain score ≥4 (11-point numerical rate scale, NRS) at admission were randomised to receive one or two inhalers containing m-SoC or p-SoC. Primary outcome measure was time until pain relief ≤30 mm, assessed on the 100-mm Visual Analogic Scale (VAS). Results: A total of 351 patients were analysed (178 m-SoC; 173 p-SoC). Median pain prior to first inhalation was 66 mm, 75% had severe pain (NRS 6-10). Median time to pain relief was 35 min [95% confidence interval (CI), 28-62] for m-SoC versus not reached in p-SoC (92 - not reached) [hazard ratio), 1.93 (1.43-2.60), P < 0.001]. Pain relief was most pronounced in the severe pain subgroup: hazard ratio, 2.5 (1.7-3.7). As SoC, 24 (7%) patients received weak opioids (6 versus 8%), 4 (1%) strong opioid and 44 (13%) escalated to weak or strong opioids (8 versus 17%, respectively, P = 0.02). Most adverse events were of mild (111/147) intensity. Conclusions: In this study, we report that methoxyflurane, initiated at triage nurse as part of a multimodal analgesic approach, is effective in achieving pain relief for trauma patients. This effect was particularly pronounced in the severe pain subgroup.