Jean Pierre Tourtier

Difficulties of triage in mass casualties incident

We read with deep interest the article by Mahaluxmivala [1]. We appreciate the work of the authors on the article. However, the data about infection of Table 1 are inconsistent with that in Results. From Table 1, infection was recorded in 2 patients in group 1, 5 patients in group 2 and 6 patients in group 3. But from Results, infection was noted in 4 patients in group 1, 5 patients in group 2 and 1 patient in group 3. This makes us confused. We do not know clearly about patient demographics. In brief, we think a corrigendum should be made; otherwise the inconsistency about the data of infection makes readers more difficult to extract the data. Nonetheless, the flaw cannot lessen this article’s complete value and we thoroughly enjoyed reading the paper with respect.

Effect of continuous oxygen insufflation on induced-gastric air volume during cardiopulmonary resuscitation in a cadaveric model

BACKGROUNDnThe main objective of this study was to compare the volume of gas insufflated in the stomach with continuous external chest compressions plus continuous oxygen insufflation (C-CPR) versus standard-CPR (S-CPR) which alternates external chest compressions and synchronized positive insufflations through a bag-valve-mask with a 30/2 ratio. The secondary objective was to compare upper airway pressures (intratracheal and intramask) generated during continuous oxygen insufflation.nnnMATERIAL AND METHODSnOpen, prospective, randomized, cross over, comparative, non-inferiority study. CPR was performed for six minutes periods, on seven fresh human corpses, with C-CPR or S-CPR in a random order. Before each CPR period, the stomach was completely emptied through the gastrostomy tube, and then 200 mL of air was injected in the stomach to be sure it was not collapsed. The gastric volume was measured at the end of each intervention. Intratracheal and intramask pressures were recorded continuously during C-CPR. Results were provided as mean ± standard deviation. Statistical analyses were done with a paired student t test.nnnRESULTSnInduced-gastric inflation was lower with C-CPR (221 ± 130 mL) than with S-CPR (5401 ± 2208 mL, p = 0.001). Throughout C-CPR, no difference was found between the intratracheal and intramask pressures (4.4 ± 1.2; 4.0 ± 0.8 cmH2O, respectively, p = 0.45).nnnCONCLUSIONnThis human cadaver study demonstrates that continuous oxygen insufflation induced less gastric inflation than intermittent insufflation during CPR.

Hands-off Time during Automated Chest Compression Device Application in Out-of-Hospital Cardiac Arrest: A Case Series Report.

Abstract Introduction: During out-of-hospital cardiac arrest (OHCA), chest compression interruptions or hands-off time (HOT) affect the prognosis. Our aim was to measure HOT due to the application of an automated chest compression device (ACD) by an advanced life support team. Materials and Methods: This was a prospective observational case series report since the introduction of a new method of installing the ACD. Inclusion criteria were patients over 18 years old with OHCA who were treated with an ACD (Lucas 2TM, Physio-Control). The ACD application was indicated only for OHCA patients transported to a hospital for Extra Corporeal Life Support (ECLS). We recorded the HOT related to switching from manual to mechanical chest compressions. An ACD consists of dorsal and ventral components, which can be installed either in one or in two steps, separated from a chest compression sequence. HOT was expressed as a median number of seconds [interquartile range]. Results: From January 1, 2012 to January 15, 2013, 30 patients were included. In the case of ACD application in one phase (n = 16), the median HOT was 25.3 s [19.8–30.5]. With regard to patients with an ACD application in two phases (n = 14), the median HOT was, respectively, 9.8 s [7.8–17] and 12.4 s [9.5–16.2], that is, a median global HOT of 23.6 s [19–27.6]. HOT was not different between ACD applications in one or two phases (p = 0.52). For a two phase application, the median chest compression time between the two manipulations was 14.2 s [6.4–18]. Conclusion: There was no significant difference between techniques in the application of the Lucas 2TM device in terms of HOT. The short time needed to apply the device lends itself well to use as a primary chest compression modality during cardiac arrest as well as a bridge to novel resuscitation strategies (ECLS). A further study is currently underway with a larger number of ECLS patients.

Characteristics of Cardiac Arrest Occurring in the Workplace: A Post Hoc Analysis of the Paris Area Fire Brigade Registry.

Objectives: The aim of this study was to describe the characteristics of out-of-hospital cardiac arrest (OHCA) in different workplaces, their management, and the survival rate. Methods: A post hoc analysis included all the OHCA cases that occurred at the workplace and were listed in the Fire Brigade of Paris database registry (2010 to 2014). Utstein-style variables, survival, and types of workplace were analyzed. Results: The study included 298 OHCA cases, mostly young (44% between 18 and 50 years), male (86%), and nontraumatic (86%). Differences in the survival chain were found to be related to the types of work location: bystander cardiopulmonary resuscitation was performed in 0% to 55% of cases, and workplace-automated external defibrillators were used in 0% to 20% of cases. Long-term survival without major incapacity was 0% to 23%. Conclusions: The characteristics of OHCA differ as a function of the type of workplace.

Research in prehospital emergency medicine: comparison by geographic origin of publications.

Department of Emergency Medicine, Fire brigade of Paris, Department of Emergency Medicine, University Hospital Lariboisière AP-HP, University Paris Diderot, Sorbonne Paris Cité, UMRS 942, Paris, Fire Bataillon of Marseille, SAMU 13, University Hospital La Timone AP-HM, Marseille, France and Central Bohemian Region, Emergency Medicine Service, Kladno, Czech Republic Correspondence to Jean-Pierre Tourtier, MD, Fire Brigade of Paris, Emergency Medical Service, 1 Place Jules Renard, 75017 Paris, France Tel: + 33 670 208 162; fax: + 33 156 796 754; e-mail: jeanpierre.tourtier@free.fr

Reply to Letter: The utility of electrocardiogram for evaluation of clinical cardiac arrest in neonatal resuscitation: Promises which need confirmation☆

We have read with interest the article by Koizumi et al. that ighlights the utility of the electrocardiogram (ECG) for the evalution of clinical cardiac arrest in neonatal resuscitation.1 The tools, hich include ECG, cardiac auscultation and pulse oximetry (PO), ffer a combination whose diagnostic sensitivity and specificity eserve further accurate assessment. The authors suggest intraospital care. We present here our experience of the extra-hospital ituation. Births are frequent (N = 300 in 2015 in our backup sysem) and take place without the use of any sophisticated technical quipment. The fastest teams on site are professional first responers in 85% of cases. They await the arrival of the medical team or a median duration of 20 min, with an interquartile range of 2–30 min; their newborn evaluation tools are those that evalute the clinical condition (Apgar, pulse palpation, etc.) associated ith pulse oximetry (PO). The use of the ECG has not been tested n newborns in our system but only in young children on the utomated external defibrillator (AED) screen in situations outide any ventricular fibrillation context. Its use has led to many alse positives due to the presence of electrical activity associated ith the perception of the first responder’s own finger pulse in lace of no pulse of the victim. Such misjudgment has been the ause of many hand-offs of victims requiring chest compressions data not published). Because of this, the completion of CPR withut interruption until the arrival of the medical team is the rule of humb. Recommendations for the care of newborns are based on the act that the heart rate is initially measured more quickly and preisely by listening to heart sounds with a stethoscope (at the cardiac pex) or by ECG than by seeking a palpable pulse.2 The ECG is faster nd more accurate, especially in the first two minutes of life. The erception of a pulse at the base of the umbilicus is reliable only if t exceeds 100 pulses per min.2 Given these data, we will start a study, first, to validate the uscultation of heart sounds by the first responders and, second, o study the possibility of exploiting the variation of the thoracic