Michel Bignand

Out-of-hospital cardiac arrest phone detection: those who most need chest compressions are the most difficult to recognize.

UNLABELLED Dispatcher-assisted cardiopulmonary resuscitation increases the likelihood of survival and thus is highly recommended. However, the detection rate of out-of-hospital cardiac arrest (OHCA) is very different from one system to another, and early recognition of cardiac arrest in the dispatch centre remains challenging. The aim of this study was to assess the provision of dispatcher-assisted cardiopulmonary resuscitation in the main French dispatch centre. METHODS In the Paris Fire Brigade, each patient over 15 years of age who presented an OHCA from 15 to 31 May 2012 was prospectively included. Field data and tape recordings of emergency calls were studied by three experienced physicians, to assess the rate (and delay) of OHCA recognition and chest compression initiation, and identify the causes of unrecognized OHCA. RESULTS Among 82 consecutive calls for detectable cardiac arrest, the dispatcher recognized 50/82 (61%). The median times from call to OHCA recognition and from call to chest compression initiation were, respectively, 2 min 23s (1 min 51 s to 3 min 7s) and 3 min 37s (2 min 57 s to 5 min). The main causes of non-recognition of OHCA were the absence or incomplete assessment of breathing and the presence of agonal breathing. No cardiac arrest was missed when the dispatcher followed the local dispatch algorithm; this included the gesture of putting the hand on the abdomen and measuring the breathing frequency. Hospital admission with a beating heart was paradoxically 18% for detected cardiac arrest and 47% for undetected cardiac arrest (p=0.007). This paradox could be explained by the relation between agonal breathing and, on the one hand, good prognosis of OHCA and, on the other hand, difficulties in recognizing OHCA. CONCLUSION The improvement of cardiac arrest recognition in the dispatch centre seemed mandatory, as the cardiac arrests of better immediate prognosis were not well detected. The measurement of OHCA recognition and CPR initiation by phone should be encouraged in dispatch centres as a key to initiating corrective measures.

Hemostatic dressings in civil prehospital practice: 30 uses of QuikClot Combat Gauze.

To report the use and describe the interest of hemostatic dressings in a civilian setting, we provided medical prehospital teams with QuikClot Combat Gauze (QCG) and asked physicians to complete a specific questionnaire after each use. Thirty uses were prospectively reported. The wounds were mostly caused by cold steel (n=15) and were primarily cervicocephalic (n=16), with 19/30 active arterial bleedings. For 26/30 uses, hemostatic dressing was justified by the inefficiency of other hemostasis techniques. Those 30 applications were associated with 22 complete cessations of bleeding, six decreases of bleeding, and ineffectiveness in two cases. The application of QCG permitted the removal of an effective tourniquet that was applied initially for three patients. No side-effects were reported. The provision of hemostatic dressings in civilian resuscitation ambulances was useful by providing an additional tool to limit bleeding while rapidly transporting the injured patient to a surgical facility.

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.

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.

Knowledge of 'trusted person' and 'advance directive' in end-of-life situations in prehospital emergency medicine 10 years after Leonetti's law publication.

time above 24 h, this did not compromise organ quality. These results are in line with a large study in singlekidney transplants that suggested a ‘no-rush’ approach [5]. Given that most BDD were eligible only for liver and kidney harvest, we chose BDD stability in detriment of rapid organ retrieval. Accordingly, laboratory criteria used to assess organ quality were liver and renal parameters. All parameters were within the normal range, occasionally lower or higher, but always recovering after appropriate therapy.

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

Usefulness of a multiplying factor in predicting the final number of victims during a mass casualty incident

Objective Whenever a mass casualty incident (MCI) occurs, it is essential to anticipate the final number of victims to dispatch the adequate number of ambulances. In France, the custom is to multiply the initial number of prehospital victims by 2–4 to predict the final number. However, no one has yet validated this multiplying factor (MF) as a predictive tool. We aimed to build a statistical model to predict the final number of victims from their initial count. Methods We observed retrospectively over 30 years of MCIs triggered in a large urban area. We considered three types of events: explosions, fires, and road traffic accidents. We collected the initial and final numbers of victims, with distinction between deaths, critical victims (T1), and delayed or minimal victims (T2–T3). The MF was calculated for each category of victims according to each type of event. Using a Poisson multivariate regression, we calculated the incidence risk ratio (IRR) of the final number of T1 as a function of the initial deaths and the initial T2–T3 counts, while controlling for potential confounding variables. Results Sixty-eight MCIs were included. The final number of T1 increased with the initial incidence of deaths [IRR: 1.8 (1.4–2.2)], the initial number of T2–T3 being greater than 12 [IRR: 1.6 (1.3–2.1)], and the presence of one or more explosion [IRR: 1.4 (1.1–1.8)]. Conclusion The MF seems to be an appealing decision-making tool to anticipate the need for ambulance resources. In explosive MCIs, we recommend multiplying T1 by 1.4 to estimate final count and the need for supplementary advanced life support teams.

Injuries induced using an active compression–decompression device (Cardiopump®) during resuscitation for out-of-hospital cardiac arrest: Observational study

Daniel Jost1,∗, Pascal Dang Minh1, Nicolas Genotelle1, Stephane Travers1, Olga Maurin1, Florence Dumas2, Michel Bignand1, Jean-Pierre Tourtier1 1 Fire Brigade of Paris, Paris, France 2 Sudden Death Expertise Center, Paris, France Purpose:Cardiopump® (CP) is a deviceusedbyprofessional rescuer teams to perform chest compression (CC) on out-of-hospital cardiac arrest (OHCA). It allowsperforming a compression followed by an active decompression, and has a gauge to assess the depth of the full compression and decompression. This study aimed to identify chest injuries induced by CC performed with CP. Materials andmethods:Prospectiveobservational study. Inclusion criteria: patients with non-traumatic OHCA>15 years, for whom CP was used. Collected data: epidemiological (age, gender, location, bystander, CPR duration), clinical (skin lesions linked to CP, rib fracture caused by CC, subcutaneous emphysema) and prognosis (return of spontaneous circulation (ROSC), “beating-heart” on arrival at the hospital). We performed uni and multivariate statistical analysis (logistic regression). Results: A total of 3385 patients were included in 2013. Of these, 590 (17%) had chest skin lesions, 121 (4%) rib fractures, and 30 (0.89%) suffered subcutaneous emphysema. Mean age of injured patients was comparable to that of non-injured (66±17 years vs 67±19, p =0.28), and so was their sex-ratio. Three logistic regression models were performed: 1. Skin lesions were linked to low-flow>30min (OR=3.1 [1.6–5.8]) and regurgitation (OR=2.1 [0.9–4.9]). 2. Rib fractures were linked to low-flow>60min (OR=7.1 [1.3–30.1]) and less frequent in OHCA at home (OR=0.38 [0.2–0.8]). 3. Subcutaneous emphysema was less frequent at home (OR=0.09 [0.01–0.48]. None of the other variableswas significantly linked to the occurrence of injury by CP. Conclusions: Chest injuries from CC performed with CP were frequent, and it was impossible to show their harmful effect on early patient outcome. A study should be conducted to compare the frequency and severity of lesions induced by CC performed by CP or no.