Cardiac arrest is a public health issue for which international guidelines are updated every five years (last bringing up to date on 2010 october). The lake of epidemiologic data on cardiac arrest justifies the building of a national register. French SAMU experienced registers especially in the field of acute coronary syndrom. Our national register "ReAC"is planned to deploy the present year for out-of-hospital cardiac arrest with the help of our scientific societies and the Department of Health. It is integrated in a program of evaluation and improvement of professional practices for physicians and prehospital teams who will be involved in its exhaustive use.

L’arrêt cardiaque en France : pourquoi un registre national ?

OBJECTIVE
This scoping review explores the structure and process-level strategies that are associated with medical retrieval outcomes. A secondary aim is to identify the range of medical retrieval outcomes used to assess the performance of remote retrieval services.


DESIGN
A scoping review of peer-reviewed literature from PubMed, CINAHL and the Web of Science was undertaken following guidelines set by the Johanna Briggs Institute manual for scoping reviews. All articles were assessed by two reviewers. Themes were derived inductively from the data extracted.


SETTING
Medical retrievals in sparsely populated remote locations in high-income countries.


PARTICIPANTS
Staff and clients of remote medical retrieval services.


INTERVENTIONS
Structures and processes (e.g. resource availability, retrieval staff structures and governance protocols) that aimed to improve medical retrieval outcomes.


OUTCOMES
Patient health outcomes and service efficiency.


RESULTS
Twenty-four articles were included. Three broad themes, related to the nature of the interventions, were included: optimising prehospital management of retrievals, staffing and resourcing of retrieval services and retrieval model evaluation. Mortality was the most frequently used outcome indicator in these studies, but was not measured consistently across studies.


CONCLUSIONS
This review highlights significant gaps in the literature that describes the structure and processes of retrieval models operating in remote areas and a dearth of literature evaluating specific operational strategies implemented within medical retrieval models. The available literature does not meaningfully assist with identifying key outcome indicators for developing a consistent monitoring and evaluation framework for retrieval services in geographically, culturally and demographically diverse remote contexts.

Optimising medical retrieval processes and outcomes in remote areas in high-income countries: A scoping review.

Relevance. To date, there are no clear criteria and optimal logistic conditions for the use of helicopters for the air medical evacuation of injured victims from the scene and from the emergency zone. Intention. To consider modern scientific views on the problem of using helicopters for air medical evacuation of victims from the place of injury. Methodology. PubMed database and eLIBRARY.ru platform were searched for publications from 2015 to 2020. Results and Discussion. The advantages of air ambulance evacuation by helicopters include shorter prehospital time, delivering victims from hard-to-reach areas directly to high-level trauma centers, and provision of extended prehospital care by highly qualified air medical teams. The use of helicopters is associated with risks to the life of the crew, requires significant financial costs and special equipment, and is limited by the lack of landing sites, weather conditions and at night. The effectiveness of the use of air ambulance helicopters depends on geographic and demographic factors, the level of injuries, the state of the road network in the region, the remoteness of ambulance stations, helicopter bases and trauma centers, the degree of interaction between rescue services and hospital specialists. Conclusion. The evacuation of casualties from the scene of the accident by helicopters of medical aviation can significantly reduce mortality in case of severe injuries.

/pdf/preimushchestva-i-nedostatki-ispolzovaniia-vertoletov-dlia-rpvosqrg8y.pdf

Преимущества и недостатки использования вертолетов для санитарно-авиационной эвакуации пострадавших с травмой (обзор литературы)

ST elevation myocardial infarction diagnoses have reduced in number over the past 10 years; however, associated morbidity and mortality remain high. Societal guidelines focus on early diagnosis and timely access to reperfusion, preferably percutaneous coronary intervention (PCI), with fibrinolytics reserved for those who cannot receive timely PCI. Proposed algorithms recommend emergency department bypass in stable patients with a clear diagnosis to reduced door-to-balloon time. Emergency providers should limit their evaluation, focusing on life-threatening comorbidities, unstable vitals, or contraindications to a catheterization laboratory. In-hospital patients prove diagnostically challenging because they may be unable to express symptoms, and reperfusion strategies can complicate other diagnoses.

Prehospital Evaluation, ED Management, Transfers, and Management of Inpatient STEMI.

• Most spinal trauma worldwide occurs in low-and middle-income countries (LMICs). Several factors may limit the applicability of current guidelines as regards the early management of spinal injury. • The pre-hospital management per se of spinal trauma in LMICs is subject to partial adherence to recommendations, with possible impact on patient outcomes. • The use of clinical (eg ASIA) and morphological (eg SLIC, TLICS, AO Spine) grading scales is not homogeneous. • The availability and cost of diagnostic equipment, and the timing of emergency imaging can vary significantly from one region to another, probably affecting the timely management of spinal injury patients. • The introduction of resource-targeted guidelines for spinal trauma may be a valuable option to overcome the limitations of real-life application of current guidelines. 

https://doi.org/10.1016/j.bas.2022.101185

A survey on the early management of spinal trauma in low and middle-income countries: From the scene of injury to the diagnostic phase (part II)

Prompt prehospital triage and transportation are essential in an organised trauma system. The benefits of helicopter transportation on mortality in a physician-staffed pre-hospital trauma system remains unknown. The aim of the study was to assess the impact of helicopter transportation on mortality and prehospital triage. Data collection was based on trauma registry for all consecutive major trauma patients transported by helicopter or ground ambulance in the Northern French Alps Trauma system between 2009 and 2017. The primary endpoint was in-hospital death. We performed multivariate logistic regression to compare death between helicopter and ground ambulance. Overall, 9458 major trauma patients were included. 37% (n = 3524) were transported by helicopter, and 56% (n = 5253) by ground ambulance. Prehospital time from the first call to the arrival at hospital was longer in the helicopter group compared to the ground ambulance group, respectively median time 95 [72–124] minutes and 85 [63–113] minutes (P < 0.001). Median transport time was similar between groups, 20 min [13–30] for helicopter and 21 min [14–32] for ground ambulance. Using multivariate logistic regression, helicopter was associated with reduced mortality compared to ground ambulance (adjusted OR 0.70; 95% CI, 0.53–0.92; P = 0.01) and with reduced undertriage (OR 0.69 95% CI, 0.60–0.80; P < 0.001). Helicopter was associated with reduced in-hospital death and undertriage by one third. It did not decrease prehospital and transport times in a system with the same crew using both helicopter or ground ambulance. The mortality and undertriage benefits observed suggest that the helicopter is the proper mode for long-distant transport to a regional trauma centre.

/pdf/association-of-helicopter-transportation-and-improved-3ybjvam1cj.pdf

Association of helicopter transportation and improved mortality for patients with major trauma in the northern French Alps trauma system: an observational study based on the TRENAU registry

Door-in to door-out times in acute ST-segment elevation myocardial infarction in emergency departments of non-interventional hospitals: A cohort study.

Interhospital transport of patients with COVID-19 under high-flow nasal cannula (HFNC).

Registre des arrêts cardiorespiratoires RENAU

At the start of the COVID-19 pandemic, early intubation was recommended on the basis of worldwide observations of severe hypoxemia. However, some patients were ultimately able to benefit from high-flow nasal cannula (HFNC) and thus avoid intubation. During the "second wave" (September to December 2020 in France), some emergency departments implemented HFNC in patients with severe COVID-19. The question then arose regarding the transfer of these most serious patients to intensive care units (ICU) and of the respiratory modalities to be used during this transfer. To assess the feasibility of interhospital transfers of COVID-19 patients needing HFNC, we conducted a bi-centric prospective observational study of all medical transfers of patients needing HFNC with the Chambery and Angers (France) mobile emergency and intensive care service (SMUR) during the "second wave" of the COVID-19 pandemic in France. Analysis of these 42 patients showed no significant variation in the respiratory requirements during the transfer. Overall, 52% of patients were intubated during their stay in ICU, including three patients intubated before or during transfer. Interhospital transfer with HFNC is very high-risk, and intubation remains indicated in the most unstable patients. However, 48% of patients benefited from HFNC and were thus able to avoid intubation during their transfer and ICU stay; for these patients, intubation would probably have been indicated in the absence of available HFNC techniques.

/pdf/interhospital-transfer-of-covid-19-patients-treated-with-2kynmo0y8r.pdf

Pascal Usseglio

Papers

Association of helicopter transportation and improved mortality for patients with major trauma in the northern French Alps trauma system: an observational study based on the TRENAU registry

Door-in to door-out times in acute ST-segment elevation myocardial infarction in emergency departments of non-interventional hospitals: A cohort study.

Interhospital transport of patients with COVID-19 under high-flow nasal cannula (HFNC).

Registre des arrêts cardiorespiratoires RENAU

Interhospital transfer of COVID-19 patients treated with high-flow nasal oxygen therapy