Prehospital Lyophilized Plasma Transfusion for Trauma-Induced Coagulopathy in Patients at Risk for Hemorrhagic Shock: A Randomized Clinical Trial.

Importance: Blood transfusion is a mainstay of therapy for trauma-induced coagulopathy, but the optimal modalities for plasma transfusion in the prehospital setting remain to be defined. Objective: To determine whether lyophilized plasma transfusion can reduce the incidence of trauma-induced coagulopathy compared with standard care consisting of normal saline infusion. Design, Setting, and Participants: This randomized clinical trial was performed at multiple centers in France involving prehospital medical teams. Participants included 150 adults with trauma who were at risk for hemorrhagic shock and associated coagulopathy between April 1, 2016, and September 30, 2019, with a 28-day follow-up. Data were analyzed from November 1, 2019, to July 1, 2020. Intervention: Patients were randomized in a 1:1 ratio to receive either plasma or standard care with normal saline infusion (control). Main Outcomes and Measures: The primary outcome was the international normalized ratio (INR) on arrival at the hospital. Secondary outcomes included the need for massive transfusion and 30-day survival. As a safety outcome, prespecified adverse events included thrombosis, transfusion-related acute lung injury, and transfusion-associated circulatory overload. Results: Among 150 randomized patients, 134 were included in the analysis (median age, 34 [IQR, 26-49] years; 110 men [82.1%]), with 68 in the plasma group and 66 in the control group. Median INR values were 1.21 (IQR, 1.12-1.49) in the plasma group and 1.20 (IQR, 1.10-1.39) in the control group (median difference, -0.01 [IQR, -0.09 to 0.08]; P = .88). The groups did not differ significantly in the need for massive transfusion (7 [10.3%] vs 4 [6.1%]; relative risk, 1.78 [95% CI, 0.42-8.68]; P = .37) or 30-day survival (hazard ratio for death, 1.07 [95% CI, 0.44-2.61]; P = .89). In the full intention-to-treat population (n = 150), the groups did not differ in the rates of any of the prespecified adverse events. Conclusions and Relevance: In this randomized clinical trial including severely injured patients at risk for hemorrhagic shock and associated coagulopathy, prehospital transfusion of lyophilized plasma was not associated with significant differences in INR values vs standard care with normal saline infusion. Nevertheless, these findings show that lyophilized plasma transfusion is a feasible and safe procedure for this patient population. Trial Registration: ClinicalTrials.gov Identifier: NCT02736812.

Diagnostic value of pleural ultrasound to refine endotracheal tube placement in pediatric intensive care unit.

AIM: To assess the diagnostic performance of a simplified lung point-of-care ultrasound (POCUS) to confirm the correct positioning of an endotracheal tube (ETT) in a pediatric intensive care unit (PICU) used to chest radiography (CXR), and to compare the time to obtain the ETT position between POCUS and CXR. METHODS: We conducted a single-center prospective study in critically ill children requiring urgent endotracheal intubation. Esophageal tube malposition was first avoided using auscultation and end-tidal CO2. The ETT position was assessed with CXR and lung POCUS using the lung sliding sign on a pleural window. All of the investigators had to read guidelines and received 1-h training on the technical aspects of lung sliding. The primary objective was the accuracy of POCUS in confirming correct nonselective endotracheal intubation as compared with CXR. RESULTS: A total of 71 patients were included from December 2016 to November 2018. CXR identified proper nonselective ETT placement in 43 of 71 (61%) patients, while the rate for selective intubation was 39%. The sensitivity and specificity of POCUS as compared with CXR were 77% and 68%, respectively. Median time to POCUS was significantly shorter than CXR (2 min to perform POCUS, 10 min to obtain radiographs, p<10-4). CONCLUSION: Pleural ultrasound, although faster than CXR, appears to be inadequate for identifying selective ETT after urgent intubation in a PICU less accustomed to this kind of ultrasound. In this heterogeneous and fragile population, timely POCUS may remain useful at the bedside as compared with auscultation, aiming at guiding optimal ETT placement and reducing respiratory complications, provided by trained physicians.

Lead contamination among Paris Fire Brigade firefighters who fought the Notre Dame Cathedral fire in Paris.

BACKGROUND: On 15th April 2019, the fire at Notre Dame Cathedral, Paris, resulted in the melting of 410 tons of lead. Four hundred fourteen Paris firefighters were involved. For the purpose of preventive medicine, the level of lead contamination among the firefighters was assessed. This study objectives' were to describe the blood lead levels (BLLs) in the firefighters, to study the influence of some parameters such as the function of firefighters and the decrease in BLLs during the follow-up investigations. METHODS: The emission of 138 kg of melted lead from the roof and spire of the Notre Dame Cathedral during the fire was estimated by the National Institute for Industrial Environment and Risks. Three categories were defined according to the estimated levels of external lead exposure and fire proximity: high (category 1, n = 170), medium (category 2, n = 151), and low (category 3, n = 93). Two to three weeks after the fire, blood samples to assess the BLLs were taken from firefighters in category 1 (N = 164) and from every female firefighter in category 1 and 2 (N = 4). When the BLL was above 50 µg/L (95th percentile of reference range concentrations for a sample of the French population), it was checked again at one month later (N = 31) and then, if still above 50 µg/L, at six months later (N = 10). RESULTS: The geometric mean of initial blood lead level was 31.5 µg/L (CI 95% [27.7-35.9]; Min-Max: 7.0-307.6 µg/L). Twenty-five percent (n = 42) of initial BLLs were above 50 µg/L, versus 10% (n = 16) at 1 month, and 2% (n = 3) at 6 months. The French binding biological BLL limit value (400 µg/L for men and 300 µg/L for women was never exceeded and all BLLs decreased over time. BLLs varied according to the function occupied during the extinguishing of the fire: operators', officers' and those of unknown function. BLLs were significantly higher compared to drivers reflecting their lower distance to fire and fume. CONCLUSIONS: The fire at Notre Dame Cathedral, Paris, resulted in moderate lead contamination among firefighters. Individual and collective protection measures probably helped to limit the contamination. Nevertheless, an effort could be made to improve the working conditions by rethinking the respiratory protection.

[Conductive hearing loss with a normal eardrum]. / Surdité de transmission à tympan normal.

Conductive hearing loss with a normal eardrum. Conductive hearing loss with a normal eardrum is defined by a hearing loss in in relation to a disturbance in the transmission of sound waves from a normal eardrum to an intact cochlear nerve. The interest in diagnosing these kinds of hearing loss is due on the one hand to their high frequency, on the other hand to the socio-professional repercussions that they can induce and finally to the fact that a large part of them are accessible to surgical treatment or, hearing aid. The CT-scan contributes to the diagnostic orientation and the preoperative assessment. If the pathologies of the middle ear dominate in frequency the possible causes of conductive hearing loss with a normal eardrum, especially otosclerosis, abnormalities of the inner ear, which can be responsible for conductive or mixed hearing loss, have recently listed thanks to advances in modern digital imaging. After a brief anatomical reminder of the tympano-ossicular system, we will deal with their positive, differential and etiological diagnosis.

Surdité de transmission à tympan normal. Les surdités de transmission à tympan normal sont définies par une diminution de la capacité auditive en relation avec une perturbation de transmission de l'onde sonore depuis un tympan normal jusqu'à un nerf cochléaire intègre. L'intérêt de diagnostiquer ces surdités tient d'une part à leur grande fréquence, d'autre part au retentissement socioprofessionnel qu'elles peuvent induire, et enfin au fait qu'une grande partie d'entre elles sont accessibles à un traitement chirurgical, ou à défaut prothétique. La tomodensitométrie contribue à l'orientation diagnostique et au bilan préopératoire. Si les pathologies de l'oreille moyenne dominent en fréquence les causes possibles de surdité de transmission à tympan normal, avec en tête l'otospongiose, des anomalies de l'oreille interne, pouvant être responsables de surdité de transmission ou de surdité mixte, ont été récemment répertoriées grâce aux progrès de l'imagerie numérique moderne.

Mobile Smartphone Technology Is Associated With Out-of-hospital Cardiac Arrest Survival Improvement: The First Year "Greater Paris Fire Brigade" Experience.

BACKGROUND: Out-of-hospital cardiac arrest (OHCA) remains associated with very high mortality. Accelerating the initiation of efficient cardiopulmonary resuscitation (CPR) is widely perceived as key to improving outcomes. The main goal was to determine whether identification and activation of nearby first responders through a smartphone application named Staying Alive (SA) can improve survival following OHCA in a large urban area (Paris). METHODS: We conducted a nonrandomized cohort study of all adults with OHCA managed by the Greater Paris Fire Brigade during 2018, irrespective of mobile application usage. We compared survival data in cases where SA did or did not lead to the activation of nearby first responders. During dispatch, calls for OHCA were managed with or without SA. The intervention group included all cases where nearby first responders were successfully identified by SA and actively contributed to CPR. The control group included all other cases. We compared survival at hospital discharge between the intervention and control groups. We analyzed patient data, CPR metrics, and first responders' characteristics. RESULTS: Approximately 4,107 OHCA cases were recorded in 2018. Among those, 320 patients were in the control group, whereas 46 patients, in the intervention group, received first responder-initiated CPR. After adjustment for confounders, survival at hospital discharge was significantly improved for patients in the intervention group (35% vs. 16%, adjusted odds ratio = 5.9, 95% confidence interval = 2.1 to 16.5, p < 0.001). All CPR metrics were improved in the intervention group. CONCLUSIONS: We report that mobile smartphone technology was associated with OHCA survival through accelerated initiation of efficient CPR by first responders in a large urban area.

Presbycusis and Fitness to Fly.

BACKGROUND: When a pilot is referred for presbycusis, his flight fitness may be questionable. The objective of this retrospective study was to describe a case series of presbycusis in a pilot population and to discuss the decisions about their flight waivers.METHODS: There were 19 pilots who were referred to the ENT-Head and Neck Surgery Department of the National Pilot Expertise Center. Their medical files were retrospectively examined.RESULTS: Of the 19 patients, 5 did not obtain flight fitness waivers. Among the 14 who received waivers, 7 had no restrictions on their flight fitness.DISCUSSION: Flight fitness was based on the maximum percentage of speech recognition and the slope of the curve for speech recognition in speech audiometry in noise and the follow-up of these findings. The results made it possible to determine a patient's fitness to fly with a waiver, which may be associated with restrictions. In our series, only 5 pilots out of 19 did not obtain a flight fitness waiver. The few published studies on the resumption of flight for patients who had presbycusis and our experience in France with similar waivers in commercial and military aviation suggest that under certain conditions and after relevant cochlear assessment, presbycusis may allow for a safe pursuit of aviation activity.Ballivet de Régloix S, Genestier L, Maurin O, Marty S, Crambert A, Pons Y. Presbycusis and fitness to fly. Aerosp Med Hum Perform. 2020; 91(5):403-408.

French lyophilized plasma versus normal saline for post-traumatic coagulopathy prevention and correction: PREHO-PLYO protocol for a multicenter randomized controlled clinical trial.

BACKGROUND: Post-trauma bleeding induces an acute deficiency in clotting factors, which promotes bleeding and hemorrhagic shock. However, early plasma administration may reduce the severity of trauma-induced coagulopathy (TIC). Unlike fresh frozen plasma, which requires specific hospital logistics, French lyophilized plasma (FLYP) is storable at room temperature and compatible with all blood types, supporting its use in prehospital emergency care. We aim to test the hypothesis that by attenuating TIC, FLYP administered by prehospital emergency physicians would benefit the severely injured civilian patient at risk for hemorrhagic shock. METHODS/DESIGN: This multicenter randomized clinical trial will include adults severely injured and at risk for hemorrhagic shock, with a systolic blood pressure < 70 mmHg or a Shock Index > 1.1. Two parallel groups of 70 patients will receive either FLYP or normal saline in addition to usual treatment. The primary endpoint is the International Normalized Ratio (INR) at hospital admission. Secondary endpoints are transfusion requirement, length of stay in the intensive care unit, survival rate at day 30, usability and safety related to FLYP use, and other biological coagulation parameters. CONCLUSION: With this trial, we aim to confirm the efficacy of FLYP in TIC and its safety in civilian prehospital care. The study results will contribute to optimizing guidelines for treating hemorrhagic shock in civilian settings. TRIAL REGISTRATION: ClinicalTrials.gov, NCT02736812. Registered on 13 April 2016. The trial protocol has been approved by the French ethics committee (CPP 3342) and the French Agency for the Safety of Medicines and Health Products (IDRCB 2015-A00866-43).

[Congenital cysts and fistulas on the neck in adults]. / Kystes et fistules congenitaux du cou chez l'adulte.

Cervical congenital malformations are relatively common in children. They can also be found in adults. The embryological development of the cervical region is closely related to the branchial clefts. This must be a diagnosis made by elimination; a cervical tumor must evoke the diagnosis of cancer. A cutaneous fistula or a cervical tumor, chronic or recent appearance in an inflammatory context, are the clinical signs. The thyroglossal duct cysts and the second branchial clefts cysts are the most common causes of median and lateral cervical cysts, respectively. Imaging contributes greatly to the orientation and diagnostic evaluation of the extent of the lesions. Treatment is initially based on antibiotic therapy and then on complete surgical excision, away from an infectious episode, the sole guarantee for the absence of local recurrence.

Maternal out-of-hospital cardiac arrest: A retrospective observational study.

AIM: Out-of-hospital cardiac arrests (OHCAs) in pregnant women are rare events. In this study, we aimed to describe a cohort of pregnant women who experienced OHCAs in a large urban area, and received treatment by the prehospital teams in a two-tiered emergency response system. METHODS: This retrospective study included pregnant women over 18 years of age who experienced OHCAs. The analysed variables included maternal age, gestational age, variables specific to the rescue system, number of shocks delivered by an automatic external defibrillator, and rates of maternal and neonatal survival. RESULTS: Over the 5-year study period, 19,515 OHCAs occurred, 16 of which were in pregnant women. These 16 patients had a median age of 31 years [interquartile range (IQR): 28-35] and a median gestational age of 20 weeks [IQR: 10-33]. Three patients (18.8%) had an initial rhythm of ventricular fibrillation. Only one patient underwent thrombolysis. Of the 16 patients, 6 (38%) died after resuscitation on the scene. The remaining 10 were transported to the hospital, of whom 5 achieved circulation through a mechanical CPR device. Only 2 patients were alive 30days after OHCA. CONCLUSIONS: Over half of the pregnant women who experienced OHCA were at least 20 weeks pregnant. Analysis of the prehospital medical data suggests that the current recommendations are difficult to apply in an out-of-hospital environment. Specific recommendations for this situation must be developed.

[Carbon monoxide poisoning, treatment and orientation]. / Intoxication au monoxyde de carbone, prise en charge et orientation.

Colourless and odourless, each year carbon monoxide is responsible for several thousand cases of poisoning. Often collective, their symptoms are non specific and can result in serious neurological sequelae or even death, if they are not detected in time. The (pre-) hospital emergency nurse plays an important role in the management of these patients, in terms of assessment, treatment and monitoring as well as the organisation of the admittance of victims, categorisation and medical triage. As part of a team, the nurse ensures that the patient enters an adapted, regulated pathway, with the most serious cases being directed towards a hospital equipped with a hyperbaric medicine facility.

Early Tympanoplasty Using a Synthetic Biomembrane for Military-Related Blast Induced Large Tympanic Membrane Perforation.

Introduction: Blast injuries in modern warfare are common, and tympanic perforation is often found. Spontaneous closures of large perforations that encompass greater than 80% of the tympanic surface are rare. Early closure of the tympanic membrane avoids the immediate infectious risk, which potentially complicates the initial management of these war-wounded patients, and allows for safe and early recovery of military activity. This study compared the outcomes of spontaneous closures and early biomembrane myringoplasty in subjects with large blast injury-induced tympanic perforation following a massive explosion. Materials and Methods: This is a retrospective, observational, cohort study military troops with large barotraumatic tympanic membrane perforation. The study investigates early surgical tympanoplasty versus observation for spontaneous closure. The hearing loss, tympanic perforation closure rate, and closure time were noted. Results: Fourteen patients (19 ears) were referred from May 2008 to April 2017, and 6 patients (9 ears) underwent early myringoplasty. A total of 89% (n = 8) and 100% (n = 9) of the ears exhibited successful sealing of the perforation at one and 6 mo, respectively. In contrast, 60% (n = 6) of the 10 ears (8 patients) without initial myringoplasty did not heal spontaneously at 6 mo, and these ears underwent a delayed tympanoplasty procedure. Notably, patients with early myringoplasty suffered lower conductive hearing loss and fewer functional signs remotely. Conclusion: Early myringoplasty using a biomembrane for blast injury-induced large tympanic perforation is a fast and minimally invasive method to achieve earlier tympanic closure and a higher closure rate for safe recovery of activity. It can be performed under general anesthesia concurrently with surgery for additional body-wide trauma. The deployment of ENT surgeons on the battlefield in the French Army has enabled early management of these patients.

[Electrocardiograms: derived derivations!] / Électrocardiogramme : la dérive des dérivations !

Simple and non-invasive, the electrocardiogram is a basic examination for studying how the cardiac muscle functions. Very commonly used, it nonetheless requires great rigour when applying the electrodes to avoid false results that can be harmful to appropriate care for the patient. A reminder of good practices.

Fishbones in the Upper Aerodigestive Tract: A Review of 24 Cases of Adult Patients.

INTRODUCTION: We present a retrospective study series and discussion of the current literature to discuss the management of fishbones in the upper aerodigestive tract. MATERIALS AND METHODS: From January 2013 to July 2016, all patients referred to our referral center because of a fishbone in the upper aerodigestive tract were analysed. RESULTS: Of the 24 patients, 95% of them reported discomfort in the throat. It was noted that 58% of physical examinations and nasofibroscopy results were normal. Ten fishbones were found in the upper aerodigestive tract. They were removed by foreign body forceps or by endoscopy depending on the location. Foreign body-related complications were not observed. Ten patients with no identifiable fishbone had no symptoms after 48 hours. Other patients, including the 10 patients with the fishbone removed, were asymptomatic after 10 days. CONCLUSION: From our experience, we recommend a systematic nasofibroscopy. If it is normal, the patient is assessed at 48h. The complementary investigation by CT scan and/or oesophagoscopy must be reserved in cases of suspicion of oesophageal localization or complication. Otherwise, rigid or flexible endoscopy may be performed when laryngoscopy is unsuccessful or for the treatment of foreign bodies lodged below this area.

[Complications of sinusitis]. / Complications des sinusites.

The complications of sinusitis are essentially secondary to ethmoidal and frontal sinusitis, occurring in patients weakened, particularly in case of immunodeficiency or anatomical defects. The gravity is due to the risk of spreading infection in intracranial tissues and orbital cavity. The diagnosis is always to discuss any symptomatology resistant to treatment and the appearance of orbital or neurological signs. The scanner and MRI contribute greatly to the orientation and diagnostic evaluation of the extent of the lesions. Treatment is based on prolonged antibiotic therapy and surgery and requires a multidisciplinary approach involving ENT, ophthalmologist, neurosurgeon and anesthesiologist resuscitator.

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.

Facial Nerve Monitoring During Parotidectomy:A Two-Center Retrospective Study.

INTRODUCTION: We present a retrospective two-center study series and discussion of the current literature to assess the benefits of facial nerve monitoring during parotidectomy. MATERIALS AND METHODS: From 2007 to 2012, 128 parotidectomies were performed in 125 patients. Of these, 47 procedures were performed without facial nerve monitoring (group 1) and 81 with facial nerve monitoring (group 2). The primary endpoint was the House-Brackmann classification at 1 month and 6 months. Facial palsy was determined when the House-Brackmann grade was 3 or higher. RESULTS: In group 1, 15 facial palsies were noted; 8 were transient and 7 were definitive. In group 2, 19 facial palsies were noted; 12 were transient and 7 were definitive. At both one and six months after parotidectomy, the rate of facial palsy in reoperation cases was significantly higher in group 1 than in group 2. CONCLUSION: Facial nerve monitoring is a simple, effective adjunct method that is available to surgeons to assist with the functional preservation of the facial nerve during parotid surgery. Although it does not improve the facial prognosis in first-line surgery, it does improve the facial prognosis in reoperations.

Comparison of Penetrating Neck Injury Management in Combat Versus Civilian Trauma: A Review of 55 Cases.

UNLABELLED: The objective was to describe a case series of penetrating neck injuries (PNIs) and compare their management in combat versus civilian trauma. METHODS: From 2012 to 2014, all soldiers and civilians referred to Percy Military Training Hospital for PNI were analyzed. The mechanism of injury, type and site of the lesion, and initial emergency management were noted. RESULTS: Among the 55 patients, 26 were wounded in action, and 29 were civilians. PNIs were commonly stab wounds resulting from an assault. Anatomical zone II, as well as the central neck compartment, was the most affected area. The most affected organ was the larynx. 74% of patients underwent computed tomography angiography (CTA), surgical exploration was performed for 42% of patients, and 33% of patients required intensive care unit monitoring. The differences between the two groups in terms of management were not statistically significant. CONCLUSIONS: The current management is based on clinical examination and CTA and is similar between soldiers and civilians. Surgical exploration is less commonly used than CTA, which is a fast and accurate method to evaluate PNI for stable patients. The classification by compartment seems more relevant than the classification by anatomical zone, particularly in absence of medical imaging.

Laboratory study on the kinetics of the warming of cold fluids-A hot topic.

OBJECTIVES: In case of mild therapeutic hypothermia after an out-of-hospital cardiac arrest, several techniques could limit the cold fluid rewarming during its perfusion. We aimed to evaluate cold fluid temperature evolution and to identify the factors responsible for rewarming in order to suggest a prediction model of temperature evolution. EQUIPMENT AND METHODS: This was a laboratory experimental study. We measured temperature at the end of the infusion line tubes (ILT). A 500ml saline bag at 4°C was administered at 15 and 30ml/min, with and without cold packs applied to the cold fluid bag or to the ILT. Cold fluid temperature was integrated in a linear mixed model. Then we performed a mathematical modelization of the thermal transfer across the ILT. RESULTS: The linear mixed model showed that the mean temperature of the cold fluid was 1°C higher (CI 95%: [0.8-1.2]) with an outflow rate of 15 versus 30ml/min (P<0.001). Similarly, the mean temperature of the cold fluid was 0.7°C higher (CI 95%: [0.53-0.9]) without cold pack versus with cold packs (P<0.001). Mathematical modelization of the thermal transfer across the ILT suggested that the cold fluid warming could be reduced by a shorter and a wider ILT. As expected, use of CP has also a noticeable influence on warning reduction. The combination of multiple parameters working against the rewarming of the solution should enable the infusion of a solute with retained caloric properties. CONCLUSIONS: By limiting this "ILT effect," the volume required for inducing mild therapeutic hypothermia could be reduced, leading to a safer and a more efficient treatment.

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

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 2(TM), 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 2(TM) 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.