[Interhospital transport with extracorporeal life support: results and perspectives after 5 years experience]. / Transport interhospitalier sous extracorporeal life support : résultats et perspectives après cinq ans d'expérience.

OBJECTIVE: Describing the experience of a referral center for interhospital patients transport treated with extracorporeal circulatory or respiratory support (ECLS), the difficulties encountered and the results obtained. STUDY DESIGN: Retrospective and observational study. PATIENTS AND METHODS: All patients with respiratory or circulatory failure accepted for extracorporeal assistance for which routine medical transport was life threatening. STATISTICAL ANALYSIS: A descriptive analysis was performed (median and interquartile deviation). Comparison of biological data was performed using a non-parametric Wilcoxon test and 5 years overall survival was determined by a Kaplan-Meier analysis. RESULTS: Over a 55-month period, 29 patients were selected for transportation under ECMO or ECLS. Indication was respiratory failure in 38 % of cases, hemodynamic instability in 52 % of cases and combined symptoms in 10 % of cases. Average duration of transportation was 40 km (9-64 km). No complication related to transport was observed. Incidence of intrahospital death was 57 %. There was no correlation between death and indication of ECLS. Five-year survival was 55 % and 39 % for venovenous and arteriovenous ECLS, respectively. CONCLUSION: In our experience, interhospital transport of patients under ECMO is feasible in satisfactory conditions of safety with trained team and standard procedures.

[Refractory infectious ARDS: place of extracorporeal membrane oxygenation]. / SDRA infectieux réfractaire: place de l'oxygénation extracorporelle.

Acute respiratory distress syndrome (ARDS) is a frequent cause of admission in intensive care unit. The treatment is well codified. Unfortunately some patients die because of hypoxemia despite a well-conducted medical treatment. Extracorporeal oxygenation could be the ultimate treatment for these refractory hypoxemia patients. We report two cases of patients suffering from severe ARDS who beneficiated from extracorporeal oxygenation, pointing out the interest of this technique during severe ARDS as well as the accessibility and the feasibility of the technique even apart from a specialized center.

A comparison of repeated high doses and repeated standard doses of epinephrine for cardiac arrest outside the hospital. European Epinephrine Study Group.

BACKGROUND: Clinical trials have not shown a benefit of high doses of epinephrine in the management of cardiac arrest. We conducted a prospective, multicenter, randomized study comparing repeated high doses of epinephrine with repeated standard doses in cases of out-of-hospital cardiac arrest. METHODS: Adult patients who had cardiac arrest outside the hospital were enrolled if the cardiac rhythm continued to be ventricular fibrillation despite the administration of external electrical shocks, or if they had asystole or pulseless electrical activity at the time epinephrine was administered. We randomly assigned 3327 patients to receive up to 15 high doses (5 mg each) or standard doses (1 mg each) of epinephrine according to the current protocol for advanced cardiac life support. RESULTS: In the high-dose group, 40.4 percent of 1677 patients had a return of spontaneous circulation, as compared with 36.4 percent of 1650 patients in the standard-dose group (P=0.02); 26.5 percent of the patients in the high-dose group and 23.6 percent of those in the standard-dose group survived to be admitted to the hospital (P=0.05); 2.3 percent of the patients in the high-dose group and 2.8 percent in the standard-dose group survived to be discharged from the hospital (P=0.34). There was no significant difference in neurologic status according to treatment among those discharged. High-dose epinephrine improved the rate of successful resuscitation in patients with asystole, but not in those with ventricular fibrillation. CONCLUSIONS: In our study, long-term survival after cardiac arrest outside the hospital was no better with repeated high doses of epinephrine than with repeated standard doses.

[Electric burns: epidemiological and therapeutic aspects]. / Brûlures par électrisation: aspects épidémiologiques et thérapeutiques.

OBJECTIVES: A retrospective study of patients with electrical burns was conducted to choose criteria for initial dispatching and establish a treatment protocol for out patient management. METHODS: The study included 67 patients injured by electrical current and admitted at Edouard Herriot Hospital Burns Unit between January 1st 1990 and January 1st 1993. RESULTS: Low-voltage currents (< 1000 Volts) responsible for serious and immediate cardio-vascular diseases occurred in domestic accidents, mostly with children. High-voltage current (> 1000 Volts) responsible for deep burn injuries occurred in accidents at work and mostly with adults. Twenty-two were outpatients and 45 were admitted at once. Two died on admission, 24 were hospitalized less than five days, 11 required repeated surgical treatments and a long stay at hospital, and 8 were severely burned and were admitted to the intensive-care unit. Two required continuous venovenous hemodialysis for three weeks. Morbidity of the last three groups was nil, morbidity remained high in term of functional and aesthetic after-effects. CONCLUSION: Information on prevention of electrical burns should be intensified.

Standard doses versus repeated high doses of epinephrine in cardiac arrest outside the hospital.

Among all of the cathecolamines used for cardiac arrest treatment, epinephrine injection during cardio-pulmonary resuscitation is currently the most powerful means of enhancing effectiveness; however, deliberations about the optimal dosage have recently become intense. In the SAMU of Lyon (F), we conducted a double blind prospective randomized study over an 18-month period, comparing repeated standard-dose epinephrine (1 mg) and repeated high-dose epinephrine (5 mg) in the management of cardiac arrest outside the hospital. Five-hundred thirty-six patients were enrolled with 265 in the standard-dose group and 271 in the high-dose group; both groups are globally similar. One-hundred eighty-one (33.8%) patients returned to spontaneous circulation (R.O.S.C.); 85 in the standard-dose group (32%) and 96 in the high-dose group (35.5%). One-hundred nineteen patients (22.2%) were admitted; 54 in the standard-dose group (20.4%) and 65 in the high-dose group (24%). At 6 months nine patients (7.6%) were alive; three patients from the standard-dose group (5.5%) and six from the high-dose group (9.2%). We never noticed cardiac or neurologic adverse effects with the high doses. The results of this study are not statistically significant, but we observed a marginal trend towards repeated 5 mg epinephrine doses. A large French multicentre study is now necessary.