Effective Sea System and Case Studies

This report describes SEA (Strategic Environmental Assessment), and case studies demonstrating the merits of SEA in Europe and North America. The report is aimed at helping readers understanding and implementing SEA

Serum lactate in refractory out-of-hospital cardiac arrest:Post-hoc analysis of the Prague OHCA study

Background: The severity of tissue hypoxia is routinely assessed by serum lactate. We aimed to determine whether early lactate levels predict outcomes in refractory out-of-hospital cardiac arrest (OHCA) treated by conventional and extracorporeal cardiopulmonary resuscitation (ECPR). Methods: This study is a post-hoc analysis of a randomized Prague OHCA study (NCT01511666) assessing serum lactate levels in refractory OHCA treated by ECPR (the ECPR group) or conventional resuscitation with prehospital achieved return of spontaneous circulation (the ROSC group). Lactate concentrations measured on admission and every 4 hours (h) during the first 24 h were used to determine their relationship with the neurological outcome (the best Cerebral Performance Category score within 180 days post-cardiac arrest). Results:In the ECPR group (92 patients, median age 58.5 years, 83% male) 26% attained a favorable neurological outcome. In the ROSC group (82 patients, median age 55 years, 83% male) 59% achieved a favorable neurological outcome. In ECPR patients lactate concentrations could discriminate favorable outcome patients, but not consistently in the ROSC group. On admission, serum lactate &gt;14.0 mmol/L for ECPR (specificity 87.5%, sensitivity 54.4%) and &gt;10.8 mmol/L for the ROSC group (specificity 83%, sensitivity 41.2%) predicted an unfavorable outcome. Conclusion: In refractory OHCA serum lactate concentrations measured anytime during the first 24 h after admission to the hospital were found to correlate with the outcome in patients treated by ECPR but not in patients with prehospital ROSC. A single lactate measurement is not enough for a reliable outcome prediction and cannot be used alone to guide treatment.</p

Planning in tiers? Tiering as a way of linking SEA and EIA

The idea of tiering can be considered as one of the major drivers for the development of strategic environmental assessment (SEA) (see, for example, Thérivel et al, 1992; UNECE, 1992; Wood and Djeddour, 1992; The rivel and Partidário, 1996; Sadler and Verheem, 1996; Partidário, 1999; Fischer, 2002a; Wood, 2003). Many decisions that have a bearing on environmental quality are taken at a higher level of decision-making than the project level. As Partidário (1999, p60) indicates: ‘The reasons [for SEA] are various but initially related to the timing of project [environmental impact assessment] EIA, i.e. it enters the decision-making process at too late a stage to be able the final decision in a satisfactory way.’ Tiering means that, by preparing a sequence of environmental assessments (EAs) at different planning levels and linking them, foreclosure may be prevented, postponement of detailed issues may be permitted and assessments can be better scoped. A tiered approach minimizes the problem of EIA being only a ‘snapshot in time’. Accordingly, the European SEADirective (2001/42/EC) explicitly assumes tiering of SEAs and EIAs at different planning levels and the SEA and EIA Directives are directly linked