Prise en charge invasive des voies aériennes en médecine d'urgence préhospitalière (vers une optimisation des stratégies)

Notre objectif était d optimiser la prise en charge des voies aériennes en urgence pour aboutir à une diminution de la morbi-mortalité accompagnant l intubation. Notre travail a permis de fixer l incidence de l intubation difficile en urgence à 7,4% et d identifier les facteurs associés à cette intubation difficile. L utilisation d une lame plastique à usage unique a été associé à un plus faible taux de succès d intubation par rapport aux lames métalliques réutilisables (76% vs. 84% respectivement). La bougie d Eschmann comme aide pour une difficulté d intubation apparaît comme la technique de choix. Nous avons montré que l injection d un bolus d étomidate immédiatement après l intubation diminuait significativement les signes de réveil (p=0,03). Enfin, notre travail pourrait permettre de proposer un nouvel hypnotique pour l induction à séquence rapide. L ensemble des facteurs identifiés dans ce travail doit être pris en compte pour améliorer les pratiques des urgentistes lors de l intubation d un patient en détresse.We aimed to optimize the airway management in emergency setting to lead to a reduction in morbi-mortality accompanying intubation. Our work made it possible to fix the incidence of difficult intubation at 7.4% and to identify the factors associated with this difficult intubation. The intubation success rate is significantly lesser when a disposable plastic blade is used compared to the reusable metallic blade (76% vs. 84% respectively). The Eschmann bougie used in case of difficult intubation appears as the technique of choice. We showed also that an etomidate bolus given immediately after intubation decrease significantly the awakening signs (p=0.03). Finally, our work could propose a new hypnotic for the crush induction. The set of factors identified in this work must be taken into account to improve emergency physicians practices during the intubation of critically ill patients.PARIS13-BU Sciences (930792102) / SudocSudocFranceF

Stability of succinylcholine solutions stored at room temperature studied by nuclear magnetic resonance spectroscopy

The effect of storage temperature on the stability of two succinylcholine chloride solutions (20 and 50 mg/ml) was evaluated. Molecular composition was analysed using nuclear magnetic resonance spectroscopy. At room temperature, the degradation rate constant was 1.2%/month for the 20 mg/ml solution and 2.1%/month for the 50 mg/ml solution. The corresponding monthly degradation rates for the two solutions were 0.18% and 0.30% when stored at 4°C, and 5.4% and 8.1% when stored at 37°C. If a 10% loss of potency is considered acceptable, then the 20 and 50 mg/ml succinylcholine solutions can be stored in emergency resuscitation carts at room temperature for 8.3 and 4.8 months, respectively

0222: Public access defibrillators location strategy in major urban aeras using geographic optimization, is there an optimal number?

PurposeIn major cities, optimal distribution of automatic external defibrillators (AED) has long been debated. International guidelines recommended placing AED where at least an out-of-hospital cardiac arrest (OHCA) occurs every 2 years. However, bystander awareness of AED location is often limited. The aim of the study was to determine a potential strategic AED placement policy.MethodsWe included all OHCA managed in Paris by Emergency Medical Services between 2000 and 2010. First, we worked on different scenarios of regular AED placement according to several deployment distances (from 200 meters to 2000 meters), then we analyzed median distance between these AED potential placements and included OHCA. Second, we identified different types of public facilities in Paris and we calculated the median distance according to each type of public facilities. We evaluated the number needed of AED in each case.ResultsAmong the 4176 OHCA of presumed cardiac etiology, 1415 (34%) occurred out-of-home and 1355 were eventually geocoded (Figure). Median distances between OHCA and district councils (n=20), post offices (n=195), subway stations (n=302), bike sharing stations (n=957) and pharmacies (n=1466) were 1052, 324, 239, 137 and 142 meters respectively.ConclusionIncreasing number of AED following a regular distribution on the territory decreases drastically the median distance between AED potential placement and OHCA until a certain number (350 AED for Paris). Additional AED placement benefit becomes less apparent. AED public facilities coverage strategy may help to optimize AED placement. The choice of the best public facility should be based on its number and repartition on the territory and its proximity to OHCA.Abstract 0222 – Figur

Ultrasensitive Troponin I and Incident Cardiovascular Disease

BACKGROUND: To examine the association of ultrasensitive cTnI (cardiac troponin I) with incident cardiovascular disease events (CVDs) in the primary prevention setting. METHODS: cTnI was analyzed in the baseline plasma (2008-2012) of CVD-free volunteers from the Paris Prospective Study III using a novel ultrasensitive immunoassay (Simoa Troponin-I 2.0 Kit, Quanterix, Lexington) with a limit of detection of 0.013 pg/mL. Incident CVD hospitalizations (coronary heart disease, stroke, cardiac arrhythmias, deep venous thrombosis or pulmonary embolism, heart failure, or arterial aneurysm) were validated by critical review of the hospital records. Hazard ratios were estimated per log-transformed SD increase of cTnI in Cox models using age as the time scale. RESULTS: The study population includes 9503 participants (40% women) aged 59.6 (6.3) years. cTnI was detected in 99.6% of the participants (median value=0.63 pg/mL, interquartile range, 0.39-1.09). After a median follow-up of 8.34 years (interquartile range, 8.0-10.07), 516 participants suffered 612 events. In fully adjusted analysis, higher cTnI (per 1 SD increase of log cTnI) was significantly associated with CVD events combined (hazard ratio, 1.18 [1.08-1.30]). Among all single risk factors, cTnI had the highest discrimination capacity for incident CVD events (C index=0.6349). Adding log cTnI to the SCORE 2 (Systematic Coronary Risk Evaluation) risk improved moderately discriminatory capacity (C index 0.698 versus 0.685; bootstrapped C index difference: 0.0135 [95% CI, 0.0131-0.0138]), and reclassification of the participants (categorical net reclassification index, 0.0628 [95% CI, 0.023-0.102]). Findings were consistent using the US pooled cohort risk equation. CONCLUSIONS: Ultrasensitive cTnI is an independent marker of CVD events in the primary prevention setting