Etude rétrospective au sein du C.H.U. Saint-Pierre sur l’application de la recommandation d’hypothermie post arrêt cardiaque par fibrillation et tachycardie ventriculaire sans pouls (accès libre)
Implementation of the therapeutic hypothermia recommendation after resuscitated cardiac arrest caused by ventricular fibrillation and tachycardia without pulse : a retrospective study in Saint-Pierre Hospital (free access)
Introduction : L’hypothermie thérapeutique est une étape primordiale pour la protection neurologique des individus comateux après arrêt cardiorespiratoire (AC) et fibrillation ventriculaire (FV). L’évaluation de l’application du protocole s’y rapportant au sein du C.H.U. Saint-Pierre (HSP) est l’objet de cette étude. Méthode : Analyses rétrospectives des dossiers informatisés de l’HSP du 01/01/2005 au 31/12/2010 dont les critères d’inclusion sont les AC extrahospitaliers admis vivants à l’hôpital avec une FV comme premier rythme cardiaque. Les patients transférés ou étant en statut NTBR sont exclus. Résultats : Parmi les 72 patients étudiés, 68 % sont vivants à la sortie de l’hôpital dont 84 % ne présentent pas de séquelle neurologique. 44 personnes ont été mises en hypothermie dont 5 indûment, et 5 ne l’ont pas été alors que cela s’avérait nécessaire. L’hypothermie (32-34 °C) a été atteinte en 11 h 23 (± 144 min) et durait en moyenne 19 h 51 (± 249 min). La survie des patients hypothermiques s’élève à 72,4 %, dont 81 % avec bonne évolution neurologique. Conclusion : Les résultats de l’application du protocole sont supérieurs à ceux de plusieurs études. Peu d’erreurs d’inclusion et d’exclusion sont présentes. L’intérêt d’implémentation d’un protocole commun aux SI - urgences - SMUR pour accélérer l’obtention de la température cible et améliorer la performance est à suggérer. La création et la mise en place d’un registre spécifique aux patients ayant eu un AC et étant refroidis paraissent intéressantes et permettraient un meilleur suivi médical, une évaluation de la prise en charge et un accroissement des connaissances actuelles en rapport à cette technique. Rev Med Brux 2013 ; 34 : 79-86
Introduction : Therapeutic hypothermia is an essential step for the neurological protection of comatose individuals after cardiorespiratory arrest (CA) and ventricular fibrillation (VF). The evaluation of the application of the Protocol thereto within the C.H.U. Saint-Pierre (SPH) is the subject of this study. Method : Retrospective analyzes of the SPH computerized records from 01/01/2005 to 31/12/2010 whose inclusion criteria are out-ofhospital CA admitted alive to the hospital with VF as initial rythm. Transferred patients or NTBR status are excluded. Results : Of the 72 patients studied, 68 % were discharged alive from the hospital, 84 % of which has no neurologic sequelae. Hypothermia was used for 44 people, unduly in 5 cases and there were also 5 other cases for which it was needed, but not applied. Hypothermia (32-34 °C) was reached in 11 h 23 (± 144 min) and lasted an average of 19 h 51 (± 249 min). Hypothermic patient survival amounted to 72.4 %, including 81 % with good neurological outcome. Conclusion : The results of the protocol application are superior to those of several other studies. Few errors of inclusion and exclusion are present. The implementing of a common protocol for IC - Emergency Units - EMS to accelerate obtaining the target temperature and improve performance seems beneficial. The Introduction : Therapeutic hypothermia is an essential step for the neurological protection of comatose individuals after cardiorespiratory arrest (CA) and ventricular fibrillation (VF). The evaluation of the application of the Protocol thereto within the C.H.U. Saint-Pierre (SPH) is the subject of this study. Method : Retrospective analyzes of the SPH computerized records from 01/01/2005 to 31/12/2010 whose inclusion criteria are out-ofhospital CA admitted alive to the hospital with VF as initial rythm. Transferred patients or NTBR status are excluded. Results : Of the 72 patients studied, 68 % were discharged alive from the hospital, 84 % of which has no neurologic sequelae. Hypothermia was used for 44 people, unduly in 5 cases and there were also 5 other cases for which it was needed, but not applied. Hypothermia (32-34 °C) was reached in 11 h 23 (± 144 min) and lasted an average of 19 h 51 (± 249 min). Hypothermic patient survival amounted to 72.4 %, including 81 % with good neurological outcome. Conclusion : The results of the protocol application are superior to those of several other studies. Few errors of inclusion and exclusion are present. The implementing of a common protocol for IC - Emergency Units - EMS to accelerate obtaining the target temperature and improve performance seems beneficial. The creation and implementation of a specific register with patients who had AC and were cooled seem interesting for a better medical follow-up, an assessment of the management and an enhancement of the current knowledge related to this technique. Rev Med Brux 2013 ; 34 : 79-86