No abstract

All the main air pollutants, with the exception of ozone, were significantly associated with a near-term increase in MI risk.

Family presence during CPR was associated with positive results on psychological variables and did not interfere with medical efforts, increase stress in the health care team, or result in medicolegal conflicts. (Funded by Programme Hospitalier de Recherche Clinique 2008 of the French Ministry of Health; ClinicalTrials.gov number, NCT01009606.).

Background Atrial fibrillation (AF) is a common finding in patients with myocardial infarction (MI). AF is not generally perceived by clinicians as a critical event during the acute phase of MI; however, its prognostic influence in MI remains controversial. Furthermore, contradictory data exist concerning death risk according to AF timing. This systematic review and first meta-analysis aim to quantify the mortality risk associated with AF in MI patients and its timing. Methods and Results A comprehensive search of several electronic databases (1970–2010, adults, any language) identified MI studies that evaluated mortality related to AF. Evidence was reviewed by 2 blinded reviewers with a formal assessment of the methodological quality of the studies. Adjusted odds ratios (OR's) were pooled across studies using the random-effects model. The I2 statistic was used to assess heterogeneity. In the 43 included studies (278,854 subjects), the mortality OR's and 95% CI associated with AF was: 1.46 (1.35–1.58), I2=76%, 23 studies. This worse prognosis persisted regardless of the timing of AF; OR (95% CI, I2, n studies) of mortality for new AF with no prior history of AF was 1.37 (1.26–1.49), I2=28%, n=9; and for prior AF was 1.28 (1.16–1.40), I2=24%, n=4. The sensitivity analysis of new AF studies adjusting for confounding factors did not show a decrease in death risk. Conclusions AF is associated with increased risk of mortality in MI patients. New AF with no history of AF prior to MI remained associated with an increased risk of mortality even after adjusting for several important AF risk factors. These subsequent increases in mortality suggest that AF can no longer be considered as a non severe event during MI.

Background Atrial fibrillation (AF) often coexists with myocardial infarction (MI), yet its prognostic influence is controversial. Prior reports studied the role of AF during the early hospitalization for acute MI on the risk of death and could not address the timing of AF in relation to the MI (i.e. prior, during, post). Further, as data come mostly from clinical trials, their applicability to the community is uncertain. The aims of our study were to assess the occurrence of AF among MI patients, determine whether it has changed over time, and quantify its impact and the impact of its timing on mortality after MI. Methods and Results This was a community-based cohort of 3220 patients hospitalized with incident (first-ever) MI from 1983 to 2007 in Olmsted County, Minnesota. AF was identified by diagnostic codes and ECG. Outcomes were all-cause and cardiovascular death. AF prior to MI was identified in 304 patients and 729 developed AF after MI (218 (30%) within 2 days, 119 (16%) between 3 and 30 days, and 392 (54%) >30 days post-MI). The cumulative incidence of AF after MI at 5 years was 19% and did not change over calendar year of MI. During a mean follow-up of 6.6 years, 1638 deaths occurred. AF was associated with an increased risk of death (HR (95% CI) 3.77 (3.37–4.21)), independently of clinical characteristics at the time of MI and heart failure. This risk differed markedly according to the timing of AF and was the greatest for AF occurring >30 days post-MI (HR (95% CI) 1.63 (1.37–1.93) for AF within 2 days, 1.81 (.45–2.27) for AF between 3 and 30 days, and 2.58 (2.21–3.00) for AF > 30 days post MI). Conclusions In the community, AF is frequent in the setting of MI. AF carries an excess risk of death, which is the highest for AF developing more than 30 days post-MI.

clinicaltrials.gov Identifier: NCT02327026.

Aims Out-of-hospital cardiac arrest (OHCA) without return of spontaneous circulation (ROSC) despite conventional resuscitation is common and has poor outcomes. Adding extracorporeal membrane oxygenation (ECMO) to cardiopulmonary resuscitation (extracorporeal-CPR) is increasingly used in an attempt to improve outcomes. Methods and results We analysed a prospective registry of 13 191 OHCAs in the Paris region from May 2011 to January 2018. We compared survival at hospital discharge with and without extracorporeal-CPR and identified factors associated with survival in patients given extracorporeal-CPR. Survival was 8% in 525 patients given extracorporeal-CPR and 9% in 12 666 patients given conventional-CPR (P = 0.91). By adjusted multivariate analysis, extracorporeal-CPR was not associated with hospital survival [odds ratio (OR), 1.3; 95% confidence interval (95% CI), 0.8–2.1; P = 0.24]. By conditional logistic regression with matching on a propensity score (including age, sex, occurrence at home, bystander CPR, initial rhythm, collapse-to-CPR time, duration of resuscitation, and ROSC), similar results were found (OR, 0.8; 95% CI, 0.5–1.3; P = 0.41). In the extracorporeal-CPR group, factors associated with hospital survival were initial shockable rhythm (OR, 3.9; 95% CI, 1.5–10.3; P = 0.005), transient ROSC before ECMO (OR, 2.3; 95% CI, 1.1–4.7; P = 0.03), and prehospital ECMO implantation (OR, 2.9; 95% CI, 1.5–5.9; P = 0.002). Conclusions In a population-based registry, 4% of OHCAs were treated with extracorporeal-CPR, which was not associated with increased hospital survival. Early ECMO implantation may improve outcomes. The initial rhythm and ROSC may help select patients for extracorporeal-CPR.

Background: Difficult intubation management algorithms have proven efficacy in operating rooms but have rarely been assessed in a prehospital emergency setting. We undertook a prospective evaluation of a simple prehospital difficult intubation algorithm. Methods: All of our prehospital emergency physicians and nurse anesthetists were asked to adhere to a simple algorithm in all cases of impossible laryngoscope-assisted tracheal intubation. They received a short refresher course and training in the use of the gum elastic bougie (GEB) and the intubating laryngeal mask airway (ILMA), which were techniques to be used as a first and a second step, respectively. In cases of difficult ventilation with arterial desaturation, IMLA was to be used first. Cricothyroidotomy was the ultimate rescue technique when ventilation through ILMA failed. Patient characteristics, adherence to the algorithm, management efficacy, and early complications were recorded (August 2005-December 2009).