BACKGROUND:The aim of the DESAC study (Devenir des Survivants d'Arrets Cardiaques) was to describe the survival rate and neurological status of out-of-hospital (out-of-hospital cardiac arrest) survivors, and to assess the influence of prehospital and intrahospital factors. METHODS:Between July 2015 and October 2018, consecutive nontraumatic out-of-hospital cardiac arrest patients aged over 18 years discharged alive from 33 intensive care units in Paris and the suburbs (France) were included. Their neurological status was assessed every 6 months using the Cerebral Performance Category (CPC) scale. Prognostic factors associated with a favorable neurological outcome at 24 months (CPC category of 1 or 2) were assessed by covariate-adjusted logistic regression. Trajectories of CPC level over time were derived using a linear mixed model in survivors with at least 3 repeated assessments. RESULTS:Out of 593 survivors, 525 were followed up for 24 months (mean age, 58.1±15.3 years, 79% males), and 449 of 525 (86%) had a favorable neurological outcome. Initial shockable rhythm (adjusted odds ratio, 3.33 [95% CI, 1.57-7.07]) and previous practice of sport (adjusted odds ratio, 3.13 [95% CI, 1.21-8.12]) were associated with favorable outcome, whereas factors with reduced odds ratio were older age (adjusted odds ratio per 10 years, 0.53 [95% CI, 0.41-0.69]) and prior percutaneous coronary intervention (adjusted odds ratio, 0.38 [95% CI, 0.17-0.85]). Therapeutic hypothermia or acute coronary interventions were not related to prognosis (P>0.05). Overall, among the 514 patients with at least 3 repeated assessments, 5 distinct CPC trajectories (2 reflecting early death were combined) were derived: 64% remained in CPC1, 13.4% in CPC2, 11% improved from CPC2 to CPC1, and 11.6% died either early or lately (>3 months) during follow-up. CONCLUSIONS:This multicentric prospective study indicates that 86% of out-of-hospital cardiac arrest survivors had a favorable neurological outcome at 24 months. Pre-event and intraevent factors (including previous practice of sport and shockable rhythm), but not in-hospital management (therapeutic hypothermia or acute coronary interventions), were associated with a favorable outcome. REGISTRATION:URL: https://www.clinicaltrials.gov; Unique identifier: NCT02494414.
BACKGROUND:Out-of-hospital cardiac arrest is a major public health challenge in France, with approximately 46,000 cases per year and survival rates ranging from 4 to 10%. Early prehospital management is a key determinant of vital and neurological prognosis. METHODS:Single-center, retrospective, observational study including 100 patients managed by the mobile intensive care unit of Melun General Hospital between January 2021 and September 2025. Neurological outcome was assessed using the Cerebral Performance Category score. Bivariate analysis and multivariate logistic regression were performed to identify factors associated with in-hospital survival. Numerical variables are reported as median [quartile1-quartile 3]. RESULTS:Median age was 66 years [54.5-73], with 59% male patients. Cardiac arrest occurred at home in 78% of cases. Bystander cardiopulmonary resuscitation was initiated in 80% of cases; public automated external defibrillator use remained marginal (9%). Median no-flow duration was 3minutes [1-8.5] and median low-flow duration was 20minutes [13-30]. Asystole was the initial rhythm in 76% of cases. In-hospital survival was 20%. Multivariate analysis showed that shorter no-flow and low-flow intervals were independently associated with survival. Bystander intervention was not significant after adjustment. CONCLUSION:Prehospital time intervals, especially no-flow duration, are the primary determinants of survival after out-of-hospital cardiac arrest. Strengthening public training in basic life support and improving automated external defibrillator accessibility are priority targets to improve outcomes.
Ergonomic conditions during ultrasound procedures may influence both acquisition time and image quality. In transcranial Doppler, positioning at the patient’s head could improve operator comfort and performance. This study aimed to evaluate whether a standardized seated position at the patient’s head enables faster acquisition of interpretable images and could improve image quality. We conducted a multicenter randomized controlled trial between August and December 2024 including emergency medicine residents without prior training in transcranial Doppler. Participants were randomized to either a free positioning group or a standardized seated position at the patient’s head. Each participant performed bilateral acquisitions of the middle cerebral artery. Acquisition time was recorded, and image quality was assessed blindly by an expert panel using a semi-quantitative scale. Forty-four residents were included, yielding 88 measurements (46 in the intervention group and 42 in the control group). Baseline characteristics were similar except for a higher number of validated semesters in the intervention group. Mean acquisition time was shorter in the intervention group (99.4 ± 47.1 s) than in the control group (121.7 ± 52.9 s), with a mean difference of 22.3 s (95
Whether the use of inhaled or intravenous sedation affects outcomes differentially in mechanically ventilated adults with acute respiratory distress syndrome (ARDS) is unknown. To determine the efficacy and safety of inhaled sevoflurane compared with intravenous propofol for sedation in patients with ARDS. Phase 3 randomized, open-label, assessor-blinded clinical trial conducted from May 2020 to October 2023 with 90-day follow-up. Adults with early moderate to severe ARDS (defined by a ratio of Pao2 to the fraction of inspired oxygen of <150 mm Hg with a positive end-expiratory pressure of ≥8 cm H2O) were enrolled in 37 French intensive care units. Patients were randomized to a strategy of inhaled sedation with sevoflurane (intervention group) or to a strategy of intravenous sedation with propofol (control group) for up to 7 days. The primary end point was the number of ventilator-free days at 28 days; the key secondary end point was 90-day survival. Of 687 patients enrolled (mean [SD] age, 65 [12] years; 30% female), 346 were randomized to sevoflurane and 341 to propofol. The median total duration of sedation was 7 days (IQR, 4 to 7) in both groups. The number of ventilator-free days through day 28 was 0.0 days (IQR, 0.0 to 11.9) in the sevoflurane group and 0.0 days (IQR, 0.0 to 18.7) in the propofol group (median difference, −2.1 [95% CI, −3.6 to −0.7]; standardized hazard ratio, 0.76 [95% CI, 0.50 to 0.97]). The 90-day survival rates were 47.1% and 55.7% in the sevoflurane and propofol groups, respectively (hazard ratio, 1.31 [95% CI, 1.05 to 1.62]). Among 4 secondary outcomes, sevoflurane was associated with higher 7-day mortality (19.4% vs 13.5%, respectively; relative risk, 1.44 [95% CI, 1.02 to 2.03]) and fewer intensive care unit–free days through day 28 (median, 0.0 [IQR, 0.0 to 6.0] vs 0.0 [IQR, 0.0 to 15.0]; median difference, –2.5 [95% CI, –3.7 to –1.4]) compared with propofol. Among patients with moderate to severe ARDS, inhaled sedation with sevoflurane resulted in fewer ventilator-free days at day 28 and lower 90-day survival than sedation with propofol. ClinicalTrials.gov Identifier: NCT04235608
