INTRODUCTION an early call to the department of urgent medical assistance--Center 15 (SAMU-centre 15) is associated to shortest delays of reperfusion in case of myocardial infarction. However, patients are not always aware of this. OBJECTIVE to assess the assimilated counsels by patients after an acute myocardial infarction. METHODS from January 1998 to June 2004, patients managed by SAMU 93 and having benefited from thrombolytic therapy prior to hospitalization and/or primary angioplasty for a ST+ acute coronary syndrome with a confirmation of acute myocardial infarction during their hospital stay were prospectively enrolled into this study. A questionnaire was administered by phone from december 2003 to july 2005, assessing the knowledge about the necessity to alert SAMU-center 15 in case of chest pain and availability of medical files data. RESULTS among the 976 patients: 111 (11%) were lost during follow-up, 162 (19%) were deceased when phone contact and 119 (12%) could not be interrogated. Among the 584 (60%) remaining subjects interrogated with a median follow-up period of 985 days (413-1596), 290 (50%) patients answered they received counseling, including 156 (27%) for taking nitrates, 19 (29%) stated they know that they should call SAMU-center 15. Patients with a high level of education and those treated by thrombolytic therapy prior to hospitalization were better informed; 464 (79%) patients declared having a prescription, 392 (67%) a hospital report, 406 (69%) an electrocardiogram, 227 (39%) a CD with their coronary angiography, and 79(14%) their medical file. CONCLUSION the level of knowledge regarding the recommended attitude in case of chest pain is poor. The availability of medical data was better. Arch Mal Cceur

Study Objective: To determine the clinical characteristics of endotracheal intubation in the French emergency prehospital medical system and compare these data with those of other systems. Methods: This study was performed in Ile de France (Paris Region) in mobile ICUs staffed by physicians. This prospective, descriptive study involved completion of a questionnaire by the operator just after endotracheal intubation was performed. Results: Six hundred eighty-five (99.1%) of 691 consecutive prehospital intubations were performed successfully in the field. The orotracheal route was used in 96.0%, and no surgical approaches such as cricothyroidotomy were used. Mechanical complications occurred in 84 patients, at a rate of 15.9% for nonarrest patients and 8.1% for arrest patients. A wide variety of sedation protocols were used. Difficult intubations (10.8%) were comparable in incidence to the number seen in US emergency departments, not US prehospital systems. By the same token, intubation success rates (99.1%) were comparable to US EDs and much higher than US prehospital results. Conclusion: The characteristics of French prehospital airway management differ significantly from those of other countries. These differences may be explained by differences in approach to prehospital management rather than differences of skill. [Adnet F, Jouriles NJ, Le Toumelin P, Hennequin B, Taillandier C, Rayeh F, Couvreur J, Nougière B, Nadiras P, Ladka A, Fleury M: Survey of out-of-hospital emergency intubations in the French prehospital medical system: A multicenter study. Ann Emerg Med October 1998;32:454-460.]

The choice of sedation for emergency intubation remains controversial. This lack of consensus has led to various sedation protocols used in French prehospital care setting. A review of data from the literature suggests that the association etomidate-suxamethonium is probable the best choice for rapid sequence intubations in the prehospital setting. Its benefits include protection against myocardial and cerebral ischaemia, decreased risk of pulmonary aspiration, and a stable haemodynamic profile. Randomized studies are needed to substantiate the advantages of the association etomidate-suxamethonium for rapid sequences intubation in the prehospital setting.

Two methods of endotracheal intubation of patients lying on the ground were compared for ease and speed of intubation and minimization of complications in a crossover study of prehospital-oriented emergency physicians. Intubation of a mannequin was attempted by the physicians in either a left lateral decubitus (LLD) position or a kneeling (K) position, followed by the alternate position. The LLD position afforded more rapid intubation, better glottic visualization, and less dental trauma. Eighty-seven percent of physicians completely visualized the glottis in the LLD position, versus 33% of the K position group. Intubation times were 10.5 versus 14.6 seconds in the LLD and K positions, respectively (P < .001). The LLD position is a more effective position (in a mannequin model) than the K position for intubation of patients found lying on the ground, a frequent situation in prehospital care.

BACKGROUND:We compared short-term prognosis of active compression-decompression (ACD) and standard (STD) cardiopulmonary resuscitation (CPR) in out-of-hospital cardiac arrests.METHODS AND RESULTS:We randomized advanced cardiac life support (ACLS) with ACD ACLS CPR on odd days and STD ACLS CPR on even days. We measured the rates of return of spontaneous circulation (ROSC), survival at 1 hour (H1), at 24 hours (H24), and at 1 month (D30): hospital discharge (HD); neurological outcome; and complications. Mean times from collapse to basic cardiac life support CPR was 9 minutes and from collapse to ACLS CPR was 21 minutes. Compared with the STD ACLS patients (n = 258), ACD ACLS patients (n = 254) had higher survival rates (ROSC, 44.9% versus 29.8%, P = .0004; H1, 36.6% versus 24.8%, P = .003; H24, 26% versus 13.6%, P = .002; HD without neurological impairment, 5.5% versus 1.9%, P = .03) and a trend for improvement in neurological outcome at D30 (Glasgow-Pittsburgh Outcome Categories = 1.6 +/- 0.8 versus 2.3 +/- 1.1. P = .09). Sternal dislodgements (2.9% versus 0.4%, P = .03) and hemoptysis (5.4% versus 1.3%, P = .01) were more frequent in the ACD ACLS group.CONCLUSIONS:Despite long time intervals, ACD significantly improved short-term survival rates in out-of-hospital cardiac arrests compared with STD CPR.

Comparer les effets préventifs de l'esmolol et de la lidocaïne sur l'augmentation de la pression artérielle moyenne (PAM) et de la pression intracrânienne (PIC) lors de l'intubation endotrachéale en neurochirurgie.Étude comparative, randomisée, en double aveugle.Vingt-deux patients de classe physique ASA I ou II, opérés en neurochirurgie, randomisés en deux groupes (groupe esmolol et groupe lidocaïne).Après induction de l'anesthésie avec thiopental, vécuronium, fentanyl et isoflurane, un groupe a reçu 1,5 mg·kg−1 d'esmolol IV et l'autre 1,5 mg·kg−1 de lidocaïne IV, 130 secondes avant l'intubation endotrachéale. La PAM (mesurée à l'aide d'un cathéter radial), la PIC (mesurée à l'aide d'un cathéter rachidien lombaire) et la pression de perfusion cérébrale (PPC), déduites des mesures précédentes, ont été déterminées avant induction de l'anesthésie, avant administration d'esmolol ou de lidocaïne, avant intubation, au moment de la variation maximale de la PAM, ainsi que 2 et 5 minutes après l'intubation.L'évolution de la PAM, de la PIC et de la PPC a été identique dans les deux groupes. Une baisse (P < 0,05) de la PPC de 92 ± 12 à 62 ± 8 mmHg après esmolol, et de 96 ± 12 à 68 ± 15 mmHg après lidocaïne a été constatée. Après l'intubation, la PPC a augmenté (P < 0,05) à 99 ± 23 mmHg après esmolol et 99 ± 17 mmHg après lidocaïne. La PIC a augmenté (P < 0,05) après intubation de 11 ± 6 à 17 + 10 mmHg dans le groupe esmolol etde10±6à16±9 mmHg dans le groupe lidocaïne.L'esmolol ou la lidocaïne administrés à la dose de 1,5 mg· kg−1 avant la laryngoscopie et l'intubation ne pré viennent pas complètement les augmentations de la PAM et de la PIC.To compare the preventive effects of esmolol and lidocaine on the increase in mean arterial pressure (MAP) and intracranial pressure (ICP) during endotracheal intubation in neurosurgery.Comparative, randomised, double-blind study.Twenty-two patients, physical status ASA I or II, undergoing neurosurgery, and randomised into two groups (esmolol group and lidocaine group).After induction of anaesthesia with thiopentone, vecuronium, fentanyl and isoflurane, one group received iv esmolol 1.5 mg·kg−1 and the other iv lidocaine 1.5 mg·kg−1, 130 sec before endotracheal intubation. The MAP measured with a radial catheter, the ICP obtained with a lumbar subarachnoid catheter and the cerebral perfusion pressure (CPP, calculated from MAP and ICP) were assessed before induction of anaesthesia, before esmolol or lidocaine injection, and before intubation, during the maximal change in MAP, as well as 2 and 5 minutes after intubation.The time course of MAP, ICP and CCP were similar throughout the study in the two groups, with a significant decrease (P < 0.05) of the CPP from 92 ± 12 to 628 mmHg after esmolol, and from 96 ± 12 to 68 ± 15 mmHg after lidocaine. Following intubation, CPP increased significantly (P < 0.05) to 99 ± 23 mmHg after esmolol and to 99 ± 17 mmHg after lidocaine. The ICP increased also significantly (P < 0.05) after intubation from 11 ± 6 to 17 ± 10 mmHg in the esmolol group, and from 10 ± 6 to 16 ± 9 mm Hg in the lidocaine group.Esmotol or lidocaine as an iv bolus of 1.5 mg·kg−1 before laryngoscopy and intubation do not completely prevent the increase in MAP and ICP.