Papers by Alain Rozenberg
Annales Françaises d Anesthésie et de Réanimation
La Revue du praticien
In the past few years, many studies have been devoted to cardiac arrest (CA) resuscitation. The &... more In the past few years, many studies have been devoted to cardiac arrest (CA) resuscitation. The "Chain of Survival" concept is considered as the best comprehensive approach of CA prognostic improvement. It includes 4 links: early access (recognition of early signs of CA and activation of the emergency medical system), early cardiopulmonary resuscitation, early defibrillation of ventricular fibrillations and early advanced cardiac life support (intubation, intravenous medication). Non withstanding all the recent progress en physiology or therapeutics, the early management is still the basis of the prognosis. That is why prehospital care organization is the main determinant of CA survival.
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La Presse Médicale
THE SURVIVAL CHAIN: The delay to restoration of spontaneous circulation is the key to prognosis o... more THE SURVIVAL CHAIN: The delay to restoration of spontaneous circulation is the key to prognosis of cardiac arrest occurring outside the hospital. Among the many etiologies of cardiac arrest, sudden onset ventricular fibrillation is the number one cause of sudden death in adults. Better prognosis depends on effective organisation founded on the concept of a "survival chain". ALERT AND RESUSCITATION: By alerting the emergency units and performing the basic gestures of cardiopulmonary resuscitation (freeing the airways, mouth-to-mouth ventilation and closed chest cardiac massage) those witnessing the event take the first steps in the survival chain while waiting for the paramedical and medical teams to arrive. DEFIBRILLATION: In case of ventricular fibrillation, prognosis is directly related to the delay to defibrillation. Defibrillators used by specially trained paramedics before a physician arrives on the scene have considerably improved prognosis. SPECIALIZED RESUSCITATION: Precise algorithms help guide treatment in accordance with the observed cardiac rhythm. Tracheal intubation and artificial ventilation are fundamental. Among the useful drugs, epinephrine is by far the most important for improving myocardial and cerebral perfusion, improving the chances of recovering spontaneous circulation. The only anti-arrhythmic drug currently used is lidocaine. Infusion of alkaline fluid is only useful in specific cases of prolonged resuscitation. Expired CO2 monitoring may be a useful guide, but discontinuing resuscitation is strictly a medical decision. AFTER RESUSCITATION: When spontaneous circulation has been achieved, the patient must be transported to a cardiac hospital for specialized care and etiological treatment.
La Revue du praticien
Out-of-hospital cardiac arrest remains a clinical problem with a survival rate of less than 5%. P... more Out-of-hospital cardiac arrest remains a clinical problem with a survival rate of less than 5%. Prompt initiation of cardiopulmonary resuscitation and rapid delivery of advanced cardiac-life procedures are required. Combined in-hospital management by experienced cardiologists and intensive care specialists is recommended. Acute coronary-artery occlusion is frequent and poorly predicted by clinical and electrocardiographic findings. Accurate diagnosis by immediate coronary angiography can be followed if necessary by coronary angioplasty. Survivors undergo extensive work-up to determine the indications of an implantable defibrillator or coronary revascularization.
Annales Françaises d Anesthésie et de Réanimation
The French system of Samu-Smur allows the admission of patients directly in intensive care unit (... more The French system of Samu-Smur allows the admission of patients directly in intensive care unit (ICU). The aim of this study is to examine the utility of the Samu-Smur with regard to such direct admission (DA). This retrospective study was performed by the Samu of Paris. Patient details were gathered from three reports: namely hospitalization, transport and regulation reports. These were analysed to decide whether the admission diagnostic was exact, whether the patient's condition was serious, whether the prehospital treatment justified direct admission into an ICU and whether the management was coherent. In 1997, 409 (31%) cases were studied among the 1,350 admitted patients in ICU. Three groups of patients were classified according to admission to surgical (n = 54), medical (n = 180), cardiological ICU (n = 175). The prehospital diagnosis was confirmed by the hospitalization report in 91% of patients in the all three groups. The patient's condition was found to the serious in all cases. Justification of the treatment was respectively found in 96, 88 and 84% of patients. The coherence of management was confirmed in 94, 96 and 89%. This study has shown that Samu-Smur management lead to justified DA in ICU for all patients in the study. Prospective studies are needed to show the advantages of this strategy in term of speed of management and outcome.
Journal Européen des Urgences, 2004
Annales Françaises d'Anesthésie et de Réanimation, 2014
Annales françaises de médecine d'urgence, 2011
Resuscitation, 2001
Internal cardiac compressions are more efficient than closed chest compressions (CCC) in cardiac ... more Internal cardiac compressions are more efficient than closed chest compressions (CCC) in cardiac arrest (CA). To evaluate the prehospital feasibility of performing a new method of minimally invasive direct cardiac massage (MID-CM TheraCardia Inc.). Prospective non-randomized open study, after ethical committee approval. Inclusion of 18-85 years old patients in witnessed CA if BLS>5 min and unsuccessful ACLS>20 min after CA. The MID-CM is an atraumatic manual cardiac pumping system deployed in the thoracic cavity through a small incision. Evaluation of: ease of insertion and performing MID-CM, complications, end-tidal CO(2) (PETCO(2)), non invasive arterial blood pressure (NIBP) and return of spontaneous circulation (ROSC). Values are mean+/-SD (min-max). Twenty-five patients included. Mean age 59+/-16 years (26-85); BLS started at 8+/-5 min (0-20), compressions started at 47+/-10 min (29-74) after CA. Dissection and insertion was fast and easy (<1 min). Deployment of the MID-CM was difficult in two patients because of pericardium adhesions and cardiomegaly. In six patients compressions were more difficult because of a 'stone heart' phenomenon. Compressions were possible during ambulance transport of four patients. There was a good palpable carotid pulse in all patients receiving internal compressions. There was a trend in increase of PETCO(2) compared to CCC. NIBP could be measured during MID-CM compressions in 9 patients (systolic>85 mmHg), never during CCC. Seven patients had a ROSC, but only four patients were admitted alive. There was no long term survival. One patient had a serious complication (heart rupture). Prehospital use of MID-CM is possible, but it is not comparable to any other resuscitation technique. Training of medical teams is mandatory to obtain good skills and to avoid complications. Further studies are necessary to evaluate efficiency and survival compared to closed chest compressions.
Resuscitation, 2003
The clinical features of coronary artery spasm as a cause of cardiac arrest were determined in a ... more The clinical features of coronary artery spasm as a cause of cardiac arrest were determined in a prospective study on out-of-hospital cardiac arrest (OHCA). Coronary angiography was performed at admission in 300 consecutive patients with no obvious non-cardiac cause of OHCA. In survivors with no or minimal coronary artery stenosis, a second angiography with provocation test and electrophysiological testing were performed at 1 month. Spasm was demonstrated in ten patients. Diagnosis was based upon (1) spontaneous spasm on the admission angiogram (3 patients), (2) transient significative ST-segment elevation at follow-up in patients with no or non-significant coronary artery lesions (4 patients) and (3) spasm during the 1 month provocation test (3 patients). Six patients survived at 1 month; spasm occurred during a new provocation test in five despite treatment with high dosage calcium channel blockers leading to coronary stenting in two, an internal cardiovertor defibrillator in one, and increased drug therapy with prolonged hospitalization in the remainder. At a mean follow-up of 55+/-27 months, no recurrent cardiac arrest occurred. Systematic coronary angiograms and provocation tests in survivors of OHCA allow prompt diagnosis of coronary artery spasm. Residual spasm despite treatment with calcium channel blockers is frequent. Therapy should therefore be guided by repetitive provocation tests, and seems to avoid recurrence of cardiac arrest.
The Journal of Trauma: Injury, Infection, and Critical Care, 1993
Journal of the American College of Cardiology, 2002
Journal of the American College of Cardiology, 1998
ABSTRA(~II'.~ ~ P¢~,ter 97A Iidocat~ (79% VS 81%, p = 0,65), Ot atrogine (47% vS 6P,,~, p = 006) ... more ABSTRA(~II'.~ ~ P¢~,ter 97A Iidocat~ (79% VS 81%, p = 0,65), Ot atrogine (47% vS 6P,,~, p = 006) There was no d~flerence tn the office emelgency death tale in MD vs DOS offices (0.06 vS 009 per I00,000 pt visitS, p ~ 0,~9), There was a ~tftkill~ ~bs6P,¢O Ot d¢fibnllatom in either MD o~ DOS offiCeS (12% vS 8%, p ~ 0,39), DDSs wore more likely tO b~ CPR,fr~ir~;I (9?% vs 65%, p ~ OT00(~01) than phyu¢zans, Only a mmofily of I~a(;liflor~rS ~ ACl.~.traine~ (I P,~ DO~ vs ~19% MDs, p ~ 0,0006). We o~.¢lu~r~ that thm~ iS I=tt~ ~ffmOm~ in tl~ pr~ar~ss of MD of DOS ofl~ for d~ling w~th ~ ca~lia¢ ¢~mer~rv~, ~van though MD Ofllc~ ext~rio~c~_ ~ t~p~fiC~nIIy hil;lh~r r~t~ of s~h t~nfs. ~x' -------:::~[1031-1' 32 I Ca~l~ Oiutol¢ Bltwl~n V~nWI©uI~r Fibrillation -,~lon POI~IS Im=~.~_~ With FlbdllMIon Duration Ve~mn, Aea~ ~ C~r~r, ~mgmn !~;, U$/4 re~u,~ IS !e~ ~ 10%, ~ ~194~ ~r~ fr~¢l~P,~, 0t the VF ECG d~ with I~m~, Thi~ s_t~ly ~t~m~ee~d w h~her ~r~mas~l o/tie length W~ i~= ~fl~l lit ~ iSO~l(~t f"d,~t Pa~t~lft~ ~ lt~l~n~t~ with a re.f~ shock ~t 6 mingle,~, ~ ~ I~t~Mttl~S (l~Ps) were r~0~ from the fio.~t (n = 2) Of ~ (n ~ 4) ven~az free walL Cyc~ le~h, APO,co and d~s~e w~m datem~ned .at ,5 ~s~, 1, 2, 3, 4, ,~nd 5 rr~ a~ [Schem,e VF (30 m~as~mmenls each) ~Or event ~. Cycle length and d~st~e inc~ while APDt0~ Sl~O~lef~d s;gnif¢~tly with time iP "~ O.001, by ANOVA) !~t0~i~ ~md ~n i ~ 3 n'~n due ~ly To APD,~ shortening and I~ between _2--..3 n~n ~ to ~ cycle length (p .~ 005; FLgt~ei. D',..35tole incre~ Item 1% ~ cycle length at 5 ~e¢ to 6,~,,= at 5 im~n.
Intensive Care Medicine, 2006
Constant flow insufflation of oxygen (CFIO) through a Boussignac multichannel endotracheal tube h... more Constant flow insufflation of oxygen (CFIO) through a Boussignac multichannel endotracheal tube has been reported to be an efficient ventilatory method during chest massage for cardiac arrest. Patients resuscitated for out-of-hospital cardiac arrest were randomly assigned to standard endotracheal intubation and mechanical ventilation (MV; n =457) or use of CFIO at a flow rate of 15 l/min (n=487). Continuous chest compressions were similar in the two groups. Pulse oximetry level was recorded every 5[Symbol: see text]min. Outcome of initial resuscitation, hospital admission, complications, and discharge from the intensive care unit (ICU) were analyzed. The randomization scheme was changed during the study, but the in-depth analysis was performed only on the first cohort of 341 patients with CFIO and 355 with MV, because of randomization problems in the second part. No difference in outcome was noted regarding return to spontaneous circulation (CFIO 21%, MV 20%), hospital admission (CFIO 17%, MV 16%), or ICU discharge (CFIO 2.4%, MV 2.3%). The level of detectable pulse saturation and the proportion of patients with saturation above 70% were higher with CFIO. Ten patients with MV but only one with CFIO had rib fractures. CFIO is a simplified alternative to MV, with favorable effects regarding oxygenation and fewer complications, as observed in this group of patients with desperate prognosis.
Annals of Emergency Medicine, 1995
To compare the maximal end-tidal carbon dioxide pressure (ETCO2 peak) values obtained during stan... more To compare the maximal end-tidal carbon dioxide pressure (ETCO2 peak) values obtained during standard (S-CPR) and active compression-decompression CPR (ACD-CPR) during prolonged resuscitation in out-of-hospital cardiac arrest. Prospective, randomized crossover study. City with a population of 3.5 million, served by an emergency medical service system providing advanced cardiac life support. Patients with nontraumatic out-of-hospital cardiac arrest. Patients were randomly assigned to receive first, for a period of 3 minutes, either ACD-CPR or S-CPR; then the two methods were alternated. ETCO2 was continuously monitored and computed. Sixteen patients (48 +/- 20 years old) were included; in 12, return of spontaneous circulation was achieved, and 5 were admitted alive to the hospital. A statistically significant increase in ETCO2 peak was obtained with ACD-CPR (27.6 +/- 3 mm Hg) compared with S-CPR (15.6 +/- 2.2 mm Hg). No major adverse effect possibly related to ACD-CPR was observed. This prospective study suggests that ACD-CPR may improve cardiac output compared with S-CPR.
Annales Françaises d'Anesthésie et de Réanimation, 1994
De très nombreux travaux ont été consacrés depuis quelques années à la réanimation des arrêts car... more De très nombreux travaux ont été consacrés depuis quelques années à la réanimation des arrêts cardiorespiratoires souvent désignés sous le terme d'arrêt cardiaque ou d'arrêt circulatoire (AC). Cependant cette littérature abondante est souvent difficile à interpréter : les résultats des études cliniques sont parfois divergents et la méthodologie de ces études est souvent tr ès dépendante du contexte dans lequel elles ont été réalis ées ; les travaux expérimentaux, bien que mieux reproductibles, font appel à des modèles animaux, cherchant à simuler les circonstances cliniques de l'AC. La transposition chez l'homme des r ésultats ainsi obtenus doit s'effectuer avec une grande prudence. La Société Française d'Anesthésie et de Réanimation a réuni un groupe d'experts dans le but de réaliser une mise au point actualisée et de proposer une conduite à tenir claire face à la survenue d'un arrêt cardiorespiratoire. Elle tient compte des développements récents de la littérature, en particulier les recommandations émises par l'American Heart Association et l'European Resuscitation Council en 1992 [1, 6, 12]. Le groupe d'experts a établi le document qui figure ci-dessous et auquel est adjointe une bibliographie, limitée aux articles essentiels. Ce texte s'adresse en priorité aux médecins anesthésistes-réanimateurs mais aussi à tous les médecins confrontés à la prise en charge d'arrêts cardiorespiratoires ainsi qu'au personnel paramédical qui les assiste. Il traite aussi bien des techniques que de l'organisation des soins.
Annales Françaises d'Anesthésie et de Réanimation, 1995
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Papers by Alain Rozenberg