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Article ; Online: The IMPACT Score: A New Score to Predict the Risk of Early Mortality in Cardiogenic Shock Patients Treated With Venoarterial Extracorporeal Membrane Oxygenation.

Veyret, Simon / Girard, Léandre / Puech, Bérénice / Dangers, Laurence / Jabot, Julien / Neuschwander, Arthur / Braunberger, Eric / Allyn, Jérôme / Allou, Nicolas / Vidal, Charles

Journal of cardiothoracic and vascular anesthesia

2023 Volume 38, Issue 2, Page(s) 451–458

Abstract: Objectives: Venoarterial extracorporeal membrane oxygenation (VA-ECMO) requires considerable human and financial resources. Few studies have focused on early mortality (ie, occurring within 72 hours after VA-ECMO implantation). The objective of this ... ...

Abstract	Objectives: Venoarterial extracorporeal membrane oxygenation (VA-ECMO) requires considerable human and financial resources. Few studies have focused on early mortality (ie, occurring within 72 hours after VA-ECMO implantation). The objective of this study was to establish a prognosis score-the IMPACT score (prediction of early mortality associated with VA-ECMO using preimplantation characteristics)-by determining the risk factors associated with early mortality. Design: This was a retrospective and observational study. Setting: The study was conducted at a University hospital. Participants: This single-center retrospective study included 147 patients treated with VA-ECMO for cardiogenic shock between 2014 and 2021. Methods: The primary outcome was early mortality (ie, occurring within 72 hours after VA-ECMO implantation). Multivariate logistic regression was performed using a bootstrapping methodology to identify factors independently associated with early mortality. To construct the score, identified variables had points (pts) assigned corresponding to their odds ratio. Results: A total of 147 patients were included in the study. Early mortality (<72 hours) was 26% (38 patients). Four variables were established: cardiac arrest (2 pts), lactate levels (3 pts), platelet count <100 g/L (4 pts), and renal-replacement therapy (5 pts). The IMPACT score had an area under the receiver operating characteristic curve of 0.78 (95% CI 0.86-0.70) to predict early mortality. Conclusions: In the authors' experience, 26% of patients treated with VA-ECMO presented early mortality. The IMPACT score is a reliable predictor of early mortality and may assist with VA-ECMO initiation decision-making.
MeSH term(s)	Humans ; Retrospective Studies ; Extracorporeal Membrane Oxygenation/methods ; Shock, Cardiogenic/diagnosis ; Shock, Cardiogenic/therapy ; Hospital Mortality ; Heart Arrest
Language	English
Publishing date	2023-11-23
Publishing country	United States
Document type	Observational Study ; Journal Article
ZDB-ID	1067317-9
ISSN	1532-8422 ; 1053-0770
ISSN (online)	1532-8422
ISSN	1053-0770
DOI	10.1053/j.jvca.2023.11.025
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Zs.A 2203: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (1.OG) ab Jg. 2022: Lesesaal (EG)
Zs.MO 31: Show issues

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Article ; Online: Modified 4T score for heparin-induced thrombocytopenia diagnosis in VA-ECMO patients.

Renou, Amélie / Neuschwander, Arthur / Kimmoun, Antoine / Brodie, Daniel / Pirracchio, Romain

Intensive care medicine

2020 Volume 46, Issue 7, Page(s) 1481–1483

MeSH term(s)	Anticoagulants/adverse effects ; Extracorporeal Membrane Oxygenation/adverse effects ; Heparin/adverse effects ; Humans ; Thrombocytopenia/chemically induced ; Thrombocytopenia/diagnosis
Chemical Substances	Anticoagulants ; Heparin (9005-49-6)
Language	English
Publishing date	2020-03-30
Publishing country	United States
Document type	Letter
ZDB-ID	80387-x
ISSN	1432-1238 ; 0340-0964 ; 0342-4642 ; 0935-1701
ISSN (online)	1432-1238
ISSN	0340-0964 ; 0342-4642 ; 0935-1701
DOI	10.1007/s00134-020-06011-8
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Zs.A 1089: Show issues

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Article ; Online: Noninvasive continuous monitoring versus intermittent oscillometric measurements for the detection of hypotension during digestive endoscopy.

Phan, Anh-Dao / Neuschwander, Arthur / Perrod, Guillaume / Rahmi, Gabriel / Cellier, Christophe / Cholley, Bernard

PloS one

2020 Volume 15, Issue 10, Page(s) e0240241

Abstract: Background: Hemodynamic monitoring during digestive endoscopy is usually minimal and involves intermittent brachial pressure measurements. New continuous noninvasive devices to acquire instantaneous arterial blood pressure may be more sensitive to ... ...

Abstract	Background: Hemodynamic monitoring during digestive endoscopy is usually minimal and involves intermittent brachial pressure measurements. New continuous noninvasive devices to acquire instantaneous arterial blood pressure may be more sensitive to detect procedural hypotension. Purpose: To compare the ability of noninvasive continuous monitoring with that of intermittent oscillometric measurements to detect hypotension during digestive endoscopy. Methods: In this observational prospective study, patients scheduled for gastrointestinal endoscopy and colonoscopy under sedation were monitored using intermittent pressure measurements and a noninvasive continuous technique (ClearSight™, Edwards). Stroke volume was estimated from the arterial pressure waveform. Mean arterial pressure and stroke volume values were recorded at T1 (prior to anesthetic induction), T2 (after anesthetic induction), T3 (gastric insufflation), T4 (end of gastroscopy), T5 (colonic insufflation). Hypotension was defined as mean arterial pressure < 65 mmHg. Results: Twenty patients (53±17 years) were included. Six patients (30%) had a hypotension detected using intermittent pressure measurements versus twelve patients (60%) using noninvasive continuous monitoring (p = 0.06). Mean arterial pressure decreased during the procedure with respect to T1 (p < 0.05), but the continuous method provided an earlier warning than the intermittent method (T3 vs T4). Nine patients (45%) had at least a 25% reduction in stroke volume, with respect to baseline. Conclusion: Noninvasive continuous monitoring was more sensitive than intermittent measurements to detect hypotension. Estimation of stroke volume revealed profound reductions in systemic flow. Noninvasive continuous monitoring in high-risk patients undergoing digestive endoscopy under sedation could help in detecting hypoperfusion earlier than the usual intermittent blood pressure measurements.
MeSH term(s)	Adult ; Aged ; Blood Pressure/physiology ; Blood Pressure Determination/methods ; Colonoscopy ; Endoscopy, Gastrointestinal/methods ; Humans ; Hypotension/physiopathology ; Middle Aged ; Oscillometry/methods ; Prospective Studies
Language	English
Publishing date	2020-10-02
Publishing country	United States
Document type	Journal Article
ISSN	1932-6203
ISSN (online)	1932-6203
DOI	10.1371/journal.pone.0240241
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Article ; Online: Multiple trauma in pregnant women: injury assessment, fetal radiation exposure and mortality. A multicentre observational study.

Abback, Paer-Selim / Benchetrit, Alison / Delhaye, Nathalie / Daire, Jean-Luc / James, Arthur / Neuschwander, Arthur / Boutonnet, Mathieu / Cook, Fabrice / Vinour, Hélène / Hanouz, Jean-Luc / Cotte, Jean / Pastene, Bruno / Jouffroy, Viridiana / Gauss, Tobias / Group, Traumabase

Scandinavian journal of trauma, resuscitation and emergency medicine

2023 Volume 31, Issue 1, Page(s) 22

Abstract: Background: Fetal radiation exposure in pregnant women with trauma is a concern. The purpose of this study was to evaluate fetal radiation exposure with regard to the type of injury assessment performed.: Methods: It is a multicentre observational ... ...

Abstract	Background: Fetal radiation exposure in pregnant women with trauma is a concern. The purpose of this study was to evaluate fetal radiation exposure with regard to the type of injury assessment performed. Methods: It is a multicentre observational study. The cohort study included all pregnant women suspected of severe traumatic injury in the participating centres of a national trauma research network. The primary outcome was the cumulative radiation dose (mGy) received by the fetus with respect to the type of injury assessment initiated by the physician in charge of the pregnant patient. Secondary outcomes were maternal and fetal morbi-mortality, the incidence of haemorrhagic shock and the physicians' imaging assessment with consideration of their medical specialty. Results: Fifty-four pregnant women were admitted for potential major trauma between September 2011 and December 2019 in the 21 participating centres. The median gestational age was 22 weeks [12-30]. 78% of women (n = 42) underwent WBCT. The remaining patients underwent radiographs, ultrasound or selective CT scans based on clinical examination. The median fetal radiation doses were 38 mGy [23-63] and 0 mGy [0-1]. Maternal mortality (6%) was lower than fetal mortality (17%). Two women (out of 3 maternal deaths) and 7 fetuses (out of 9 fetal deaths) died within the first 24 h following trauma. Conclusions: Immediate WBCT for initial injury assessment in pregnant women with trauma was associated with a fetal radiation dose below the 100 mGy threshold. Among the selected population with either a stable status with a moderate and nonthreatening injury pattern or isolated penetrating trauma, a selective strategy seemed safe in experienced centres.
MeSH term(s)	Female ; Humans ; Pregnancy ; Infant ; Pregnant Women ; Cohort Studies ; Fetus ; Multiple Trauma ; Radiation Exposure ; Retrospective Studies
Language	English
Publishing date	2023-05-02
Publishing country	England
Document type	Observational Study ; Multicenter Study ; Journal Article
ZDB-ID	2455990-8
ISSN	1757-7241 ; 1757-7241
ISSN (online)	1757-7241
ISSN	1757-7241
DOI	10.1186/s13049-023-01084-y
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Article ; Online: Automated weaning from mechanical ventilation: Results of a Bayesian network meta-analysis.

Neuschwander, Arthur / Chhor, Vibol / Yavchitz, Amélie / Resche-Rigon, Matthieu / Pirracchio, Romain

Journal of critical care

2020 Volume 61, Page(s) 191–198

Abstract: Purpose: Mechanical ventilation (MV) weaning is a crucial step. Automated weaning modes reduce MV duration but the question of the best automated mode remains unanswered. Our objective was to compare the major automated modes for MV weaning in ... ...

Abstract	Purpose: Mechanical ventilation (MV) weaning is a crucial step. Automated weaning modes reduce MV duration but the question of the best automated mode remains unanswered. Our objective was to compare the major automated modes for MV weaning in critically ill and post-operative adult patients. Material and methods: We conducted a network Bayesian meta-analysis to compare different automated modes. We searched MEDLINE, EMBASE and Cochrane central registry for randomized control trials comparing automated weaning modes either to another automated mode or to standard-of-care. The primary outcome was the duration of MV weaning extracted from the original trials. Results: 663 articles were screened and 26 trials (2097patients) were included in the final analysis. All automated modes included in the study (ASV°, Intellivent ASV, Smartcare, Automode°, PAV° and MRV°) outperformed standard-of-care but no automated mode reduced the duration of mechanical ventilation weaning as compared to others in the network meta-analysis. Conclusion: Compared to standard weaning practice, all automated modes significantly reduced the duration of MV weaning in critically ill and post-operative adult patients. When cross-compared using a network meta-analysis, no specific mode was different in reducing the duration of MV weaning. The study was registered in PROSPERO (CRD42015024742).
MeSH term(s)	Adult ; Bayes Theorem ; Humans ; Intensive Care Units ; Network Meta-Analysis ; Respiration, Artificial ; Time Factors ; Ventilator Weaning
Language	English
Publishing date	2020-11-01
Publishing country	United States
Document type	Journal Article ; Meta-Analysis
ZDB-ID	632818-0
ISSN	1557-8615 ; 0883-9441
ISSN (online)	1557-8615
ISSN	0883-9441
DOI	10.1016/j.jcrc.2020.10.025
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Zs.A 2152: Show issues

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Article ; Online: Blunt Traumatic Aortic Injury Management, a French TraumaBase Analytic Cohort.

Boutin, Louis / Caballero, Marie-Josée / Guarrigue, Delphine / Hammad, Emmanuelle / Rennuit, Isabelle / Delhaye, Nathalie / Neuschwander, Arthur / Meyer, Alain / Bitot, Valérie / Mathais, Quentin / Boutonnet, Mathieu / Julia, Pierre / Olaf, Mercier / Duranteau, Jacques / Hamada, Sophie R

European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery

2022 Volume 63, Issue 3, Page(s) 401–409

Abstract: Objective: Blunt traumatic aortic injury (BTAI) in severe trauma patients is rare but potentially lethal. The aim of this work was to perform a current epidemiological analysis of the clinical and surgical management of these patients in a European ... ...

Abstract	Objective: Blunt traumatic aortic injury (BTAI) in severe trauma patients is rare but potentially lethal. The aim of this work was to perform a current epidemiological analysis of the clinical and surgical management of these patients in a European country. Methods: This was a multicentre, retrospective study using prospectively collected data from the French National Trauma Registry and the National Uniform Hospital Discharge Database from 10 trauma centres in France. The primary endpoint was the prevalence of BTAI. The secondary endpoints focused chronologically on injury characteristics, management, and patient outcomes. Results: 209 patients were included with a mean age of 43 ± 19 years and 168 (80%) were men. The calculated prevalence of BTAI at hospital admission was 1% (162/15 094) (BTAI admissions/all trauma). The time to diagnosis increased with the severity of aortic injury and the clinical severity of the patients (grade 1: 94 [74, 143] minutes to grade 4: 154 [112, 202] minutes, p = .020). This delay seemed to be associated with the intensity of the required resuscitation. Sixty seven patients (32%) received no surgical treatment. Among those treated, 130 (92%) received endovascular treatment, 14 (10%) open surgery (two were combined), and 123 (85%) were treated within the first 24 hours. Overall mortality was 20% and the attributed cause of death was haemorrhagic shock (69%). Mortality was increased according to aortic injury severity, from 6% for grade 1 to 65% for grade 4 (p < .001). Twenty-six (18.3%) patients treated by endovascular aortic repair had complications. Conclusion: BTAI prevalence at hospital admission was low but occurred in severe high velocity trauma patients and in those with a high clinical suspicion of severe haemorrhage. The association of shock with high grade aortic injury and increasing time to diagnosis suggests a need to optimise early resuscitation to minimise the time to treatment. Endovascular treatment has been established as the reference treatment, accounting for more than 90% of interventional treatment options for BTAI.
MeSH term(s)	Adult ; Aorta, Thoracic/surgery ; Endovascular Procedures/adverse effects ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Time Factors ; Treatment Outcome ; Vascular System Injuries/diagnosis ; Vascular System Injuries/epidemiology ; Vascular System Injuries/surgery ; Wounds, Nonpenetrating/diagnosis ; Wounds, Nonpenetrating/epidemiology ; Wounds, Nonpenetrating/surgery ; Young Adult
Language	English
Publishing date	2022-02-08
Publishing country	England
Document type	Journal Article
ZDB-ID	1225869-6
ISSN	1532-2165 ; 1078-5884
ISSN (online)	1532-2165
ISSN	1078-5884
DOI	10.1016/j.ejvs.2021.09.043
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Zs.A 2283: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (2.OG) ab Jg. 2022: Lesesaal (EG)
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Article ; Online: Clinical decision support for severe trauma patients: Machine learning based definition of a bundle of care for hemorrhagic shock and traumatic brain injury.

Lang, Elodie / Neuschwander, Arthur / Favé, Gersende / Abback, Paer-Selim / Esnault, Pierre / Geeraerts, Thomas / Harrois, Anatole / Hanouz, Jean-Luc / Kipnis, Eric / Leone, Marc / Legros, Vincent / Mellati, Nouchan / Pottecher, Julien / Hamada, Sophie / Pirracchio, Romain

The journal of trauma and acute care surgery

2021 Volume 92, Issue 1, Page(s) 135–143

Abstract: Background: Deviation from guidelines is frequent in emergency situations, and this may lead to increased mortality. Probably because of time constraints, 55% is the greatest reported guidelines compliance rate in severe trauma patients. This study ... ...

Abstract	Background: Deviation from guidelines is frequent in emergency situations, and this may lead to increased mortality. Probably because of time constraints, 55% is the greatest reported guidelines compliance rate in severe trauma patients. This study aimed to identify among all available recommendations a reasonable bundle of items that should be followed to optimize the outcome of hemorrhagic shocks (HSs) and severe traumatic brain injuries (TBIs). Methods: We first estimated the compliance with French and European guidelines using the data from the French TraumaBase registry. Then, we used a machine learning procedure to reduce the number of recommendations into a minimal set of items to be followed to minimize 7-day mortality. We evaluated the bundles using an external validation cohort. Results: This study included 5,924 trauma patients (1,414 HS and 4,955 TBI) between 2011 and August 2019 and studied compliance to 36 recommendation items. Overall compliance rate to recommendation items was 71.6% and 66.9% for HS and TBI, respectively. In HS, compliance was significantly associated with 7-day decreased mortality in univariate analysis but not in multivariate analysis (risk ratio [RR], 0.91; 95% confidence interval [CI], 0.90-1.17; p = 0.06). In TBI, compliance was significantly associated with decreased mortality in univariate and multivariate analysis (RR, 0.85; 95% CI, 0.75-0.92; p = 0.01). For HS, the bundle included 13 recommendation items. In the validation cohort, when this bundle was applied, patients were found to have a lower 7-day mortality rate (RR, 0.46; 95% CI, 0.27-0.63; p = 0.01). In TBI, the bundle included seven items. In the validation cohort, when this bundle was applied, patients had a lower 7-day mortality rate (RR, 0.55; 95% CI, 0.34-0.71; p = 0.02). Discussion: Using a machine-learning procedure, we were able to identify a subset of recommendations that minimizes 7-day mortality following traumatic HS and TBI. These two bundles remain to be evaluated in a prospective manner. Level of evidence: Care Management, level II.
MeSH term(s)	Adult ; Brain Injuries, Traumatic/diagnosis ; Brain Injuries, Traumatic/mortality ; Brain Injuries, Traumatic/therapy ; Critical Care/methods ; Critical Care/standards ; Decision Support Systems, Clinical ; Emergency Medical Services/methods ; Emergency Medical Services/standards ; Female ; France/epidemiology ; Guideline Adherence/statistics & numerical data ; Hospital Mortality ; Humans ; Machine Learning ; Male ; Patient Care Bundles/adverse effects ; Patient Care Bundles/methods ; Patient Care Bundles/standards ; Practice Guidelines as Topic ; Quality Improvement ; Registries/statistics & numerical data ; Shock, Hemorrhagic/diagnosis ; Shock, Hemorrhagic/mortality ; Shock, Hemorrhagic/therapy ; Trauma Severity Indices
Language	English
Publishing date	2021-09-27
Publishing country	United States
Document type	Journal Article
ZDB-ID	2651070-4
ISSN	2163-0763 ; 2163-0755
ISSN (online)	2163-0763
ISSN	2163-0755
DOI	10.1097/TA.0000000000003401
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Zs.A 127: Show issues

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Article ; Online: Red Blood Cell Transfusion Requirements Before and After Implementation of a Perioperative Patient Blood Management Program in Adult Patients Undergoing Cardiac Surgery. A Before and After Observational Study.

Journal of cardiothoracic and vascular anesthesia

2023 Volume 38, Issue 1, Page(s) 73–79

Abstract: Objectives: Anemia and transfusion are common in cardiac surgery patients, and are associated with significant morbidity and mortality. Multiple perioperative interventions have been described to reduce blood transfusion, but are rarely combined ... ...

Abstract	Objectives: Anemia and transfusion are common in cardiac surgery patients, and are associated with significant morbidity and mortality. Multiple perioperative interventions have been described to reduce blood transfusion, but are rarely combined altogether. The aim of this study was to compare the incidence of red blood cell (RBC) transfusion in adult patients undergoing cardiac surgery before and after the implementation of a perioperative patient blood management (PBM) program. Design: Before-and-after observational study. Setting: Single-center French university teaching hospital. Participants: Adult patients scheduled for cardiac surgery. Interventions: Perioperative patient blood management program including pre-, intra-, and postoperative interventions aimed at identifying and correcting anemia, minimizing blood loss during surgery, and optimizing coagulation. Measurements and main results: Four hundred thirty-four patients were included in the study from January 2021 to July 2022. The incidence of perioperative RBC transfusion (intraoperatively and during the first 2 postoperative days) was significantly reduced from 43% (90/213) in the pre-PBM period to 27% (60/221) in the post-PBM period (p < 0.001). The application of a PBM program was associated with a reduction in perioperative RBC transfusion by multivariate analysis (odds ratio 0.55, 95% CI 0.36-0.85, p = 0.007), and was associated with a reduction in the median number of RBC units transfused within transfused patients (p = 0.025). These effects persisted at day 30 after surgery (p = 0.029). Conclusion: A perioperative PBM program in adult patients undergoing cardiac surgery was associated with a significant reduction in perioperative RBC transfusion, which persisted at day 30.
MeSH term(s)	Adult ; Humans ; Erythrocyte Transfusion ; Blood Transfusion ; Anemia ; Cardiac Surgical Procedures/adverse effects ; Hospitals, University
Language	English
Publishing date	2023-10-20
Publishing country	United States
Document type	Observational Study ; Journal Article
ZDB-ID	1067317-9
ISSN	1532-8422 ; 1053-0770
ISSN (online)	1532-8422
ISSN	1053-0770
DOI	10.1053/j.jvca.2023.10.023
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Zs.A 2203: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (1.OG) ab Jg. 2022: Lesesaal (EG)
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Article ; Online: Association of Early, High Plasma-to-Red Blood Cell Transfusion Ratio With Mortality in Adults With Severe Bleeding After Trauma.

Roquet, Florian / Neuschwander, Arthur / Hamada, Sophie / Favé, Gersende / Follin, Arnaud / Marrache, David / Cholley, Bernard / Pirracchio, Romain

JAMA network open

2019 Volume 2, Issue 9, Page(s) e1912076

Abstract: Importance: Optimal transfusion management is crucial when treating patients with trauma. However, the association of an early, high transfusion ratio of fresh frozen plasma (FFP) to packed red blood cells (PRBC) with survival remains uncertain.: ... ...

Abstract	Importance: Optimal transfusion management is crucial when treating patients with trauma. However, the association of an early, high transfusion ratio of fresh frozen plasma (FFP) to packed red blood cells (PRBC) with survival remains uncertain. Objective: To study the association of an early, high FFP-to-PRBC ratio with all-cause 30-day mortality in patients with severe bleeding after trauma. Design, setting, and participants: This cohort study analyzes the data included in a multicenter national French trauma registry, Traumabase, from January 2012 to July 2017. Traumabase is a prospective, active, multicenter adult trauma registry that includes all consecutive patients with trauma treated at 15 trauma centers in France. Overall, 897 patients with severe bleeding after trauma were identified using the following criteria: (1) received 4 or more units of PRBC during the first 6 hours or (2) died from hemorrhagic shock before receiving 4 units of PRBC. Exposures: Eligible patients were divided into a high-ratio group, defined as an FFP-to-PRBC ratio more than 1:1.5, and a low-ratio group, defined as an FFP-to-PRBC ratio of 1:1.5 or less. The ratio was calculated using the cumulative units of FFP and PRBC received during the first 6 hours of management. Main outcomes and measures: A Cox regression model was used to analyze 30-day survival with the transfusion ratio as a time-dependent variable to account for survivorship bias. Results: Of the 12 217 patients included in the registry, 897 (7.3%) were analyzed (median [interquartile range] age, 38 (29-54) years; 639 [71.2%] men). The median (interquartile range) injury severity score was 34 (22-48), and the overall 30-day mortality rate was 33.6% (301 patients). A total of 506 patients (56.4%) underwent transfusion with a high ratio and 391 (43.6%) with a low ratio. A high transfusion ratio was associated with a significant reduction in 30-day mortality (hazard ratio, 0.74; 95% CI, 0.58-0.94; P = .01). When only analyzing patients who had complete data, a high transfusion ratio continued to be associated with a reduction in 30-day mortality (hazard ratio, 0.57; 95% CI, 0.33-0.97; P = .04). Conclusions and relevance: In this analysis of the Traumabase registry, an early FFP-to-PRBC ratio of more than 1:1.5 was associated with increased 30-day survival among patients with severe bleeding after trauma. This result supports the use of early, high FFP-to-PRBC transfusion ratios in patients with severe trauma.
MeSH term(s)	Adult ; Blood Component Transfusion ; Erythrocyte Transfusion ; Female ; France ; Hemorrhage/mortality ; Hemorrhage/prevention & control ; Hemorrhage/therapy ; Hospital Mortality ; Humans ; Male ; Middle Aged ; Proportional Hazards Models ; Retrospective Studies ; Time Factors ; Trauma Centers ; Trauma Severity Indices ; Treatment Outcome ; Wounds and Injuries/complications ; Wounds and Injuries/mortality ; Wounds and Injuries/therapy
Language	English
Publishing date	2019-09-04
Publishing country	United States
Document type	Journal Article
ISSN	2574-3805
ISSN (online)	2574-3805
DOI	10.1001/jamanetworkopen.2019.12076
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Article ; Online: Intraoperative management of brain-dead organ donors by anesthesiologists during an organ procurement procedure: results from a French survey.

Champigneulle, Benoit / Neuschwander, Arthur / Bronchard, Régis / Favé, Gersende / Josserand, Julien / Lebas, Benjamin / Bastien, Olivier / Pirracchio, Romain

BMC anesthesiology

2019 Volume 19, Issue 1, Page(s) 108

Abstract: Background: This study aimed at describing usual anesthetic practices for brain-dead donors (BDD) during an organ procurement (OP) procedure and to assess the knowledge and self-confidence of French anesthesiologists with this practice.: Methods: An ... ...

Abstract	Background: This study aimed at describing usual anesthetic practices for brain-dead donors (BDD) during an organ procurement (OP) procedure and to assess the knowledge and self-confidence of French anesthesiologists with this practice. Methods: An electronic and anonymous survey with closed-questions about anesthetic management of BDD was distributed to French anesthesiologists via the mailing list of the French Society of Anesthesiology and Intensive Care Medicine. Results: Four hundred fifty-eight responses were analyzed. Respondents were mainly attending physicians with more than 10 years of clinical experience. 78% of them declared being cognizant of guidelines regarding management of BDD. Advanced hemodynamic monitoring and endocrine substitution were rarely considered by respondents (31 and 35% of respondents, respectively). 98% of the respondents used crystalloids for fluid resuscitation. During the procedure, use of neuromuscular blockers, opioids and sedative agents were considered by respectively 84, 61 and 27% of the respondents. A very high level of agreement (10 [8-10], on a ten-points Likert-style scale) was reported concerning the expected impact of intraoperative anesthetic management on the primary function of grafts. Conclusions: Declared anesthetic practice appeared in accordance with guidelines concerning organ donor management in the ICU. Further studies are needed to evaluate the specific impact of intraoperative management during this procedure and thus the need for specific anesthetic guidelines.
MeSH term(s)	Anesthesia/methods ; Anesthesiologists/psychology ; Brain Death ; Clinical Competence ; France ; Health Care Surveys ; Health Knowledge, Attitudes, Practice ; Humans ; Tissue and Organ Procurement/methods ; Tissue and Organ Procurement/organization & administration
Language	English
Publishing date	2019-06-15
Publishing country	England
Document type	Journal Article
ISSN	1471-2253
ISSN (online)	1471-2253
DOI	10.1186/s12871-019-0766-y
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In stock of ZB MED Cologne/Königswinter

Order via subito

More links

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In stock of ZB MED Cologne/Königswinter

Order via subito

Full text online

More links

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In stock of ZB MED Cologne/Königswinter

Order via subito

More links

Kategorien

Order via subito

Inter-library loan at ZB MED

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Order via subito

Inter-library loan at ZB MED