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1. Contributing factors to early recurrence of ventricular fibrillation during out-of-hospital cardiac arrest: An observational retrospective study

Author

Romain Kedzierewicz, Romain Jouffroy, Daniel Jost, Vivien Hong Tuan Ha, Olivier Stibbe, Frédéric Lemoine, Julie Trichereau, Sabine Lemoine, Benoit Frattini, Frédérique Briche, Clément Derkenne, Paris Fire Brigade Cardiac Arrest Task Force investigators, Bertrand Prunet, Pascal Diegelmann, René Bihannic, Paris-Centre de Recherche Cardiovasculaire (PARCC (UMR_S 970/ U970)), Hôpital Européen Georges Pompidou [APHP] (HEGP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Paris (UP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité), Brigade de sapeurs pompiers de Paris (BSPP), and CCSD, Accord Elsevier

Subjects
Adult, Male, medicine.medical_specialty, Emergency Medical Services, Paris, Multivariate analysis, Adolescent, Early Recurrence, [SDV]Life Sciences [q-bio], Electric Countershock, 030204 cardiovascular system & hematology, Emergency Nursing, Out of hospital cardiac arrest, 03 medical and health sciences, 0302 clinical medicine, medicine, Humans, Aged, Retrospective Studies, business.industry, Basic life support, 030208 emergency & critical care medicine, Retrospective cohort study, Middle Aged, medicine.disease, Cardiopulmonary Resuscitation, [SDV] Life Sciences [q-bio], Shock (circulatory), Ventricular fibrillation, Emergency medicine, Ventricular Fibrillation, Recurrent ventricular fibrillation, Emergency Medicine, Observational study, Female, medicine.symptom, Cardiology and Cardiovascular Medicine, business, Out-of-Hospital Cardiac Arrest
Abstract

International audience; Introduction: In out-of-hospital cardiac arrest (OHCA), external electric shock (EES) is recommended for treating ventricular fibrillation (VF). Refibrillation commonly occurs within one minute post-shock. We aimed to investigate refibrillation times and identifyclinical and electrical factors associated with them.Materials and methods: This retrospective observational study, based on the Paris Fire Brigade database, included non-traumatic OHCA over 18 years of age who received at least one shock with an AED from Basic Life Support (BLS) rescuers and from which we randomly selected a sample to measure the refibrillation-times. Without prior reference to it in the literature, we classified the refibrillation-time into two modalities according to whether it was above or below the median-time. We performed multiple regression analysis to assess associations between refibrillation-time and potential explanatory factors.Results: Among 13,181 patients who experienced OHCA from January 2010 to January 2014, we analysed AED data from 215 patients (590 shocks), 82.1% males, median age 61[IQR: 52-75] years. Most of them occurred at home (57%), were witnessed (87%), and were shockable (88.8%). A median of 5[4-7] EES/patients were delivered. The median-time from shock to refibrillation was 25[13-44] s. Multivariate analysis showed that a shorter post-shock hands-off time favoured earlier refibrillation (p = 0.034), as well as older age (p = 0.002) (Fig. 2, Supplementary table).Conclusion: In non-traumatic OHCA, most refibrillations occurred within 45-s post-shock. Age and post-shock hands-off time were the two contributing factors to time to refibrillation.

Published
2020
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2. Effect of Pre-Hospital Ticagrelor During the First 24 h After Primary Percutaneous Coronary Intervention in Patients With ST-Segment Elevation Myocardial Infarction

Author

Gilles Montalescot, Arnoud W. van ’t Hof, Leonardo Bolognese, Warren J. Cantor, Angel Cequier, Mohamed Chettibi, Jean-Philippe Collet, Shaun G. Goodman, Christopher J. Hammett, Kurt Huber, Magnus Janzon, Frédéric Lapostolle, Jens Flensted Lassen, Muriel Licour, Béla Merkely, Néjoua Salhi, Johanne Silvain, Robert F. Storey, Jurriën M. ten Berg, Anne Tsatsaris, Uwe Zeymer, Eric Vicaut, Christian W. Hamm, Rachid Bougherbal, Mohamed Tahar Bouafia, Djamaleddine Nibouche, Abdelkader Moklati, Ahmed Benalia, Omar Kaid, Messaad Krim, Christopher Hammett, Paul Garrahy, Rohan Jayasinghe, Stephen Rashford, Thomas Neunteufl, Helmut Brussee, Hannes Alber, Franz Weidinger, Michael Brunner, Johann Sipoetz, Gerhard Prause, Michael Baubin, Dieter Sebald, Warren Cantor, Ram Vijayaraghavan, Iqbal Bata, Andrea Lavoie, Jan Ravkilde, Lisette Okkels Jensen, Alf Møl Christensen, Marianne Toftegaard, Dennis Köhler, Gregory Ducrocq, Nicolas Danchin, Patrick Henry, Bernard Livarek, Romain Berthier, Thomas Hovasse, Philippe Garot, Laurent Payot, Hakim Benamer, Jean Baptiste Esteve, Simon Elhadad, Emmanuel Teiger, Jean Louis Bonnet, Franck Paganelli, Yves Cottin, François Schiele, Christophe Thuaire, Guillaume Cayla, Pierre Coste, Patrick Ohlmann, Eric Bonnefoy Cudraz, Pierre Lantelme, Thibault Perret, Christophe Tron, Axel De Labriolle, Edouardo Aptecar, Olivier Beliard, Olivier Varenne, Rami El Mahmoud, Emmanuelle Filippi-Codaccioni, Denis Angoulvant, Patrick Peycher, Olivier Poitrineau, Xavier Tabone, Patrick Ecollan, Claire Broche, Yves Lambert, Nicolas Briole, Arielle Beruben, Nicolas Porcher, Jean-Pierre Auffray, Marc Freysz, Franck Depardieu, David Poubel, Jean-Emmanuel De La Cousaye, Jean-Claude Bartier, Benoît Jardel, Bertrand Boulanger, Hervé Labourel, Louis-Christophe Soulat, Véronique Julie, Michel Thicoipe, Olivier Capel, Olivier Stibbe, Pierre Carli, Karim Tazarourte, Fabrice Alcouffe, David Aboucaya, Gaële Aubert, Gérald Kierzek, Séverine Cahun-Giraud, Christian Hamm, Thomas Dengler, Roland Prondzinsky, Paul Marc Biever, Andreas Schäfer, Melchior Seyfarth, Bernd Lemke, Gerald Werner, Holger Nef, Holger Steiger, Matthias Leschke, Thomas Münzel, Marco Campo Dell Orto, Christian Loges, Monika Schinke, Frank Koberne, Hans Peter Reiffen, Klaus Tiroch, Dirk Wierich, Michael Kneussel, Simon Little, Hartmut Sauer, Rita Laufenberg-Feldmann, Imre Ungi, Iván Horváth, István Édes, István Mártai, Sergio Berti, Francesco Chiarella, Paolo Calabria, Massimo Fineschi, Marcello Galvani, Marco Valgimigli, Luciano Moretti, Maurizio Tespili, Massimo Mandó, Francesco Bermano, Robusto Biagioni, Andrea Fabbri, Adelina Ricciardelli, Maria Romana Petroni, Umberto Roberto Vatteroni, Francesco Palumbo, Frank F. Willems, Amar Al Mafragi, Ton A.A.C.M. Heestermans, Martijn J. Van Eck, Wim M.J.M. Heutz, H.H. Meppelder, Anika Roukema-de Jong, Harm Van de Pas, Ángel Cequier Fillat, Manel Sabaté Tenas, Josepa Mauri Ferrer, Antoni Serra Peñaranda, Joan Ángel Ferrer, Bruno García Del Blanco, Faustino Miranda Guardiola, Juan Miguel Ruiz Nodar, Andrés Íñiguez Romo, Nicolás Vázquez González, Ramiro Trillo Nouche, Luis Díaz De La Llera, José María Hernández García, Fernando Rivero-Crespo, Felipe Hernández Hernández, José Luis Zamorano Gómez, Xavier Jiménez Fárega, Gilberto Alonso Fernández, José Luis Toboso, Mercedes Carrasco, Victoria Barreiro, José Antonio Iglesias Vázquez, María del Mar Ruiz Montero, Fernando Rosell Ortiz, Guillermo Garcia Escudero, Vicente Sánchez-Brunete Ingelmo, Antonio Lara García, Jonas Oldgren, Fredrik Calais, Robert Kastberg, Per-Adolf Bergsten, Hans Blomberg, Kristian Thörn, Gunnar Skoog, Azfar Zaman, Robert Gerber, Alisdair Ryding, Mark Spence, Neil Swanson, Martin Been, Konrad Grosser, Peter Schofield, David Mackin, Paul Fell, Tom Quinn, Teresa Foster, David McManus, Andy Carson, Institut de cardiologie [CHU Pitié-Salpêtrière], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Pitié-Salpêtrière [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Unité de Recherche sur les Maladies Cardiovasculaires, du Métabolisme et de la Nutrition = Institute of cardiometabolism and nutrition (ICAN), Université Pierre et Marie Curie - Paris 6 (UPMC)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Pitié-Salpêtrière [AP-HP], Hôpital Avicenne [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), AstraZeneca, Hôpital Lariboisière, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Lariboisière-Fernand-Widal [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Diderot - Paris 7 (UPD7), CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Unité de Recherche sur les Maladies Cardiovasculaires, du Métabolisme et de la Nutrition = Research Unit on Cardiovascular and Metabolic Diseases (ICAN), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Sorbonne Université (SU), Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-CHU Pitié-Salpêtrière [APHP], Université Pierre et Marie Curie - Paris 6 (UPMC)-Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Pitié-Salpêtrière [APHP], Hôpital avicenne, Université Paris 13 (UP13)-Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Hôpital Avicenne, and Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Hôpital Lariboisière-Université Paris Diderot - Paris 7 (UPD7)

Subjects
medicine.medical_specialty, medicine.medical_treatment, 030204 cardiovascular system & hematology, 03 medical and health sciences, 0302 clinical medicine, Coronary thrombosis, [SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, Internal medicine, medicine, ST segment, 030212 general & internal medicine, Myocardial infarction, thrombosis, business.industry, Percutaneous coronary intervention, medicine.disease, 3. Good health, reperfusion, myocardial infarction, stents, Conventional PCI, platelets, Cardiology, Platelet aggregation inhibitor, Cardiology and Cardiovascular Medicine, business, Ticagrelor, TIMI, medicine.drug
Abstract

Objectives The aim of this landmark exploratory analysis, ATLANTIC-H 24 , was to evaluate the effects of pre-hospital ticagrelor during the first 24 h after primary percutaneous coronary intervention (PCI) in the ATLANTIC (Administration of Ticagrelor in the cath Lab or in the Ambulance for New ST elevation myocardial infarction to open the Coronary artery) study. Background The ATLANTIC trial in patients with ongoing ST-segment elevation myocardial infarction showed that pre-hospital ticagrelor was safe but did not improve pre-PCI coronary reperfusion compared with in-hospital ticagrelor. We hypothesized that the effect of pre-hospital ticagrelor may not have manifested until after PCI due to the rapid transfer time (31 min). Methods The ATLANTIC-H 24 analysis included 1,629 patients who underwent PCI, evaluating platelet reactivity, Thrombolysis In Myocardial Infarction flow grade 3, ≥70% ST-segment elevation resolution, and clinical endpoints over the first 24 h. Results Following PCI, largest between-group differences in platelet reactivity occurred at 1 to 6 h; coronary reperfusion rates numerically favored pre-hospital ticagrelor, and the degree of ST-segment elevation resolution was significantly greater in the pre-hospital group (median, 75.0% vs. 71.4%; p = 0.049). At 24 h, the composite ischemic endpoint was lower with pre-hospital ticagrelor (10.4% vs. 13.7%; p = 0.039), as were individual endpoints of definite stent thrombosis (p = 0.0078) and myocardial infarction (p = 0.031). All endpoints except death (1.1% vs. 0.2%; p = 0.048) favored pre-hospital ticagrelor, with no differences in bleeding events. Conclusions The effects of pre-hospital ticagrelor became apparent after PCI, with numerical differences in platelet reactivity and immediate post-PCI reperfusion, associated with reductions in ischemic endpoints, over the first 24 h, whereas there was a small excess of mortality. (Administration of Ticagrelor in the cath Lab or in the Ambulance for New ST elevation myocardial infarction to open the Coronary artery [ATLANTIC, NCT01347580 ])

Published
2016
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3. Prehospital ticagrelor in ST-segment elevation myocardial infarction

Author

Gilles, Montalescot, Arnoud W, van 't Hof, Frédéric, Lapostolle, Johanne, Silvain, Jens Flensted, Lassen, Leonardo, Bolognese, Warren J, Cantor, Angel, Cequier, Mohamed, Chettibi, Shaun G, Goodman, Christopher J, Hammett, Kurt, Huber, Magnus, Janzon, Béla, Merkely, Robert F, Storey, Uwe, Zeymer, Olivier, Stibbe, Patrick, Ecollan, Wim M J M, Heutz, Eva, Swahn, Jean-Philippe, Collet, Frank F, Willems, Caroline, Baradat, Muriel, Licour, Anne, Tsatsaris, Eric, Vicaut, Christian W, Hamm, Angeles Alonso, Garcia, and Universitat de Barcelona

Subjects
Male, medicine.medical_specialty, Ticagrelor, Emergency Medical Services, Randomization, Adenosine, Ticlopidine, Adenosina, Myocardial Infarction, Hemorrhage, Myocardial Reperfusion, Malalties coronàries, Coronary Angiography, law.invention, Time-to-Treatment, Coronary diseases, Electrocardiography, Randomized controlled trial, Double-Blind Method, law, Internal medicine, medicine, ST segment, Humans, Myocardial infarction, Aged, business.industry, Anticoagulants, General Medicine, Middle Aged, medicine.disease, Clopidogrel, Surgery, Infart de miocardi, Conventional PCI, Cardiology, Anticoagulants (Medicina), Purinergic P2Y Receptor Antagonists, Drug Therapy, Combination, Female, Myocardial infarction diagnosis, Anticoagulants (Medicine), business, medicine.drug
Abstract

BACKGROUND: The direct-acting platelet P2Y12 receptor antagonist ticagrelor can reduce the incidence of major adverse cardiovascular events when administered at hospital admission to patients with ST-segment elevation myocardial infarction (STEMI). Whether prehospital administration of ticagrelor can improve coronary reperfusion and the clinical outcome is unknown.METHODS: We conducted an international, multicenter, randomized, double-blind study involving 1862 patients with ongoing STEMI of less than 6 hours' duration, comparing prehospital (in the ambulance) versus in-hospital (in the catheterization laboratory) treatment with ticagrelor. The coprimary end points were the proportion of patients who did not have a 70% or greater resolution of ST-segment elevation before percutaneous coronary intervention (PCI) and the proportion of patients who did not have Thrombolysis in Myocardial Infarction flow grade 3 in the infarct-related artery at initial angiography. Secondary end points included the rates of major adverse cardiovascular events and definite stent thrombosis at 30 days.RESULTS: The median time from randomization to angiography was 48 minutes, and the median time difference between the two treatment strategies was 31 minutes. The two coprimary end points did not differ significantly between the prehospital and in-hospital groups. The absence of ST-segment elevation resolution of 70% or greater after PCI (a secondary end point) was reported for 42.5% and 47.5% of the patients, respectively. The rates of major adverse cardiovascular events did not differ significantly between the two study groups. The rates of definite stent thrombosis were lower in the prehospital group than in the in-hospital group (0% vs. 0.8% in the first 24 hours; 0.2% vs. 1.2% at 30 days). Rates of major bleeding events were low and virtually identical in the two groups, regardless of the bleeding definition used.CONCLUSIONS: Prehospital administration of ticagrelor in patients with acute STEMI appeared to be safe but did not improve pre-PCI coronary reperfusion. (Funded by AstraZeneca; ATLANTIC ClinicalTrials.gov number, NCT01347580.).

Published
2014
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