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Since 2014, a trauma system (TS) for the Provence-Alpes-Cote-d'Azur (PACA) region has been set up with protocols based on the European guidelines for the management of bleeding trauma patients. The present study aims to assess compliance with protocols in penetrating thoracic trauma on admission to a level I trauma centre and to determine whether compliance impacts morbidity and mortality.This multicentric pre-post study included all penetrating thoracic trauma patients referred to Marseille area level I centres between January 2009 and December 2019. On the basis of the European guidelines, eight objectively measurable recommendations concerning the in-hospital trauma care for the first 24 h were analysed. Per-patient and per-criterion compliance rates and their impact on morbidity and mortality were evaluated before and after TS implementation.A total of 426 patients were included. No differences between the two groups (before and after 2014) were reported for demographics or injury severity. The median (interquartile range) per-patient compliance rate increased from 67% [0.50; 0.75] to 75% [0.67; 1.0] (p 0.01) after implementation of a TS. The 30-day morbidity-mortality was, respectively, of 17% (30/173) and 13% (32/253) (p = 0.18) before and after TS implementation. A low per-patient compliance rate was associated with an increase in the 30-day morbidity-mortality rate (p 0.01). Severity score-adjusted per-patient compliance rates were associated with decreased 30-day morbidity-mortality (odds ratio [IC 95%] = 0.98 [0.97; 0.99] p = 0.01).Implementation of a TS was associated with better compliance to European recommendations and better outcomes for severe trauma patients. These findings should encourage strict adherence to European trauma protocols to ensure the best patient outcomes.

Introdução: A doença cardiovascular é a principal causa de óbito no Brasil. O tratamento para doença aterosclerótica coronária (DAC) inclui a terapêutica medicamentosa isolada ou associada a intervenção, que pode ser percutânea ou cirúrgica. O risco de óbito intra-hospitalar após cirurgia de revascularização miocárdica (CRM), pode ser avaliado por meio da identificação de fatores préoperatórios e quantificado através de escores. Objetivo: Analisar previamente à cirurgia os elementos relacionados a mortalidade na fase hospitalar após CRM isolada e desenvolver um escore de risco pré-operatório (ERPO). Métodos: Estudo observacional, retrospectivo, unicêntrico, realizado do Instituto Dante Pazzanese de Cardiologia (IDPC). Foram analisadas comorbidades e exames complementares prévios dos 9.826 pacientes submetidos à CRM isolada no IDPC no período de 01/01/1999 a 31/12/2017 e sua correlação com óbito hospitalar no pós-operatório. Para a construção do escore, os pacientes foram divididos em dois grupos, sendo o primeiro denominado grupo construção com 7.860 (80%) dos indivíduos e o segundo grupo validação com 1966 (20%). Resultados: A média de idade entre os pacientes foi de 62,43 anos. O sexo mais prevalente foi o masculino (70,2%). Foram identificados 15 fatores independentemente relacionados à mortalidade hospitalar. O modelo logístico final foi calculado no grupo construção com um C-statistic de 0,745 (intervalo de confiança [IC] de 95%, 0,720-0,770) e no grupo validação foi testado o escore obtendo área da curva ROC de 0,716 (IC 95%, 0,666-0,767). O risco de óbito variou de 1,2% naqueles considerados de baixo risco, até 16,3% entre os considerados de risco muito alto pelo ERPO. O desfecho óbito ocorreu em 489 pacientes (5%). Conclusão: O ERPO mostrou, na população estudada, possuir um bom poder de discriminação em definir aqueles que são considerados de baixo, intermediário, alto e muito alto risco para óbito no pós-operatório, podendo servir então como ferramenta auxiliar no pré-operatório para o médico/equipe assistente. Background: Cardiovascular disease is the leading cause of death in Brazil. Treatment for coronary atherosclerotic disease (CAD) includes drug therapy alone or associated with intervention, which can be percutaneous or surgical. The risk of in-hospital death after coronary artery bypass grafting (CABG) can be assessed by identifying preoperative factors and quantified through scores. Objectives: Analyze prior surgery the elements related to mortality in the hospital phase after isolated CABG and develop a preoperative risk score (ERPO). Methods: Observational, retrospective, single-center study conducted by the Dante Pazzanese Institute of Cardiology (IDPC). Comorbidities and previous complementary exams of 9,826 patients undergoing isolated CABG at IDPC from 01/01/1999 to 12/31/2017 were analyzed and their correlation with postoperative hospital death. For the score building, patients were divided into two groups, the first being called the construction group with 7,860 (80%) of the individuals and the second validation group with 1,966 (20%). Results: The mean age among patients was 62.43 years. The most prevalent sex was male (70.2%). 15 independently related factors were identified to hospital mortality. The final logistic model was calculated in the construction group with a C-statistic of 0.745 (95% confidence interval [CI], 0.720-0.770) and in the validation group, the score was tested, obtaining area under the curve (AUC) of 0.716 (95% CI, 0.666-0.767). The risk of death ranged from 1.2% in those considered to be of low risk, to 16.3% among those considered to be at very high risk by ERPO. The death outcome occurred in 489 patients (5%). Conclusion: The ERPO showed, in the studied population, to have a good power of discrimination in defining those who are considered low, intermediate, high and very high risk for death in the postoperative period, and can then serve as an auxiliary tool in the preoperative period for the doctor/assistant team.

Objective The ongoing coronavirus disease-2019 pandemic leads to the saturation of critical care facilities worldwide. Collective aeromedical evacuations (MEDEVACS) might help rebalance the demand and supply of health care. If interhospital transport of patients suffering from ARDS is relatively common, little is known about the specific challenges of collective medevac. Oxygen management in such context is crucial. We describe our experience with a focus on this resource. Methods We retrospectively analyzed the first six collective medevac performed during the coronavirus disease-2019 pandemic by the French Military Health Service from March 17 to April 3, 2020. Oxygen management was compliant with international guidelines as well as aeronautical constraints and monitored throughout the flights. Presumed high O2 consumers were scheduled to board the last and disembark the first. Results Thirty-six mechanically ventilated patients were successfully transported within Europe. The duration of onboard ventilation was 185 minutes (145-198.5 minutes), including the flight, the boarding and disembarking periods. Oxygen intake was 1,650 L per patient per flight (1,350-1,950 L patient per flight) and 564 L per patient per hour (482-675 L per patient−1 per hour) and surpassed our anticipation. As anticipated, presumed high O2 consumers had a reduced ventilation duration onboard. The estimations of oxygen consumptions were frequently overshot, and only two hypoxemia episodes occurred. Conclusion Oxygen consumption was higher than expected, despite anticipation and predefined oxygen management measures, and encourages to a great caution in the processing of such collective medevac missions.

Background In early 2020, the coronavirus disease 2019 (COVID-19) pandemic outbreak has posed the risk of critical care resources overload in every affected country. Collective interhospital transport of critically ill COVID-19 patients as a way to mitigate the localised pressure from overloaded intensive care units at a national or international level has not been reported yet. The aim of this study was to provide descriptive data about the first six collective aeromedical evacuation (MEDEVAC) of COVID-19 patients performed within Europe. Methods This retrospective study included all adult patients transported by the first six collective MEDEVAC missions for COVID-19 patients performed within Europe on the 18th, 21st, 24th, 27th, 31st of March and the 3rd of April 2020. Results Thirty-six patients with acute respiratory distress syndrome (ARDS) were transported aboard six MEDEVAC missions. The median duration of mechanical ventilation in ICU before transportation was 4 days (3−5.25). The median PaO2/FiO2 ratio obtained before, during the flight and at day 1 after the transport was 180 mmHg (156–202,5), 143 mmHg (118,75–184,75) and 174 mmHg (129,5–205,5), respectively, with no significant difference. The median norepinephrine infusion rate observed before, during the flight and at day 1 after the transport was 0,08 µg/kg-1. min-1 (0,00-0,20), 0,08 (0,00-0,25), and 0,07 (0,03-0,18), respectively, with no significant difference. No life-threatening event was reported. Conclusion Collective aero-MEDEVAC of COVID-19 critically ill patients could provide a reliable solution to help control the burden of the disease at a national or international level.

International audience

Acute erythroleukemia (AEL) is a rare disease typically associated with a poor prognosis. The median survival ranges between 3-9 months from initial diagnosis. Hypomethylating agents (HMAs) have been shown to prolong survival in patients with myelodysplastic syndromes (MDS) and AML, but there is limited data of their efficacy in AEL. We collected data from 210 AEL patients treated at 28 international sites. Overall survival (OS) and PFS were estimated using the Kaplan-Meier method and the log-rank test was used for subgroup comparisons. Survival between treatment groups was compared using the Cox proportional hazards regression model. Eighty-eight patients were treated with HMAs, 44 front line, and 122 with intensive chemotherapy (ICT). ICT led to a higher overall response rate (complete or partial) compared to first-line HMA (72% vs. 46.2%, respectively; p, Publication costs were supported by the University of Salzburg.