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1. Welcome to the operating theatre! Introductory bootcamp in operating theatre specialities for medical students

Author

Etienne Buscail, Manon Bolzinger, Jason Shourick, Marie Laure Lier, Phillipe Sautier, Magali Delhoste, Fabrice Muscari, Nicolas Carrère, Charlotte Maulat, Yoann Dalmas, Pierre Brinas, Thomas Prudhomme, Cyril Podio, Charles-Henri Houze-Cerfon, Odile Rauzy, Thomas Geeraerts, and Olivier Abbo

Subjects
Undergraduate Medical Education, Surgical Education, Anaesthesia Education, Medical Students, Career, Stereotype, Special aspects of education, LC8-6691, Medicine
Abstract

Abstract Introduction Since the early 2000's, the appeal of certain operating room specialties has decreasedamong medical school graduate students. The recent reform of the second and third cycles of medical studies in France provides an opportunity to set up teaching programs around operating room specialties. We have organised a teaching unit which is part of the final year of medical studies. The main objectives are: (1) to examine whether a boot camp can modify students’ opinions and preconceived assumptions about a surgical and/or anaesthetist career (2) to determine whether these changes in perception, have an impact on students' interest in pursuing a surgical/anaesthetic career compared with the current situation. Materials and methods The “working in the operating theatre” boot camp (UETB) took place after the written exams of the sixth year of medical school, before students choose their future specialty for residency. This program included practical workshops, readings and time for exchanges surgeons and anaesthetists. At the beginning and at the end of the UETB, feedback forms were collected. Results The cohort included 59 students from the Toulouse medical school, academic year 2023–2024. After attending the UETB, there was a significant qualitative improvement in interest in a surgical and intensive care-anaesthesia career. Feedback on how the UETB influenced the choice of a future specialty was very positive, with statistically significant qualitive improvement., Additionally, the students’ perception of a work-life quality as a surgeon and/or anaesthetist improved significantly. Conclusion The outcome of this study makes a strong case for integrating additional exposure to the various surgical subspecialties into the graduate medical curriculum in France. By helping to dispel misperceptions of “a surgical/anaesthetist career” early on, opportunities such as the UETB program may enable addressing the attrition rate observed among surgical and anaesthetic residency applications.

Published
2024
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2. The Effects of Antioxidant Cocktail on Ophthalmological Changes Induced by a 60-Day Head-Down Bed Rest in a Randomized Trial

Author

Marc Kermorgant, Fanny Varenne, Anne Pavy-Le Traon, Thomas Geeraerts, Lisa Barioulet, Pierre Fournié, Rebecca Billette de Villemeur, Marie-Pierre Bareille, Arnaud Beck, Adrianos Golemis, Inês Antunes, Guillemette Gauquelin-Koch, Vincent Soler, and Jean-Claude Quintyn

Subjects
optical coherence tomography, optic nerve sheath diameter, intraocular pressure, head-down bed rest, countermeasure, microgravity, Science
Abstract

Neuro-ophthalmological changes have been reported after prolonged exposure to microgravity; however, the pathophysiology remains unclear. Furthermore, several countermeasures have been suggested to counteract the side effects of microgravity. The objectives of the present study were twofold: (1) to assess the neuro-ophthalmological impact of 60 days of head-down bed rest (HDBR) and (2) to determine the potential effects of an antioxidant cocktail. In this case, 20 healthy male subjects completed a 60-day HDBR and were randomly allocated into two groups: a control condition without an antioxidant cocktail (CON) and a condition with an antioxidant cocktail (NUT). The retinal nerve fibre layer thickness (RNFLT) and central retinal thickness (CRT) were assessed with spectral domain optical coherence tomography. The optic nerve sheath diameter (ONSD) was measured by ocular ultrasonography and used to assess indirect changes in the intracranial pressure (ICP). The intraocular pressure (IOP) was assessed by Goldmann applanation tonometry. The CRT tended to be reduced after HDBR. The ONSD was increased at the end and after HDBR. The IOP tended to decrease after HDBR. Finally, the antioxidant cocktail had minor impacts on the ophthalmological changes induced by HDBR. It is worth noting that two participants presented peripapillary edema.

Published
2024
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3. Postoperative outcomes after total sevoflurane inhalation sedation using a disposable delivery system (Sedaconda-ACD) in cardiac surgery

Author

François Labaste, Paul Cauquil, Magda Lestarquit, Pascale Sanchez-Verlaan, Abdulrahman Aljuayli, Bertrand Marcheix, Thomas Geeraerts, Fabrice Ferre, Fanny Vardon-Bounes, and Vincent Minville

Subjects
sevoflurane, cardiovascular surgery, troponin, Sedaconda, cardiac surgery, Medicine (General), R5-920
Abstract

IntroductionThe COVID-19 pandemic prompted our team to develop new solutions for performing cardiac surgery without intravenous anesthetics due to a shortage of these drugs. We utilized an anesthetic conserving device (Sedaconda-ACD) to administer total inhaled anesthesia because specific vaporizers were unavailable for administering inhaled agents during cardiopulmonary bypass (CPB) in our center. We documented our experience and postoperative cardiovascular outcomes. The primary outcome was the peak level of troponin, with secondary outcomes encompassing other cardiovascular complications.Material and methodsA single-center retrospective study was conducted. We performed a multivariate analysis with a propensity score. This investigation took place at a large university referral center.ParticipantsAdult patients (age ≥ 18) who underwent elective cardiac surgery with CPB between June 2020 to March 2021.InterventionDuring the inclusion period, two anesthesia protocols for the maintenance of anesthesia coexisted—total inhaled anesthesia with Sedaconda-ACD and our classic protocol with intravenous drugs during and after CPB.Primary endpointTroponin peak level recorded after surgery (highest level recorded within 48 h following the surgery).ResultsOut of the 654 included patients, 454 were analyzed after matching (intravenous group = 297 and inhaled group = 157). No significant difference was found between the groups in postoperative troponin peak levels (723 ng/l vs. 993 ng/l–p = 0.2). Total inhaled anesthesia was associated with a decreased requirement for inotropic medications (OR = 0.53, 95% CI 0.29–0.99, p = 0.04).ConclusionIn our cohort, the Sedaconda-ACD device enabled us to achieve anesthesia without intravenous agents, and we did not observe any increase in postoperative complications. Total inhaled anesthesia with sevoflurane was not associated with a lower incidence of myocardial injury assessed by the postoperative troponin peak level. However, in our cohort, the use of inotropic drugs was lower.

Published
2024
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4. Epidemiology and outcome predictors in 450 patients with hanging-induced cardiac arrest: a retrospective study

Author

Marie Salvetti, Guillaume Schnell, Nicolas Pichon, Maleka Schenck, Pierrick Cronier, Sebastien Perbet, Jean-Baptiste Lascarrou, Christophe Guitton, Olivier Lesieur, Laurent Argaud, Gwenhael Colin, Bernard Cholley, Jean-Pierre Quenot, Hamid Merdji, Thomas Geeraerts, Michael Piagnerelli, Gwenaelle Jacq, Marine Paul, Jonathan Chelly, Louise de Charentenay, Nicolas Deye, Marc Danguy des Déserts, Guillaume Thiery, Marc Simon, Vincent Das, Frederic Jacobs, Charles Cerf, Julien Mayaux, Pascal Beuret, Abdelkader Ouchenir, Antoine Lafarge, Bertrand Sauneuf, Cedric Daubin, Alain Cariou, Stein Silva, and Stephane Legriel

Subjects
near-hanging, intensive care unit, coma/therapy, outcome, cardiopulmonary resuscitation, Neurology. Diseases of the nervous system, RC346-429
Abstract

BackgroundCardiac arrest is the most life-threatening complication of attempted suicide by hanging. However, data are scarce on its characteristics and outcome predictors.MethodsThis retrospective observational multicentre study in 31 hospitals included consecutive adults admitted after cardiac arrest induced by suicidal hanging. Factors associated with in-hospital mortality were identified by multivariate logistic regression with multiple imputations for missing data and adjusted to the temporal trends over the study period.ResultsOf 450 patients (350 men, median age, 43 [34–52] years), 305 (68%) had a psychiatric history, and 31 (6.9%) attempted hanging while hospitalized. The median time from unhanging to cardiopulmonary resuscitation was 0 [0–5] min, and the median time to return of spontaneous circulation (ROSC) was 20 [10–30] min. Seventy-nine (18%) patients survived to hospital discharge. Three variables were independently associated with higher in-hospital mortality: time from collapse or unhanging to ROSC>20 min (odds ratio [OR], 4.71; 95% confidence intervals [95%CIs], 2.02–10.96; p = 0.0004); glycaemia >1.4 g/L at admission (OR, 6.38; 95%CI, 2.60–15.66; p < 0.0001); and lactate >3.5 mmol/L at admission (OR, 6.08; 95%CI, 1.71–21.06; p = 0.005). A Glasgow Coma Scale (GCS) score of >5 at admission was associated with lower in-hospital mortality (OR, 0.009; 95%CI, 0.02–0.37; p = 0.0009).ConclusionIn patients with hanging-induced cardiac arrest, time from collapse or unhanging to return of spontaneous circulation, glycaemia, arterial lactate, and coma depth at admission were independently associated with survival to hospital discharge. Knowledge of these risk factors may help guide treatment decisions in these patients at high risk of hospital mortality.

Published
2023
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5. Is it valid to assess an individual’s performance in team training simulation when the supporting team are confederates? A controlled and randomized clinical trial

Author

Jérémie Traoré, Frédéric Balen, Thomas Geeraerts, Sandrine Charpentier, Xavier Dubucs, and Charles-Henri Houzé-Cerfon

Subjects
Health education, Simulation training, Interprofessional education, Crisis resource management, Emergency medicine, Special aspects of education, LC8-6691, Medicine
Abstract

Background During simulation training, the confederate is a member of the pedagogical team. Its role is to facilitate the interaction between participants and the environment, and is thought to increase realism and immersion. Its influence on participants' performance in full-scale simulation remains however unknown. The purpose of this study was to observe the effect of the presence of confederates on the participants’ performance during full-scale simulation of crisis medical situations. Methods This was a prospective, randomized study comparing 2 parallel groups. Participants were emergency medicine residents engaging in a simulation session, with or without confederates. Participants were then evaluated on their Crisis Resource Management performance (CRM). The overall performance score on the Ottawa Global Rating Scale was assessed as primary outcome and the 5 non-technical CRM skills as secondary outcomes. Results A total of 63 simulation sessions, including 63 residents, were included for statistical analysis (n = 32 for Control group and 31 for Confederate group). The mean Overall Performance score was 3.9 ± 0.8 in the Control group and 4.0 ± 1.1 in the Confederate group, 95% confidence interval of the difference [-0.6; 0.4], p = 0.60. No significant differences between the two groups were observed on each CRM items (leadership, situational awareness, communication, problem solving, resource utilization) Conclusion In this randomized and controlled study, the presence of confederates during full-scale simulated practice of crisis medical situations does not seem to influence the CRM skills performance of Emergency medicine residents. Trial registration This study does not need to be registered on Clintrial as it does not report a health care intervention on human participants.

Published
2022
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6. Effect of an individualized versus standard blood pressure management during mechanical thrombectomy for anterior ischemic stroke: the DETERMINE randomized controlled trial

Author

Benjamin Maïer, Benjamin Gory, Russell Chabanne, Benoît Tavernier, Baptiste Balanca, Gérard Audibert, Laurie-Anne Thion, Morgan Le Guen, Thomas Geeraerts, Lionel Calviere, Vincent Degos, Bertrand Lapergue, Sebastien Richard, Azeddine Djarallah, Ornellia Mophawe, Perrine Boursin, Chloé Le Cossec, Raphael Blanc, Michel Piotin, Mikael Mazighi, Etienne Gayat, and on behalf of the DETERMINE Investigators

Subjects
Stroke, Blood pressure, Thrombectomy, Disability, Mean arterial pressure, Circulation, Medicine (General), R5-920
Abstract

Abstract Background Hypotension and blood pressure (BP) variability during endovascular therapy (EVT) for acute ischemic stroke (AIS) due to an anterior large vessel occlusion (LVO) is associated with worse outcomes. However, the optimal BP threshold during EVT is still unknown given the lack of randomized controlled evidence. We designed the DETERMINE trial to assess whether an individualized BP management during EVT could achieve better functional outcomes compared to a standard BP management. Methods The DETERMINE trial is a multicenter, prospective, randomized, controlled, open-label, blinded endpoint clinical trial (PROBE design). AIS patients with a proximal anterior LVO are randomly assigned, in a 1:1 ratio, to an experimental arm in which mean arterial pressure (MAP) is maintained within 10% of the first MAP measured before EVT, or a control arm in which systolic BP (SBP) is maintained within 140–180 mm Hg until reperfusion is achieved or artery closure in case of EVT failure. The primary outcome is the rate of favorable functional outcomes, defined by a modified Rankin Scale (mRS) between 0 and 2 at 90 days. Secondary outcomes include excellent outcome and ordinal analysis of the mRS at 90 days, early neurological improvement at 24 h (National Institutes of Health Stroke Scale), final infarct volume, symptomatic intracranial hemorrhage rates, and all-cause mortality at 90 days. Overall, 432 patients will be included. Discussion DETERMINE will assess the clinical relevance of an individualized BP management before reperfusion compared to the one size fits all approach currently recommended by international guidelines. Trial registration ClinicalTrials.gov , NCT04352296. Registered on 20th April 2020.

Published
2022
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7. Is there a benefit for anesthesiologists of adding difficult airway scenarios for learning fiberoptic intubation skills using virtual reality training? A randomized controlled study.

Author

Loic Cailleau, Thomas Geeraerts, Vincent Minville, Olivier Fourcade, Thomas Fernandez, Jean Etienne Bazin, Linden Baxter, Vassilis Athanassoglou, Henry Jefferson, Anika Sud, Tim Davies, Cyprian Mendonca, Matteo Parotto, and Matt Kurrek

Subjects
Medicine, Science
Abstract

Fiberoptic intubation for a difficult airway requires significant experience. Traditionally only normal airways were available for high fidelity bronchoscopy simulators. It is not clear if training on difficult airways offers an advantage over training on normal airways. This study investigates the added value of difficult airway scenarios during virtual reality fiberoptic intubation training. A prospective multicentric randomized study was conducted 2019 to 2020, among 86 inexperienced anesthesia residents, fellows and staff. Two groups were compared: Group N (control, n = 43) first trained on a normal airway and Group D (n = 43) first trained on a normal, followed by three difficult airways. All were then tested by comparing their ORSIM® scores on 5 scenarios (1 normal and 4 difficult airways). The final evaluation ORSIM® score for the normal airway testing scenario was significantly higher for group N than group D: median score 76% (IQR 56.5-90) versus 58% (IQR 51.5-69, p = 0.0039), but there was no difference in ORSIM® scores for the difficult intubation testing scenarios. A single exposure to each of 3 different difficult airway scenarios did not lead to better fiberoptic intubation skills on previously unseen difficult airways, when compared to multiple exposures to a normal airway scenario. This finding may be due to the learning curve of approximately 5-10 exposures to a specific airway scenario required to reach proficiency.

Published
2023
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8. Perioperative Risk Assessment of Patients Using the MyRISK Digital Score Completed Before the Preanesthetic Consultation: Prospective Observational Study

Author

Fabrice Ferré, Rodolphe Laurent, Philippine Furelau, Emmanuel Doumard, Anne Ferrier, Laetitia Bosch, Cyndie Ba, Rémi Menut, Matt Kurrek, Thomas Geeraerts, Antoine Piau, and Vincent Minville

Subjects
Computer applications to medicine. Medical informatics, R858-859.7, Surgery, RD1-811
Abstract

BackgroundThe ongoing COVID-19 pandemic has highlighted the potential of digital health solutions to adapt the organization of care in a crisis context. ObjectiveOur aim was to describe the relationship between the MyRISK score, derived from self-reported data collected by a chatbot before the preanesthetic consultation, and the occurrence of postoperative complications. MethodsThis was a single-center prospective observational study that included 401 patients. The 16 items composing the MyRISK score were selected using the Delphi method. An algorithm was used to stratify patients with low (green), intermediate (orange), and high (red) risk. The primary end point concerned postoperative complications occurring in the first 6 months after surgery (composite criterion), collected by telephone and by consulting the electronic medical database. A logistic regression analysis was carried out to identify the explanatory variables associated with the complications. A machine learning model was trained to predict the MyRISK score using a larger data set of 1823 patients classified as green or red to reclassify individuals classified as orange as either modified green or modified red. User satisfaction and usability were assessed. ResultsOf the 389 patients analyzed for the primary end point, 16 (4.1%) experienced a postoperative complication. A red score was independently associated with postoperative complications (odds ratio 5.9, 95% CI 1.5-22.3; P=.009). A modified red score was strongly correlated with postoperative complications (odds ratio 21.8, 95% CI 2.8-171.5; P=.003) and predicted postoperative complications with high sensitivity (94%) and high negative predictive value (99%) but with low specificity (49%) and very low positive predictive value (7%; area under the receiver operating characteristic curve=0.71). Patient satisfaction numeric rating scale and system usability scale median scores were 8.0 (IQR 7.0-9.0) out of 10 and 90.0 (IQR 82.5-95.0) out of 100, respectively. ConclusionsThe MyRISK digital perioperative risk score established before the preanesthetic consultation was independently associated with the occurrence of postoperative complications. Its negative predictive strength was increased using a machine learning model to reclassify patients identified as being at intermediate risk. This reliable numerical categorization could be used to objectively refer patients with low risk to teleconsultation.

Published
2023
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9. Rebleeding After Aneurysmal Subarachnoid Hemorrhage in Two Centers Using Different Blood Pressure Management Strategies

Author

Lionel Calviere, Celine S. Gathier, Marie Rafiq, Inez Koopman, Vanessa Rousseau, Nicolas Raposo, Jean François Albucher, Alain Viguier, Thomas Geeraerts, Christophe Cognard, Gabriel J. E. Rinkel, Mervyn D. I. Vergouwen, and Jean-Marc Olivot

Subjects
rebleeding, intracranial aneurysm, subarachnoid hemorrhage, blood pressure, delayed cerebral ischemia, Neurology. Diseases of the nervous system, RC346-429
Abstract

BackgroundHigh systolic blood pressure (SBP) after aneurysmal subarachnoid hemorrhage (aSAH) has been associated with an increased risk of rebleeding. It remains unclear if an SBP lowering strategy before aneurysm treatment decreases this risk without increasing the risk of a delayed cerebral ischemia (DCI). Therefore, we compared the rates of in-hospital rebleeding and DCI among patients with aSAH admitted in two tertiary care centers with different SBP management strategies.MethodsRetrospective cohort study. Consecutive patients from Utrecht and Toulouse admitted within 24 h after the aSAH onset were enrolled. In Toulouse, the target SBP before aneurysm treatment was ≤140 mm Hg, while, in Utrecht, an increased SBP was only treated in extreme situations. We compared SBP levels, the incidence of rebleeding within 24 h after admission, and DCI during hospitalization.ResultsWe enrolled 373 patients in Utrecht and 149 in Toulouse. The mean SBP on admission was similar but lower in Toulouse 4 h after admission (127.3 ± 17.4 vs. 138. ± 25.7 mmHg; p < 0.0001). After a median delay of 3.7 h (IQR, 2.3–7.4) from admission, 4 patients (3%) in Toulouse vs. 29 (8%) in Utrecht experienced a rebleeding. After adjustment for Prognosis on Admission of Aneurysmal Subarachnoid Hemorrhage (PAASH) score, aneurysm size, age, and delay from ictus to admission, the HR was 0.66 (95% CI: 0.23–1.92). Incidence of DCI was 18% in Toulouse and 25% in Utrecht (adjusted OR, 0.68; 95% CI: 0.41–1.11).ConclusionOur results suggest that an intensive SBP lowering strategy between admission and aneurysm treatment does not decrease the risk of rebleeding and does not increase the risk of DCI compared to a more conservative strategy.

Published
2022
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12. Management of Cerebral Venous Thrombosis Due to Adenoviral COVID-19 Vaccination

Author

Adrian Scutelnic, Katarzyna Krzywicka, Joshua Mbroh, Anita van de Munckhof, Mayte Sánchez van Kammen, Diana Aguiar de Sousa, Erik Lindgren, Katarina Jood, Albrecht Günther, Sini Hiltunen, Jukka Putaala, Andreas Tiede, Frank Maier, Rolf Kern, Thorsten Bartsch, Katharina Althaus, Alfonso Ciccone, Markus Wiedmann, Mona Skjelland, Antonio Medina, Elisa Cuadrado‐Godia, Thomas Cox, Avinash Aujayeb, Nicolas Raposo, Katia Garambois, Jean‐Francois Payen, Fabrice Vuillier, Guillaume Franchineau, Serge Timsit, David Bougon, Marie‐Cécile Dubois, Audrey Tawa, Clement Tracol, Emmanuel De Maistre, Fabrice Bonneville, Caroline Vayne, Annerose Mengel, Dominik Michalski, Johann Pelz, Matthias Wittstock, Felix Bode, Julian Zimmermann, Judith Schouten, Alina Buture, Sean Murphy, Vincenzo Palma, Alberto Negro, Alexander Gutschalk, Simon Nagel, Silvia Schoenenberger, Giovanni Frisullo, Carla Zanferrari, Francesco Grillo, Fabrizio Giammello, Mar Morin Martin, Alvaro Cervera, Jim Burrow, Carlos Garcia Esperon, Beng Lim Alvin Chew, Timothy J. Kleinig, Cristina Soriano, Domenico S. Zimatore, Marco Petruzzellis, Ahmed Elkady, Miguel S. Miranda, João Fernandes, Åslög Hellström Vogel, Elias Johansson, Anemon Puthuppallil Philip, Shelagh B. Coutts, Simerpreet Bal, Brian Buck, Catherine Legault, Dylan Blacquiere, Hans D. Katzberg, Thalia S. Field, Vanessa Dizonno, Thomas Gattringer, Christian Jacobi, Annemie Devroye, Robin Lemmens, Espen Saxhaug Kristoffersen, Monica Bandettini di Poggio, Masoud Ghiasian, Theodoros Karapanayiotides, Sophie Chatterton, Miriam Wronski, Karl Ng, Robert Kahnis, Thomas Geeraerts, Peggy Reiner, Charlotte Cordonnier, Saskia Middeldorp, Marcel Levi, Eric C. M. van Gorp, Diederik van de Beek, Justine Brodard, Johanna A. Kremer Hovinga, Marieke J. H. A. Kruip, Turgut Tatlisumak, José M. Ferro, Jonathan M. Coutinho, Marcel Arnold, Sven Poli, Mirjam R. Heldner, Virology, Hematology, HUS Neurocenter, Department of Neurosciences, University of Helsinki, Neurologian yksikkö, Clinicum, Neurology, Graduate School, ACS - Atherosclerosis & ischemic syndromes, ANS - Neurovascular Disorders, Vascular Medicine, ACS - Pulmonary hypertension & thrombosis, ARD - Amsterdam Reproduction and Development, ANS - Neuroinfection & -inflammation, AII - Infectious diseases, and Repositório da Universidade de Lisboa

Subjects
SINUS THROMBOSIS, Venous Thrombosis, COVID-19 Vaccines, SARS-CoV-2, Vascular damage Radboud Institute for Health Sciences [Radboudumc 16], Vaccination, 3112 Neurosciences, Embòlia i trombosi cerebral, Anticoagulants, COVID-19, Immunoglobulins, Intravenous, 610 Medicine & health, Hematology, Vacunes, COVID-19 (Malaltia), 3124 Neurology and psychiatry, Adenoviridae, Neurology, SDG 3 - Good Health and Well-being, Humans, Hematologi, Neurology (clinical), Intracranial Thrombosis
Abstract

© 2022 The Authors. Annals of Neurology published by Wiley Periodicals LLC on behalf of American Neurological Association.562 This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made., Objective: Cerebral venous thrombosis (CVT) caused by vaccine-induced immune thrombotic thrombocytopenia (VITT) is a rare adverse effect of adenovirus-based severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2) vaccines. In March 2021, after autoimmune pathogenesis of VITT was discovered, treatment recommendations were developed. These comprised immunomodulation, non-heparin anticoagulants, and avoidance of platelet transfusion. The aim of this study was to evaluate adherence to these recommendations and its association with mortality. Methods: We used data from an international prospective registry of patients with CVT after the adenovirus-based SARS-CoV-2 vaccination. We analyzed possible, probable, or definite VITT-CVT cases included until January 18, 2022. Immunomodulation entailed administration of intravenous immunoglobulins and/or plasmapheresis. Results: Ninety-nine patients with VITT-CVT from 71 hospitals in 17 countries were analyzed. Five of 38 (13%), 11 of 24 (46%), and 28 of 37 (76%) of the patients diagnosed in March, April, and from May onward, respectively, were treated in-line with VITT recommendations (p < 0.001). Overall, treatment according to recommendations had no statistically significant influence on mortality (14/44 [32%] vs 29/55 [52%], adjusted odds ratio [OR] = 0.43, 95% confidence interval [CI] = 0.16-1.19). However, patients who received immunomodulation had lower mortality (19/65 [29%] vs 24/34 [70%], adjusted OR = 0.19, 95% CI = 0.06-0.58). Treatment with non-heparin anticoagulants instead of heparins was not associated with lower mortality (17/51 [33%] vs 13/35 [37%], adjusted OR = 0.70, 95% CI = 0.24-2.04). Mortality was also not significantly influenced by platelet transfusion (17/27 [63%] vs 26/72 [36%], adjusted OR = 2.19, 95% CI = 0.74-6.54). Conclusions: In patients with VITT-CVT, adherence to VITT treatment recommendations improved over time. Immunomodulation seems crucial for reducing mortality of VITT-CVT. ANN NEUROL 2022;92:562-573., This research was funded by The Netherlands Organisation for Health Research and Development (ZonMw, grant number 10430072110005) and the Dr. C. J. Vaillant Foundation.

Published
2022
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13. Utilization of mechanical power and associations with clinical outcomes in brain injured patients: a secondary analysis of the extubation strategies in neuro-intensive care unit patients and associations with outcome (ENIO) trial

Author

Wahlster, Sarah, Sharma, Monisha, Taran, Shaurya, Town, James A, Stevens, Robert D, Cinotti, Raphaël, Asehoune, Karim, Pelosi, Paolo, Robba, Chiara, Paër-Sélim Abback, Anaïs Codorniu, Giuseppe Citerio, Vittoria Ludovica Sala, Marinella Astuto, Eleonora Tringali, Daniela Alampi, Monica Rocco, Jessica Giuseppina Maugeri, Agrippino Bellissima, Matteo Filippini, Nicoletta Lazzeri, Andrea Cortegiani, Mariachiara Ippolito, Denise Battaglini, Patrick Biston, Mohamed Fathi Al-Gharyani, Russell Chabanne, Léo Astier, Benjamin Soyer, Samuel Gaugain, Alice Zimmerli, Urs Pietsch, Miodrag Filipovic, Giovanna Brandi, Giulio Bicciato, Ainhoa Serrano, Berta Monleon, Peter van Vliet, Benjamin Marcel Gerretsen, Iris Xochitl Ortiz-Macias, Jun Oto, Noriya Enomoto, Tomomichi Matsuda, Nobutaka Masui, Pierre Garçon, Jonathan Zarka, Wytze J Vermeijden, Alexander Daniel Cornet, Sergio Reyes Inurrigarro, Rafael Cirino Lara Domínguez, Maria Mercedes Bellini, Maria Milagros Gomez Haedo, Laura Lamot, Jose Orquera, Matthieu Biais, Delphine Georges, Arvind Baronia, Roberto Carlos Miranda-Ackerman, Francisco José Barbosa-Camacho, John Porter, Miguel Lopez-Morales, Thomas Geeraerts, Baptiste Compagnon, David Pérez-Torres, Estefanía Prol-Silva, Hana Basheer Yahya, Ala Khaled, Mohamed Ghula, Cracchiolo Neville Andrea, Palma Maria Daniela, Cristian Deana, Luigi Vetrugno, Manuel J Rivera Chavez, Rocio Mendoza Trujillo, Vincent Legros, Benjamin Brochet, Olivier Huet, Marie Geslain, Mathieu van der Jagt, Job van Steenkiste, Hazem Ahmed, Alexander Edward Coombs, Jessie Welbourne, Ana Alicia Velarde Pineda, Víctor Hugo Nubert Castillo, Mohammed A Azab, Ahmed Y Azzam, David Michael Paul van Meenen, Gilberto Adrian Gasca, Alfredo Arellano, Forttino Galicia-Espinosa, José Carlos García-Ramos, Ghanshyam Yadav, Amarendra Kumar Jha, Vincent Robert-Edan, Pierre-Andre Rodie-Talbere, Gaurav Jain, Sagarika Panda, Sonika Agarwal, Yashbir Deewan, Syed Tariq Reza, Md Mozaffer Hossain, Christos Papadas, Vasiliki Chantziara, Chrysanthi Sklavou, Yannick Hourmant, Nicolas Grillot, Romain Pirracchio, Abdelraouf Akkari, Mohamed Abdelaty, Ahmed Hashim, Yoann Launey, Elodie Masseret, Sigismond Lasocki, Soizic Gergaud, Nicolas Mouclier, Sulekha Saxena, Avinash Agrawal, Shakti Bedanta Mishra, Samir Samal, Julio Cesar Mijangos, Mattias Haënggi, Mohan Gurjar, Marcus J Schultz, Callum Kaye, Daniela Agustin Godoy, Pablo Alvarez, Aikaterini Ioakeimidou, Yoshitoyo Ueno, Rafael Badenes, Abdurrahmaan Ali Suei Elbuzidi, Michaël Piagnerelli, Muhammed Elhadi, Jean Catherine Digitale, Nicholas Fong, Ricardo Campos Cerda, Norma de la Torre Peredo, Wahlster, S, Sharma, M, Taran, S, Town, J, Stevens, R, Cinotti, R, Asehoune, K, Pelosi, P, Robba, C, Abback, P, Codorniu, A, Citerio, G, Sala, V, Astuto, M, Tringali, E, Alampi, D, Rocco, M, Maugeri, J, Bellissima, A, Filippini, M, Lazzeri, N, Cortegiani, A, Ippolito, M, Battaglini, D, Biston, P, Al-Gharyani, M, Chabanne, R, Astier, L, Soyer, B, Gaugain, S, Zimmerli, A, Pietsch, U, Filipovic, M, Brandi, G, Bicciato, G, Serrano, A, Monleon, B, van Vliet, P, Gerretsen, B, Ortiz-Macias, I, Oto, J, Enomoto, N, Matsuda, T, Masui, N, Garcon, P, Zarka, J, Vermeijden, W, Cornet, A, Inurrigarro, S, Dominguez, R, Bellini, M, Gomez Haedo, M, Lamot, L, Orquera, J, Biais, M, Georges, D, Baronia, A, Miranda-Ackerman, R, Barbosa-Camacho, F, Porter, J, Lopez-Morales, M, Geeraerts, T, Compagnon, B, Perez-Torres, D, Prol-Silva, E, Yahya, H, Khaled, A, Ghula, M, Andrea, C, Daniela, P, Deana, C, Vetrugno, L, Chavez, M, Trujillo, R, Legros, V, Brochet, B, Huet, O, Geslain, M, van der Jagt, M, van Steenkiste, J, Ahmed, H, Coombs, A, Welbourne, J, Velarde Pineda, A, Nubert Castillo, V, Azab, M, Azzam, A, van Meenen, D, Gasca, G, Arellano, A, Galicia-Espinosa, F, Garcia-Ramos, J, Yadav, G, Jha, A, Robert-Edan, V, Rodie-Talbere, P, Jain, G, Panda, S, Agarwal, S, Deewan, Y, Reza, S, Hossain, M, Papadas, C, Chantziara, V, Sklavou, C, Hourmant, Y, Grillot, N, Pirracchio, R, Akkari, A, Abdelaty, M, Hashim, A, Launey, Y, Masseret, E, Lasocki, S, Gergaud, S, Mouclier, N, Saxena, S, Agrawal, A, Mishra, S, Samal, S, Mijangos, J, Haenggi, M, Gurjar, M, Schultz, M, Kaye, C, Godoy, D, Alvarez, P, Ioakeimidou, A, Ueno, Y, Badenes, R, Suei Elbuzidi, A, Piagnerelli, M, Elhadi, M, Digitale, J, Fong, N, Cerda, R, de la Torre Peredo, N, Wahlster, Sarah, Sharma, Monisha, Taran, Shaurya, Town, James A, Stevens, Robert D, Cinotti, Raphaël, Asehoune, Karim, Pelosi, Paolo, Robba, Chiara, and Paër-Sélim Abback, Anaïs Codorniu, Giuseppe Citerio, Vittoria Ludovica Sala, Marinella Astuto, Eleonora Tringali, Daniela Alampi, Monica Rocco, Jessica Giuseppina Maugeri, Agrippino Bellissima, Matteo Filippini, Nicoletta Lazzeri, Andrea Cortegiani, Mariachiara Ippolito, Denise Battaglini, Patrick Biston, Mohamed Fathi Al-Gharyani, Russell Chabanne, Léo Astier, Benjamin Soyer, Samuel Gaugain, Alice Zimmerli, Urs Pietsch, Miodrag Filipovic, Giovanna Brandi, Giulio Bicciato, Ainhoa Serrano, Berta Monleon, Peter van Vliet, Benjamin Marcel Gerretsen, Iris Xochitl Ortiz-Macias, Jun Oto, Noriya Enomoto, Tomomichi Matsuda, Nobutaka Masui, Pierre Garçon, Jonathan Zarka, Wytze J Vermeijden, Alexander Daniel Cornet, Sergio Reyes Inurrigarro, Rafael Cirino Lara Domínguez, Maria Mercedes Bellini, Maria Milagros Gomez Haedo, Laura Lamot, Jose Orquera, Matthieu Biais, Delphine Georges, Arvind Baronia, Roberto Carlos Miranda-Ackerman, Francisco José Barbosa-Camacho, John Porter, Miguel Lopez-Morales, Thomas Geeraerts, Baptiste Compagnon, David Pérez-Torres, Estefanía Prol-Silva, Hana Basheer Yahya, Ala Khaled, Mohamed Ghula, Cracchiolo Neville Andrea, Palma Maria Daniela, Cristian Deana, Luigi Vetrugno, Manuel J Rivera Chavez, Rocio Mendoza Trujillo, Vincent Legros, Benjamin Brochet, Olivier Huet, Marie Geslain, Mathieu van der Jagt, Job van Steenkiste, Hazem Ahmed, Alexander Edward Coombs, Jessie Welbourne, Ana Alicia Velarde Pineda, Víctor Hugo Nubert Castillo, Mohammed A Azab, Ahmed Y Azzam, David Michael Paul van Meenen, Gilberto Adrian Gasca, Alfredo Arellano, Forttino Galicia-Espinosa, José Carlos García-Ramos, Ghanshyam Yadav, Amarendra Kumar Jha, Vincent Robert-Edan, Pierre-Andre Rodie-Talbere, Gaurav Jain, Sagarika Panda, Sonika Agarwal, Yashbir Deewan, Gilberto Adrian Gasca, Alfredo Arellano, Syed Tariq Reza, Md Mozaffer Hossain, Christos Papadas, Vasiliki Chantziara, Chrysanthi Sklavou, Yannick Hourmant, Nicolas Grillot, Job van Steenkiste, Mathieu van der Jagt, Romain Pirracchio, Abdelraouf Akkari, Mohamed Abdelaty, Ahmed Hashim, Yoann Launey, Elodie Masseret, Sigismond Lasocki, Soizic Gergaud, Nicolas Mouclier, Sulekha Saxena, Avinash Agrawal, Shakti Bedanta Mishra, Samir Samal, Julio Cesar Mijangos, Mattias Haënggi, Mohan Gurjar, Marcus J Schultz, Callum Kaye, Daniela Agustin Godoy, Pablo Alvarez, Aikaterini Ioakeimidou, Yoshitoyo Ueno, Rafael Badenes, Abdurrahmaan Ali Suei Elbuzidi, Michaël Piagnerelli, Muhammed Elhadi, Syed Tariq Reza, Jean Catherine Digitale, Nicholas Fong, Ricardo Campos Cerda, Norma de la Torre Peredo

Subjects
Mechanical power, Mechanical ventilation, Traumatic brain injury, Acute respiratory distress syndrome, Acute ischemic stroke, Acute brain injury, Intracranial hemorrhage, Subarachnoid hemorrhage
Abstract

Background: There is insufficient evidence to guide ventilatory targets in acute brain injury (ABI). Recent studies have shown associations between mechanical power (MP) and mortality in critical care populations. We aimed to describe MP in ventilated patients with ABI, and evaluate associations between MP and clinical outcomes. Methods: In this preplanned, secondary analysis of a prospective, multi-center, observational cohort study (ENIO, NCT03400904), we included adult patients with ABI (Glasgow Coma Scale ≤ 12 before intubation) who required mechanical ventilation (MV) ≥ 24h. Using multivariable log binomial regressions, we separately assessed associations between MP on hospital day (HD)1, HD3, HD7 and clinical outcomes: hospital mortality, need for reintubation, tracheostomy placement, and development of acute respiratory distress syndrome (ARDS). Results: We included 1217 patients (mean age 51.2years [SD 18.1], 66% male, mean body mass index [BMI] 26.3 [SD 5.18]) hospitalized at 62 intensive care units in 18 countries. Hospital mortality was 11% (n = 139), 44% (n = 536) were extubated by HD7 of which 20% (107/536) required reintubation, 28% (n = 340) underwent tracheostomy placement, and 9% (n = 114) developed ARDS. The median MP on HD1, HD3, and HD7 was 11.9J/min [IQR 9.2-15.1], 13J/min [IQR 10-17], and 14J/min [IQR 11-20], respectively. MP was overall higher in patients with ARDS, especially those with higher ARDS severity. After controlling for same-day pressure of arterial oxygen/fraction of inspired oxygen (P/F ratio), BMI, and neurological severity, MP at HD1, HD3, and HD7 was independently associated with hospital mortality, reintubation and tracheostomy placement. The adjusted relative risk (aRR) was greater at higher MP, and strongest for: mortality on HD1 (compared to the HD1 median MP 11.9J/min, aRR at 17J/min was 1.22, 95% CI 1.14-1.30) and HD3 (1.38, 95% CI 1.23-1.53), reintubation on HD1 (1.64; 95% CI 1.57-1.72), and tracheostomy on HD7 (1.53; 95%CI 1.18-1.99). MP was associated with the development of moderate-severe ARDS on HD1 (2.07; 95% CI 1.56-2.78) and HD3 (1.76; 95% CI 1.41-2.22). Conclusions: Exposure to high MP during the first week of MV is associated with poor clinical outcomes in ABI, independent of P/F ratio and neurological severity. Potential benefits of optimizing ventilator settings to limit MP warrant further investigation.

Published
2023

15. Mass Training In Situ During COVID-19 Pandemic

Author

Charles-Henri Houze-Cerfon, Stein Silva, Vincent Minville, Marilyne Fernandes, Rachel Rigal, Sébastien Couarraze, Thomas Geeraerts, Fanny Vardon-Bounes, Richard Pizzuto, Fouad Marhar, Jean Ruiz, Thierry Seguin, Bernard Georges, Muriel Legendre, Béatrice Riu, Louis Delamarre, Claire Larcher, Sandra Malavaud, Diane Osinski, Fabrice Ferré, Olivier Mathe, and Olivier Fourcade

Subjects
training, Coronavirus disease 2019 (COVID-19), SARS-CoV-2, healthcare workers, Epidemiology, business.industry, Training (meteorology), COVID-19, sick leave, Medicine (miscellaneous), simulation, medicine.disease, Education, Personnel, Hospital, Contamination, Modeling and Simulation, Pandemic, ComputingMethodologies_DOCUMENTANDTEXTPROCESSING, Humans, Medicine, Empirical Investigations, Medical emergency, business, Pandemics
Abstract

Supplemental digital content is available in the text., Introduction Avoiding coronavirus disease 2019 (COVID-19) work-related infection in frontline healthcare workers is a major challenge. A massive training program was launched in our university hospital for anesthesia/intensive care unit and operating room staff, aiming at upskilling 2249 healthcare workers for COVID-19 patients' management. We hypothesized that such a massive training was feasible in a 2-week time frame and efficient in avoiding sick leaves. Methods We performed a retrospective observational study. Training focused on personal protective equipment donning/doffing and airway management in a COVID-19 simulated patient. The educational models used were in situ procedural and immersive simulation, peer-teaching, and rapid cycle deliberate practice. Self-learning organization principles were used for trainers' management. Ordinary disease quantity in full-time equivalent in March and April 2020 were compared with the same period in 2017, 2018, and 2019. Results A total of 1668 healthcare workers were trained (74.2% of the target population) in 99 training sessions over 11 days. The median number of learners per session was 16 (interquartile range = 9–25). In the first 5 days, the median number of people trained per weekday was 311 (interquartile range = 124–385). Sick leaves did not increase in March to April 2020 compared with the same period in the 3 preceding years. Conclusions Massive training for COVID-19 patient management in frontline healthcare workers is feasible in a very short time and efficient in limiting the rate of sick leave. This experience could be used in the anticipation of new COVID-19 waves or for rapidly preparing hospital staff for an unexpected major health crisis.

Published
2022
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16. Cerebral perfusion using ASL in patients with COVID-19 and neurological manifestations: A retrospective multicenter observational study

Author

François-Daniel Ardellier, Seyyid Baloglu, Magdalena Sokolska, Vincent Noblet, François Lersy, Olivier Collange, Jean-Christophe Ferré, Adel Maamar, Béatrice Carsin-Nicol, Julie Helms, Maleka Schenck, Antoine Khalil, Augustin Gaudemer, Sophie Caillard, Julien Pottecher, Nicolas Lefèbvre, Pierre-Emmanuel Zorn, Muriel Matthieu, Jean Christophe Brisset, Clotilde Boulay, Véronique Mutschler, Yves Hansmann, Paul-Michel Mertes, Francis Schneider, Samira Fafi-Kremer, Mickael Ohana, Ferhat Meziani, Nicolas Meyer, Tarek Yousry, Mathieu Anheim, François Cotton, Hans Rolf Jäger, Stéphane Kremer, Fabrice Bonneville, Gilles Adam, Guillaume Martin-Blondel, Jérémie Pariente, Thomas Geeraerts, Hélène Oesterlé, Federico Bolognini, Julien Messie, Ghazi Hmeydia, Joseph Benzakoun, Catherine Oppenheim, Jean-Marc Constans, Serge Metanbou, Adrien Heintz, Blanche Bapst, Imen Megdiche, Lavinia Jager, Patrick Nesser, Yannick Talla Mba, Thomas Tourdias, Juliette Coutureau, Céline Hemmert, Philippe Feuerstein, Nathan Sebag, Sophie Carre, Manel Alleg, Claire Lecocq, Emmanuel Schmitt, René Anxionnat, François Zhu, Géraud Forestier, Aymeric Rouchaud, Pierre-Olivier Comby, Frederic Ricolfi, Pierre Thouant, Sylvie Grand, Alexandre Krainik, Isaure de Beaurepaire, Grégoire Bornet, Audrey Lacalm, Patrick Miailhes, Julie Pique, Claire Boutet, Xavier Fabre, Béatrice Claise, Sonia Mirafzal, Laure Calvet, Hubert Desal, Jérome Berge, Grégoire Boulouis, Apolline Kazemi, Nadya Pyatigorskaya, Augustin Lecler, Suzana Saleme, Myriam Edjlali-Goujon, Basile Kerleroux, Jean-Christophe Brisset, Samir Chenaf, Les Hôpitaux Universitaires de Strasbourg (HUS), Hôpital de Hautepierre [Strasbourg], Laboratoire des sciences de l'ingénieur, de l'informatique et de l'imagerie (ICube), École Nationale du Génie de l'Eau et de l'Environnement de Strasbourg (ENGEES)-Université de Strasbourg (UNISTRA)-Institut National des Sciences Appliquées - Strasbourg (INSA Strasbourg), Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Institut National de Recherche en Informatique et en Automatique (Inria)-Les Hôpitaux Universitaires de Strasbourg (HUS)-Centre National de la Recherche Scientifique (CNRS)-Matériaux et Nanosciences Grand-Est (MNGE), Université de Strasbourg (UNISTRA)-Université de Haute-Alsace (UHA) Mulhouse - Colmar (Université de Haute-Alsace (UHA))-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut de Chimie du CNRS (INC)-Centre National de la Recherche Scientifique (CNRS)-Université de Strasbourg (UNISTRA)-Université de Haute-Alsace (UHA) Mulhouse - Colmar (Université de Haute-Alsace (UHA))-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut de Chimie du CNRS (INC)-Centre National de la Recherche Scientifique (CNRS)-Réseau nanophotonique et optique, Université de Strasbourg (UNISTRA)-Université de Haute-Alsace (UHA) Mulhouse - Colmar (Université de Haute-Alsace (UHA))-Centre National de la Recherche Scientifique (CNRS)-Université de Strasbourg (UNISTRA)-Centre National de la Recherche Scientifique (CNRS), University College of London [London] (UCL), Nouvel Hôpital Civil de Strasbourg, Département de Neuroradiology [Rennes], Neuroimagerie: méthodes et applications (EMPENN), Institut National de la Santé et de la Recherche Médicale (INSERM)-Inria Rennes – Bretagne Atlantique, Institut National de Recherche en Informatique et en Automatique (Inria)-Institut National de Recherche en Informatique et en Automatique (Inria)-SIGNAL, IMAGE ET LANGAGE (IRISA-D6), Institut de Recherche en Informatique et Systèmes Aléatoires (IRISA), Université de Rennes (UR)-Institut National des Sciences Appliquées - Rennes (INSA Rennes), Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Université de Bretagne Sud (UBS)-École normale supérieure - Rennes (ENS Rennes)-Institut National de Recherche en Informatique et en Automatique (Inria)-CentraleSupélec-Centre National de la Recherche Scientifique (CNRS)-IMT Atlantique (IMT Atlantique), Institut Mines-Télécom [Paris] (IMT)-Institut Mines-Télécom [Paris] (IMT)-Université de Rennes (UR)-Institut National des Sciences Appliquées - Rennes (INSA Rennes), Institut Mines-Télécom [Paris] (IMT)-Institut Mines-Télécom [Paris] (IMT)-Institut de Recherche en Informatique et Systèmes Aléatoires (IRISA), Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Université de Bretagne Sud (UBS)-École normale supérieure - Rennes (ENS Rennes)-CentraleSupélec-Centre National de la Recherche Scientifique (CNRS)-IMT Atlantique (IMT Atlantique), Institut Mines-Télécom [Paris] (IMT)-Institut Mines-Télécom [Paris] (IMT), CHU Pontchaillou [Rennes], Service de Médecine Intensive et Réanimation [Strasbourg], CHU Strasbourg, Département de Radiologie [Bichat] (DR- Bichat), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-AP-HP - Hôpital Bichat - Claude Bernard [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), AP-HP - Hôpital Bichat - Claude Bernard [Paris], Immuno-Rhumatologie Moléculaire, Université de Strasbourg (UNISTRA)-Institut National de la Santé et de la Recherche Médicale (INSERM), Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg (UNISTRA), Groupe d'Analyse des Itinéraires et des Niveaux Salariaux (GAINS), Le Mans Université (UM), Les Hôptaux universitaires de Strasbourg (HUS), Observatoire Français de la Sclérose En Plaques [Lyon] (OFSEP), Centre for Integrative Biology - CBI (Inserm U964 - CNRS UMR7104 - IGBMC), Institut de Génétique et de Biologie Moléculaire et Cellulaire (IGBMC), Université de Strasbourg (UNISTRA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université de Strasbourg (UNISTRA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Centre Hospitalier Lyon Sud [CHU - HCL] (CHLS), Hospices Civils de Lyon (HCL), Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), Hôpital Louis Pasteur [Colmar] (CH Colmar), Hôpital Sainte-Anne [Paris], CHU Amiens-Picardie, CHirurgie, IMagerie et REgénération tissulaire de l’extrémité céphalique - Caractérisation morphologique et fonctionnelle - UR UPJV 7516 (CHIMERE), Université de Picardie Jules Verne (UPJV), SFNR-COVID Group, CHU Henri Mondor [Créteil], Hôpital Marie Madeleine [Forbach] (CHIC Unisanté+), CHU de Bordeaux Pellegrin [Bordeaux], Centre Hospitalier Emile Muller [Mulhouse] (CH E.Muller Mulhouse), Groupe Hospitalier de Territoire Haute Alsace (GHTHA), Centre Hospitalier de Haguenau, Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Hôpital Dupuytren [CHU Limoges], Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon), Centre Hospitalier Universitaire [Grenoble] (CHU), Hôpital privé d’Antony, Centre Hospitalier Universitaire de Saint-Etienne [CHU Saint-Etienne] (CHU ST-E), CHU Clermont-Ferrand, and Société Française de Neuroradiologie [Paris] (SFNR)

Subjects
Multicenter Study, Radiological and Ultrasound Technology, Cerebrovascular Circulation, COVID-19, Radiology, Nuclear Medicine and imaging, Neuroimaging, Neurology (clinical), Magnetic Resonance Imaging, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Abstract

International audience; Background and purpose: Cerebral hypoperfusion has been reported in patients with COVID-19 and neurological manifestations in small cohorts. We aimed to systematically assess changes in cerebral perfusion in a cohort of 59 of these patients, with or without abnormalities on morphological MRI sequences.Methods: Patients with biologically-confirmed COVID-19 and neurological manifestations undergoing a brain MRI with technically adequate arterial spin labeling (ASL) perfusion were included in this retrospective multicenter study. ASL maps were jointly reviewed by two readers blinded to clinical data. They assessed abnormal perfusion in four regions of interest in each brain hemisphere: frontal lobe, parietal lobe, posterior temporal lobe, and temporal pole extended to the amygdalo-hippocampal complex.Results: Fifty-nine patients (44 men (75%), mean age 61.2 years) were included. Most patients had a severe COVID-19, 57 (97%) needed oxygen therapy and 43 (73%) were hospitalized in intensive care unit at the time of MRI. Morphological brain MRI was abnormal in 44 (75%) patients. ASL perfusion was abnormal in 53 (90%) patients, and particularly in all patients with normal morphological MRI. Hypoperfusion occurred in 48 (81%) patients, mostly in temporal poles (52 (44%)) and frontal lobes (40 (34%)). Hyperperfusion occurred in 9 (15%) patients and was closely associated with post-contrast FLAIR leptomeningeal enhancement (100% [66.4%-100%] of hyperperfusion with enhancement versus 28.6% [16.6%-43.2%] without, p=0.002). Studied clinical parameters (especially sedation) and other morphological MRI anomalies had no significant impact on perfusion anomalies.Conclusion: Brain ASL perfusion showed hypoperfusion in more than 80% of patients with severe COVID-19, with or without visible lesion on conventional MRI abnormalities.

Published
2023
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18. Immunohistologic Features of Cerebral Venous Thrombosis Due to Vaccine-Induced Immune Thrombotic Thrombocytopenia

Author

Thomas Geeraerts, Céline Guilbeau-Frugier, Cédric Garcia, Vincent Memier, Nicolas Raposo, Fabrice Bonneville, Céline Gales, Jean Darcourt, Sophie Voisin, Agnès Ribes, Marie Piel-Julian, Fanny Bounes, Jean François Albucher, Franck-Emmanuel Roux, Jacques Izopet, Norbert Telmon, Jean Marc Olivot, Pierre Sié, Jan Bauer, Bernard Payrastre, and Roland S. Liblau

Subjects
Neurology, Neurology (clinical)
Abstract

ObjectivesVaccine-induced immune thrombotic thrombocytopenia (VITT), a recently described entity characterized by thrombosis at unusual locations such as cerebral venous sinus and splanchnic vein, has been rarely described after adenoviral-encoded COVID-19 vaccines. In this study, we report the immunohistological correlates in 3 fatal cases of cerebral venous thrombosis related to VITT analyzed at an academic medical center.MethodsDetailed neuropathologic studies were performed in 3 cases of cerebral venous thrombosis related to VITT after adenoviral COVID-19 vaccination.ResultsAutopsy revealed extensive cerebral vein thrombosis in all 3 cases. Polarized thrombi were observed with a high density of neutrophils in the core and a low density in the tail. Endothelial cells adjacent to the thrombus were largely destroyed. Markers of neutrophil extracellular trap and complement activation were present at the border and within the cerebral vein thrombi. SARS-CoV-2 spike protein was detected within the thrombus and in the adjacent vessel wall.DiscussionData indicate that neutrophils and complement activation associated with antispike immunity triggered by the vaccine is probably involved in the disease process.

Published
2023
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19. Perioperative risk assessment of patients using the ‘MyRISK’ digital score completed before the preanesthetic consultation: a prospective, observational trial. (Preprint)

Author

Fabrice Ferré, Rodolphe Laurent, Philippine Furelau, Emmanuel Doumard, Anne Ferrier, Laetitia Bosch, Cyndie Ba, Rémi Menut, Matt Kurrek, Thomas Geeraerts, Antoine Piau, and Vincent Minville

Abstract

BACKGROUND The pandemic highlighted the potential of digital health solutions to adapt the organization of care in a crisis context. OBJECTIVE Our aim was to demonstrate the prognostic value of the perioperative ‘MyRISK score’ derived from data collected on a digital conversational agent (chatbot) before the preanesthetic consultation (PAC). METHODS Single-center, prospective, observational study. The 16 items composing the MyRISK score were selected by Delphi method. An algorithm was used to stratify low (‘green’), intermediate (‘orange’) and high (‘red’) risk patients. Postoperative complications occurring in the first 6 months (composite criterion) were numerically collected and verified by phone and consultation of the electronic medical database. A logistic regression was carried out to identify their explanatory variables. A machine learning model was trained to predict the MyRISK score using a dataset of 1823 ‘green’ and ‘red’ patients to re-classify ‘orange’ individuals. User satisfaction and usability were assessed. RESULTS Four hundered and one patients were included. Sixteen of the 389 patients (4.1%) analyzed for the primary endpoint experienced a postoperative complication. An ASA score ≥ 3 and a ‘red’ score were independent predictors of postoperative complications (Odds Ratios of 5.8 [CI95%: 1.7 - 20.2; p=0.006] and 5.9 [CI95%: 1.5 - 22.3; p=0.009] respectively). Once ‘orange’ patients re-classified according to the prediction of the trained model, a ‘red’ score was identified as a strong predictor of postoperative complications with an Odds Ratio of 21.8 [CI95%: 2.8 - 171.5; p=0.003]. Patient satisfaction Numeric Rating Scale and System Usability Scale were 8 [7-9]/10 and 90 [82.5-95]/100 respectively. CONCLUSIONS We demonstrate the good prognostic predictive value of the MyRISK digital perioperative risk score established before the PAC. Its predictive strength was increase using a machine learning model reclassifying intermediate-risk patient. This numerical categorization could be used to guide patients between teleconsultation and face-to-face PAC, or to provide a perioperative personalized care pathway for high-risk patients.

Published
2022
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20. Intrahospital Trauma Flowcharts - cognitive aids for intrahospital trauma management from the French Society of Anaesthesia and Intensive Care Medicine and the French Society of Emergency Medicine

Author

Tobias Gauss, Hervé Quintard, Benjamin Bijok, Guillaume Bouhours, Thomas Clavier, Fabrice Cook, Hugues de Courson, Jean-Stéphane David, Caroline Duracher-Gout, Delphine Garrigue, Thomas Geeraerts, Sophie Hamada, Olivier Joannes-Boyau, Romain Jouffroy, Antoine Lamblin, Olivier Langeron, Pierre Lanot, Sigismond Lasocki, Marc Leone, Sébastien Mirek, Laurent Muller, Pierre Pasquier, Bertrand Prunet, Sébastien Perbet, Mathieu Raux, Justin Richards, Claire Roger, Antoine Roquilly, Emmanuel Weiss, Pierre Bouzat, Julien Pottecher, Bordeaux population health (BPH), and Université de Bordeaux (UB)-Institut de Santé Publique, d'Épidémiologie et de Développement (ISPED)-Institut National de la Santé et de la Recherche Médicale (INSERM)

Subjects
Anesthesiology and Pain Medicine, Traumatic Brain Injury, Resuscitation, Cognitive aid, Shock, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, General Medicine, Guideline, Damage Control, Critical Care and Intensive Care Medicine, Trauma
Published
2022
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21. Anaesthetic and peri-operative management for thrombectomy procedures in stroke patients

Author

Hervé Quintard, Vincent Degos, Mikael Mazighi, Jérôme Berge, Pierre Boussemart, Russel Chabanne, Samy Figueiredo, Thomas Geeraerts, Yoann Launey, Ludovic Meuret, Jean-Marc Olivot, Julien Pottecher, Francesca Rapido, Sébastien Richard, Suzana Saleme, Virginie Siguret-Depasse, Olivier Naggara, Hugues De Courson, and Marc Garnier

Subjects
Anesthesiology and Pain Medicine, General Medicine, Critical Care and Intensive Care Medicine
Published
2023
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23. How does head position induced intracranial pressure changes impact sympathetic activity and cerebral blood flow?

Author

Marc, Kermorgant, Marc, Labrunée, Fabien, Despas, Ophélie, Hélissen, Thomas, Geeraerts, Elisabeth, Lambert, Eric, Schmidt, Jean-Michel, Senard, Dina N, Arvanitis, Nathalie, Nasr, and Anne Pavy-Le, Traon

Subjects
Male, Adult, Head-Down Tilt, Cellular and Molecular Neuroscience, Sympathetic Nervous System, Intracranial Pressure, Heart Rate, Endocrine and Autonomic Systems, Cerebrovascular Circulation, Humans, Blood Pressure, Neurology (clinical), Baroreflex
Abstract

Acute head-down-tilt (HDT) simulates short duration hemodynamic impact of microgravity. We sought to determine whether an increase in ICP caused by acute HDT affects sympathetic nervous system activity and cerebral blood flow velocities (CBFV) in healthy male volunteers.HDT protocol was established as follows: basal condition immediately followed by gradual negative angles (-10°, -20° and -30°) lasting 10mn and then a return to basal condition. Velocities in the MCA (CBFV) were monitored using TCD. Sympathetic activity was assessed using MSNA. Baroreflex sensitivity (BRS) was measured using the sequence method. ICP changes were assessed using ultrasonography of the optic nerve sheath diameter (ONSD). Cerebral autoregulation (CA) was evaluated by transfer function and the autoregulatory index (Mxa).Twelve male volunteers (age: 35 ± 2 years) were included. Neither blood pressure nor heart rate was significantly modified during HDT. ONSD increased significantly at each step of HDT and remained elevated during Recovery. MSNA burst incidence increased at -30°. A positive correlation between variations in ONSD and variations in MSNA burst incidence was observed at -20°. CBFV were significantly diminished at -20° and -30. In the LF band, the transfer function coherence was reduced at -30° and the transfer function phase was increased at -30° and during Recovery.We found that an acute though modest increase in ICP induced by HDT was associated with an increase of sympathetic activity as assessed by MSNA, and with a reduction of CBFV with preserved CA.

Published
2022
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