Association between neurological outcomes and prehospital time in patients with out-of-hospital cardiopulmonary arrest.
Yoshikawa K, Endo A, Takayama W, Shoko T, Otomo Y, Morishita K. | Acute Med Surg. 2025 Mar 6;12(1):e70025
DOI: https://doi.org/10.1002/ams2.70025  | Télécharger l'article au format  
Keywords: cardiopulmonary resuscitation; emergency medical services; out‐of‐hospital cardiac arrest; prehospital time; transportation of patient.

ORIGINAL ARTICLE

Introduction : Out-of-hospital cardiac arrest (OHCA) remains an important health care issue. Considering the importance of such a time course after cardiac arrest, detailed evaluation of the prehospital time (i.e., time from EMS contact to a patient to hospital arrival) is essential to improve the mortality and neurologic outcome of OHCA. In this study, we aimed to evaluate the impact of prehospital time on neurological outcomes in patients with OHCA.

Méthode : This retrospective observational study included adult non-traumatic OHCA patients who were transported to 2 emergency centers in Tokyo from January 2015 to December 2020. The following data were obtained retrospectively from medical records.

Résultats : Of the 3120 OHCA patients who were transported during the study period, 2215 patients were evaluated via the inclusion and exclusion criteria. Sixty-nine patients were alive at hospital discharge with a good neurological outcome (i.e., CPC 1 or 2). The multivariate logistic regression model showed that prehospital time (time from EMS contact to hospital arrival) was an independent predictor for hospital discharge with good neurological outcome, in addition to age, bystander CPR, initial rhythm, and cause of cardiac arrest. The GAM plot showed that the adjusted odds ratio of prehospital time for the good neurological outcome was decreased linearly according to time, and the threshold was approximately 30 min.

Conclusion : The threshold of allowable prehospital time, including field activity and transport, for OHCA patients might be 30 min at least in a Japanese urban setting.

Conclusion (proposition de traduction) : Le seuil de temps préhospitalier admissible, y compris l'activité sur le terrain et le transport, pour les patients victimes d'un ACO pourrait être de 30 minutes au moins dans un environnement urbain japonais.

Accidentology in scuba diving.
Hochart E, Boet S, Pignel R, Louge P. | Ann Fr Med Urgence. 2025 mars-avril;15(2):107-120
DOI: https://www.jle.com/10.1684/afmu.2025.0633
Keywords: Plongée ; Accident ; Hyperbare ; Décompression ; Barotraumatisme

MISE AU POINT

Editorial : La plongée sous-marine, qu’elle soit professionnelle ou de loisir, a considérablement évolué au cours du siècle passé, permettant une pratique plus accessible à tous. Toutefois, les accidents de plongée, bien que rares, peuvent entraîner des complications graves. Ces accidents peuvent être catégorisés en quatre types : barotraumatismes, accidents biochimiques liés à la toxicité des gaz sous pression, accidents de désaturation, et accidents liés aux contraintes environnementales (œdème pulmonaire d’immersion). Les lois physiques de Boyle-Mariotte, Dalton, et Henry expliquent les mécanismes sous-jacents des accidents de plongée. Les conséquences physiologiques de l’immersion incluent des modifications cardiovasculaires, respiratoires, rénales et endocriniennes. La prise en charge pré- et intrahospitalière inclut l’administration d’oxygène à haute concentration, la réhydratation et le réchauffement passif de la victime. Le transport de la victime doit être réalisé en position allongée pour minimiser le risque de migration des bulles issues d’une surpression pulmonaire ou d’une distension d’une dystrophie bulleuse parenchymateuse eu égard à leur taille. Le diagnostic précis repose sur une anamnèse détaillée et peut nécessiter la réalisation d’une imagerie. Les accidents de décompression (ADD) sont particulièrement complexes, impliquant la formation de bulles dans les tissus et le sang, entraînant des réactions inflammatoires et ischémiques. Une prise en charge hospitalière rapide et spécialisée est essentielle pour minimiser les risques de séquelles graves. Ce document fournit une base complète pour les professionnels de la santé en termes de reconnaissance et de gestion des accidents de plongée, soulignant l’importance de la recompression hyperbare dans le traitement de certains types d’accidents.

Conclusion (proposition de traduction) : La plongée sous-marine, sport en vogue et malgré les avancées technologiques visant à améliorer la sécurité, reste risquée. Dans ce contexte, il est essentiel d’établir un dispositif de retour d’expérience pour la plongée sous-marine, qu’elle soit professionnelle ou récréative. Cela permet d’apprendre des événements passés pour mieux préparer l’avenir. Les symptômes des accidents sont nombreux et variés, nécessitant parfois une recompression thérapeutique. Les circonstances de l’accident, les paramètres de la plongée, l’anamnèse ainsi que l’examen clinique orienteront le diagnostic différentiel ainsi que l’attitude à suivre. Cet exercice peut se révéler laborieux pour un médecin non-aguerri, peu confronté à ce type d’accidents et qui restent peu fréquents. Cet article offre des conseils mais il est crucial de consulter l’avis d’un spécialiste hyperbare et en cas de signes inhabituels survenant dans les 24 h post-plongée.

Prehospital Management of Adults With Traumatic Out-of-Hospital Circulatory Arrest-A Joint Position Statement.
Breyre AM, George N, Nelson AR, Ingram CJ, Lardaro T, Vanderkolk W, Lyng JW. | Ann Emerg Med. 2025 Mar;85(3):e25-e39
DOI: https://doi.org/10.1016/j.annemergmed.2024.12.015
Keywords: Aucun

Policy statements

Editorial : The National Association of Emergency Medical Services Physicians (NAEMSP), American College of Surgeons Committee on Trauma (ACS-COT), and American College of Emergency Physicians (ACEP) believe that evidence-based, pragmatic, and collaborative protocols addressing the care of patients with traumatic out-of-hospital circulatory arrest (TOHCA) are needed to optimize patient outcomes and clinician safety. When the etiology of arrest is unclear, particularly without clear signs of life-threatening trauma, standard basic and advanced cardiac life support (BCLS/ACLS) treatments for medical cardiac arrest are appropriate. Traumatic circulatory arrest may result from massive hemorrhage, airway obstruction, obstructive shock, respiratory disturbances, cardiogenic causes, or massive head trauma. While resuscitation and/or transport is appropriate for some populations, it is appropriate to withhold or discontinue resuscitation attempts for TOHCA patients for whom these efforts are nonbeneficial. This position statement and resource document were written as an update to the 2013 joint position statements. NAEMSP, ACEP, and ACS-COT recommend.

Conclusion : Patients with TOHCA generally have low survivability, but achievement of ROSC with neurologic recovery and survival is possible for some patients. Except when death is obvious, there are no singular criteria on which EMS agencies should base decisions to initiate, withhold, or discontinue resuscitative efforts in the field for adult TOHCA. Within the scope of practice of their local EMS clinicians, resource availability, and other operational and geographical considerations, EMS agencies may incorporate multiple variables, including mechanism of injury, presenting cardiac rhythm, duration of arrest, proximity to definitive care, and public safety implications when developing prehospital protocols to guide withholding or discontinuation of resuscitation attempts in TOHCA patients. Further research is needed to better define factors that are more objectively predictive of survival or death, including duration of arrest, proximity to definitive care, and the role of prehospital clinical interventions on TOHCA outcomes.

Conclusion (proposition de traduction) : Les patients victimes d'un arrêt circulatoire traumatique extra-hospitalier ont généralement un faible taux de survie, mais certains d'entre eux peuvent retrouver une activité cardiaque spontanée (ROSC) et survivre avec une récupération neurologique. Sauf en cas de décès évident, il n'existe pas de critère unique sur lequel les services médicaux d'urgence (SMU) doivent se baser pour décider de commencer, de suspendre ou d'interrompre les efforts de réanimation sur le terrain pour les adultes victimes d'un arrêt circulatoire traumatique extra-hospitalier. Dans le cadre de leur pratique clinique locale, de la disponibilité des ressources et d'autres considérations opérationnelles et géographiques, les services d'urgence peuvent prendre en compte plusieurs variables, notamment le mécanisme de la blessure, le rythme cardiaque, la durée de l'arrêt, la proximité des soins spécialisés et les implications en matière de sécurité publique, lorsqu'ils élaborent des protocoles préhospitaliers pour guider la suspension ou l'arrêt des tentatives de réanimation chez les patients victimes d'un arrêt circulatoire traumatique extra-hospitalier. Des recherches supplémentaires sont nécessaires pour mieux définir les facteurs qui permettent de prédire de manière plus objective la survie ou le décès, notamment la durée de l'arrêt cardiaque, la proximité des soins définitifs et le rôle des interventions cliniques préhospitalières sur les résultats des arrêts circulatoires traumatiques hors milieu hospitalier.

Appropriate Use Criteria for Handheld/Pocket Ultrasound Devices.
No authors listed | Ann Emerg Med. 2025 Mar;85(3):e19-e24
DOI: https://doi.org/10.1016/j.annemergmed.2024.11.012
Keywords: Aucun

POLICY STATEMENT

Editorial : Technological advances have allowed miniaturization of ultrasound technology such that point-of-care ultrasound is available for use with modern tablets and smartphones. Since 2009, a multitude of products have become available in the US market for use with both iOS and Android operating systems. These “pocket devices” target both the inhospital and out-of-hospital markets. Some have the ability to store patient data, interface wirelessly with image archival systems, and insert information into electronic health records or electronic workflow solutions. They have demonstrated image quality that is comparable with conventional machines when used by trained physicians and good concordance with computed tomography imaging. With increased accessibility to point-of-care ultrasound, promoting responsible use of these systems is required.

Conclusion : The same applications that have been set as the standard for point-of-care ultrasound practice apply to pocket devices. The American College of Emergency Physicians (ACEP) policy, “Ultrasound Guidelines: Emergency, Point-of-Care, and Clinical Ultrasound Guidelines in Medicine,” contains detailed descriptions regarding settings of use, scope of practice, training, credentialing, quality assurance, and reimbursement

Conclusion (proposition de traduction) : Les mêmes utilisations qui ont été définies comme la norme pour la pratique de l'échographie sur le lieu de soins s'appliquent aux appareils de poche. La politique de l'American College of Emergency Physicians (ACEP), « Ultrasound Guidelines : Emergency, Point-of-Care, and Clinical Ultrasound Guidelines in Medicine », contient des descriptions détaillées concernant les conditions d'utilisation, le champ d'application, la formation, l'accréditation, l'assurance qualité et le financement.

Pharmacologic Treatment of Acute Attacks of Episodic Migraine: A Systematic Review and Network Meta-analysis for the American College of Physicians.
Gartlehner G, Dobrescu A, Wagner G, Chapman A, Persad E, Nowak C, Klerings I, Neubauer C, Feyertag J, Gadinger A, Thaler K. | Ann Intern Med. 2025 Mar 18
DOI: https://doi.org/10.7326/annals-24-02034
Keywords:

Online ahead of print.

Introduction : Migraine is common, affecting 15% of Americans.
Purpose: To compare benefits and harms of pharmacologic treatments for acute attacks of episodic migraine in adults and assess cost-effectiveness.

Méthode : Three electronic databases searched to October 2024, gray literature, and reference lists.
Study selection: Two investigators independently selected English-language randomized trials.
Data extraction: Single reviewer data extraction with second review. Dual independent risk of bias and certainty of evidence (COE) assessment.

Résultats : Twenty-one head-to-head and 165 placebo-controlled trials were included in meta-analyses and network meta-analyses. Triptans were more effective than acetaminophen (low COE) and nonsteroidal anti-inflammatory drugs (NSAIDs) (high COE) for pain outcomes at 2 hours and pain freedom up to 48 hours. Triptan and acetaminophen combinations were more effective than acetaminophen alone (moderate COE) for pain outcomes at 2 hours and pain freedom up to 48 hours but not more than triptans alone (low COE). Triptan and NSAID combinations were more effective for pain outcomes at 2 hours and pain freedom up to 48 hours compared with acetaminophen (low COE), gepants (low COE), NSAIDs (high COE), and triptan monotherapy (moderate COE). Triptan regimens, however, often had a higher risk for adverse events. One study found triptans more cost-effective than ditans and gepants.
Limitations: Harms assessment was limited to randomized trials. Many comparisons lacked sufficient evidence to draw conclusions.

Conclusion : Triptans and combinations of triptans were more effective than NSAID and acetaminophen alone.

Conclusion (proposition de traduction) : Les triptans et les associations de triptans ont été plus efficaces que les AINS et l'acétaminophène seuls.

Commentaire : Une migraine épisodique aiguë est définie comme 1 à 14 jours de céphalée par mois.
Les données ont montré que les triptans associés aux AINS étaient plus efficaces pour obtenir une absence de douleur ou un soulagement de la douleur après 2 heures, une absence de douleur jusqu'à 48 heures et un moindre besoin de médicaments de secours que l'acétaminophène, les gépants (rimégépant), les AINS et les triptans en monothérapie.
Le comité des lignes directrices cliniques a déterminé que les triptans, les AINS (aspirine, célécoxib, diclofénac, ibuprofène et naproxène), l'acétaminophène et l'association d'un triptan avec un AINS ou de l'acétaminophène étaient efficaces pour traiter la migraine épisodique aiguë modérée à sévère, par rapport au placebo.

Effect of non-invasive rhythm control on outcomes in patients with first diagnosed atrial fibrillation presenting to an emergency department.
Salbach C, Yildirim M, Hund H, Müller-Hennessen M, Frey N, Katus HA, Giannitsis E, Milles BR. | BMC Emerg Med. 2025 Mar 3;25(1):35
DOI: https://doi.org/10.1186/s12873-025-01194-z  | Télécharger l'article au format  
Keywords: Atrial fibrillation; First diagnosed atrial fibrillation; Non-invasive rhythm control; Real-world evidence.

RESEARCH

Introduction : Evidence suggests a benefit of a rhythm control approach in patients with a recent diagnosis of atrial fibrillation (AF). This study sought to evaluate clinical characteristics, treatment strategies and outcomes in patients with first diagnosed AF (FDAF) undergoing a non-invasive rhythm control strategy in an emergency department (ED).

Méthode : This analysis uses data from the Heidelberg Registry of Atrial Fibrillation (HERA-FIB). HERA-FIB is a retrospective single-centre observational study which consecutively included patients presenting to the ED of the University Hospital of Heidelberg between June 2009 and March 2020 with a sequential follow-up for all-cause mortality, stroke, major bleeding events and myocardial infarction (MI). Outcomes of patients with FDAF were related to treatment strategy (non-invasive rhythm vs. rate control).

Résultats : Among the 2,758 (27%) patients who presented with FDAF, a non-implementation of a non-invasive rhythm control strategy at admission was observed in 75.4% and associated with an excess of all-cause mortality hazard ratio (HR): 1.61 (95%CI 1.30-1.99), p < 0.0001 and incident MI HR: 1.88 (95% CI 1.22-2.90), p = 0.0043 during follow-up. The non-implementation of a non-invasive rhythm control remained an independent predictor for all-cause mortality and MI even after adjustment for significant univariate variables with an adjusted HR of 1.52 (95%CI: 1.14-2.04, p = 0.0043) and 1.89 (95%CI: 1.03-3.45, p = 0.0392), respectively.

Conclusion : Real-world data from FDAF patients presenting to an ED showed a benefit regarding all-cause mortality and MI favouring a non-invasive rhythm control strategy. Further prospective research is needed to validate this hypothesis.

Conclusion (proposition de traduction) : Les données probantes issues du monde réel (preuves empiriques) auprès de patients dont la fibrillation atriale a été diagnostiquée pour la première fois et qui se sont présentés aux urgences ont montré un avantage en termes de mortalité toutes causes confondues et d'infarctus, en faveur d'une stratégie de contrôle du rythme non invasif (ndlr : conversion pharmacologique ou électrique mais pas une ablation par radiofréquence). D'autres études prospectives sont nécessaires pour valider cette hypothèse.

Implementation of a CPR quality data collection program in the emergency department: a quality improvement initiative.
Mok G, Vaillancourt S, Fu M, Gray S, Chartier LB, Wong N, Allan KS, Warsi F, Callender C, McGowan M, Petrosoniak A. | CJEM. 2025 Jun;27(6):451-459
DOI: https://doi.org/10.1007/s43678-025-00882-w
Keywords: CPR; Cardiac arrest; Quality improvement.

Quality Improvement and Patient Safety (QIPS

Introduction : We used quality improvement (QI) methodology to improve cardiopulmonary resuscitation (CPR) data collection within the emergency department (ED) for non-traumatic cardiac arrests. This novel program aimed to improve CPR data collection from a baseline of 48.7-80% between August 15th, 2023-April 14th, 2024.

Méthode : The outcome measure was percentage of cases with CPR data available. The secondary measures included CPR rate and depth (composite measure), compression fraction, and CPR pauses < 10 s. Manual review of electronic health records and Zoll Case Review_© was utilized for data extraction. The project team was created utilizing a stakeholder matrix. Diagnostics included an Ishikawa diagram, QI huddles, simulation, and process mapping. Interventions included: introduction of an emergency medical services (EMS)-to-ED adapter, simulation and education, and data debriefing. Elements were introduced and tested with simulation prior to implementation. P-charts and x-charts were used to determine successful completion of aims.

Résultats : CPR data were available in 48.7% (19/39) of cardiac arrest cases during the baseline period (February 15th, 2023-August 14th, 2023). Special cause variation was met during the implementation period with a shift (≥ 8 consecutive points above or below median), improving data collection to 89.1% (49/55). Improvements were identified with a shift for CPR in target for rate and depth (1.8-20.4%) and compression fraction (82.2-86.9%). No special cause variation was identified for CPR pauses < 10 s.

Conclusion : Through the use of QI methodology, we successfully improved CPR data collection within our ED from 48.7-89.1% for non-traumatic cardiac arrests. Improvements were seen in CPR in target for rate and depth, and compression fraction. This program provides a foundation for reliable CPR performance measurement and improvement, and serves as an example for other ED's with similar interest in CPR performance improvement.

Conclusion (proposition de traduction) : Grâce à la méthodologie d'amélioration de la qualité, nous avons réussi à améliorer la collecte de données sur la réanimation cardio-pulmonaire au sein de notre service d'urgence, qui est passée de 48,7 à 89,1 % pour les arrêts cardiaques non traumatiques. Des améliorations ont été constatées dans la RCP en ce qui concerne la vitesse, la profondeur et la fraction de compression. Ce programme jette les bases d'une mesure et d'une amélioration fiables des performances de la RCP et sert d'exemple à d'autres services d'urgence qui s'intéressent de la même manière à l'amélioration des performances de la RCP.

Evaluating the safety of procedural sedation in emergency department settings among the pediatric population: a systematic review and meta-analysis of randomized controlled trials.
Khan MT, Ishaq A, Rohail S, Sulaiman SA, Raza FA, Habib H, Goyal A. | CJEM. 2025 Mar;27(3):178-190
DOI: https://doi.org/10.1007/s43678-024-00809-x
Keywords: Adverse events; Emergency department; Pediatric population; Procedural sedation; Sedation monitoring; Sedation protocol.

Original Research

Introduction : Our meta-analysis aimed to evaluate the safety of procedural sedation and analgesia in pediatric emergency department (ED) settings by investigating the incidence of cardiac, respiratory, gastrointestinal, and neurological adverse events associated with different sedation medications.

Méthode : In accordance with PRISMA guidelines, a comprehensive database search for randomized controlled trials was performed across ten databases from January 2005 to June 2024. Our inclusion criteria included randomized controlled trials involving children under 18 years old undergoing pediatric sedation and analgesia in the ED. Data on medication types, dosages, administration routes, and adverse events were extracted and analyzed. Primary endpoints included cardiac, respiratory, gastrointestinal, and neurological adverse events.

Résultats : Seventeen studies met the inclusion criteria, a total of 2,302 procedural sedations. The most common adverse events were vomiting, agitation, and hypoxia, which occurred in 104.9 [95% CI = 76.9-132.9], 37.5 [95% CI = 20.6-54.4], 38.3 [95% CI = 23.9-52.6] of each 1000 sedations, respectively. Other adverse events included apnea, hypotension, and the need for bag-valve mask ventilation, which occurred in 8.6 [95% CI: 3.5-13.6], 9.3 [95% CI: -1.4 to 20.1], and 13.5 [95% CI: 3.2-23.8] of each 1,000 sedations, respectively. Severe adverse events were rare, with no reported instances of intubation and only one case of laryngospasm. Subgroup analyses revealed varying incidence rates of adverse events across different sedation protocols, with ketamine and its combinations showing higher rates of specific respiratory complications.

Conclusion : Procedural sedation in pediatric EDs is generally safe, with a low incidence of adverse events, such as vomiting, agitation, and hypoxia. Life-threatening respiratory adverse events are extremely rare. Our findings thus support the careful selection and monitoring of sedation protocols to minimize risks.

Conclusion (proposition de traduction) : La sédation procédurale dans les services d'urgence pédiatriques est généralement sûre, avec une faible incidence d'effets indésirables, tels que vomissements, agitation et hypoxie. Les événements indésirables respiratoires mettant en jeu le pronostic vital sont extrêmement rares. Nos résultats plaident donc en faveur d'une sélection et d'un suivi attentifs des protocoles de sédation afin de minimiser les risques.

Sex and age differences in atypical chief complaints for acute decompensated heart failure in the emergency department.
Regan ML, Bischof JJ, Bush M, Waller AE, Platts-Mills TF, Casey MF, Meyer ML. | Clin Exp Emerg Med. 2025 Mar;12(1):47-55
DOI: https://doi.org/10.15441/ceem.24.226  | Télécharger l'article au format  
Keywords: Emergency departments; Heart failure; Hospital emergency service; Sex characteristics.

Cardiovascular

Introduction : About one million United States emergency department (ED) visits annually are due to acute decompensated heart failure (ADHF) symptoms. Characterizing the presentation of ED symptoms among ADHF patients may improve clinical care; however, sex and age differences in ED chief complaints have not been thoroughly investigated. In this paper, we describe differences in chief complaints and comorbid conditions for ED patients with ADHF diagnoses, stratified by sex and age.

Méthode :  We conducted a retrospective analysis of adults presenting to North Carolina EDs using the North Carolina Disease Event Tracking and Epidemiologic Collection Tool (NC DETECT), a statewide syndromic surveillance system, between 2010 and 2016, screening for patients with a diagnosis of ADHF. We evaluated frequencies of chief complaint categories for ED visits and comorbid conditions, stratified by sex and age, and computed standardized differences.

Résultats : The most common chief complaints were dyspnea (19.1%), chest pain (13.5%), and other respiratory complaints (13.4%). In the 18-44 years age group, women were more likely than men to report nausea/vomiting (6.7% vs. 4.1%) and headache (4.2% vs. 2.0%). In those 45-64 and ≥65 years, complaints were similar by sex. When stratified by age group alone, the 18-44 and 45-64 years age groups had more complaints of chest pain, whereas balance issues, weakness, and confusion were more common in the ≥65 years age group.

Conclusion : Differences in atypical ADHF symptoms were seen in in ED patients based on sex and age. Understanding the variation in ADHF symptoms among ED patients can facilitate the identification of ED patients with ADHF and improve management of ADHF-related symptoms.

Conclusion (proposition de traduction) : Des différences dans les symptômes atypiques d'insuffisance cardiaque aiguë décompensée ont été observées chez les patients des urgences en fonction du sexe et de l'âge. La compréhension des variations des symptômes de l'insuffisance cardiaque aiguë décompensée chez les patients des urgences peut faciliter l'identification des patients des urgences atteints d'insuffisance cardiaque aiguë décompensée et améliorer la prise en charge des symptômes liés à l'insuffisance cardiaque aiguë décompensée.

A review of hypoglycemia and dextrose treatment in patients with cardiac arrest.
Goodwin G, Hinton M, Bengio M, Patel A, Gaeto N, Tran H, Kashan S, Zitek T. | Clin Exp Emerg Med. 2025 Mar;12(1):90-93
DOI: https://doi.org/10.15441/ceem.24.305  | Télécharger l'article au format  
Keywords: Aucun

Mini-Review - Resuscitation

Introduction : Hypoglycemia is a cause of cardiac arrest and is associated with an increased risk of death in the critically ill. However, reports of sudden cardiac arrest in hypoglycemic patients are very rare, with a small number of published case reports. Results from animal studies indicate that the mechanism by which hypoglycemia causes cardiac arrest seems to be either lethal arrhythmia or seizures with resultant respiratory arrest. There is no strong evidence of a causal link between hypoglycemia and fatal arrhythmia in humans, but arrhythmias are thought to occur from sympathetic activation triggered by hypoglycemia, followed by excessive vagal counteraction.
Medical trainees have long been taught to assess the “Hs (hypovolaemia, hypoxia, hydrogen ion [acidosis], hyperkalaemia/hypokalaemia, hypothermia) and Ts (toxins, tamponade [cardiac], tension pneumothorax, thrombosis [coronary and pulmonary])” when elucidating the cause of cardiac arrest. In 2010, hypoglycemia was removed from the list of “Hs” in the Advanced Cardiac Life Support guidelines because of a lack of evidence. However, in our experience, it remains commonplace to check the glucose level with a fingerstick test in patients with cardiac arrest and to administer dextrose if the level is low. In this narrative review article, we review the evidence related to hypoglycemia during cardiac arrest and the use of dextrose in cardiac arrest patients.

Conclusion : We believe that routine use of fingerstick glucose levels during cardiac arrest should be abandoned. Given the rarity of and un- certainty around hypoglycemia as a cause of sudden cardiac ar- rest, we recommend only a selective assessment of blood glucose levels in cardiac arrest patients. Although prospective human data are lacking, existing data suggest that dextrose may be harmful to some patients in cardiac arrest. Therefore, we recom- mend only administering dextrose to cardiac arrest patients if they have severe hypoglycemia confirmed in a venous blood sample (if possible). More research, particularly, a large, random- ized-controlled trial investigating the utility and outcomes of dextrose during cardiac arrest, is needed.

Conclusion (proposition de traduction) : Nous pensons qu'il faut abandonner l'utilisation systématique du dextro au cour de l'arrêt cardiaque. Compte tenu de la rareté et de l'incertitude entourant l'hypoglycémie en tant que cause d'arrêt cardiaque inopiné, nous ne recommandons qu'une évaluation sélective des taux de glycémie chez les patients ayant fait un arrêt cardiaque. Bien que les données humaines prospectives manquent, les données existantes suggèrent que le glucose peut être nocif pour certains patients en arrêt cardiaque. Par conséquent, nous recommandons de n'administrer du glucose aux patients en arrêt cardiaque qu'en cas d'hypoglycémie sévère confirmée par un échantillon de sang veineux (si possible). D'autres recherches, en particulier un vaste essai contrôlé randomisé portant sur l'utilité et les résultats de l'administration de glucose en cas d'arrêt cardiaque, sont nécessaires.

Treatment of hyponatremia: comprehension and best clinical practice.
Sumi H, Tominaga N, Fujita Y, Verbalis JG; Electrolyte Winter Seminar Collaborative Group. | Clin Exp Nephrol. 2025 Mar;29(3):249-258
DOI: https://doi.org/10.1007/s10157-024-02606-3  | Télécharger l'article au format  
Keywords: Hyponatremia; Osmotic demyelination syndrome; Overly rapid correction; Treatment.

INVITED REVIEW ARTICLE

Editorial : This review article series on water and electrolyte disorders is based on the 'Electrolyte Winter Seminar' held annually for young nephrologists in Japan. The seminar features dynamic case-based discussions, some of which are included as self-assessment questions in this series. The second article in this series focuses on treatment of hyponatremia, a common water and electrolyte disorder frequently encountered in clinical practice. Hyponatremia presents diagnostic challenges due to its various etiologies and the presence of co-morbidities that affect water and electrolyte homeostasis. Furthermore, limited evidence, including a lack of robust randomized controlled trials, complicates treatment decisions and increases the risk of poor outcomes from inappropriate management of both acute and chronic hyponatremia. This review provides a comprehensive overview of treatment of hyponatremia for better comprehension and improved clinical practice.

Conclusion : Hyponatremia varies among patients and frequently exhibits a heterogeneous pathophysiology, posing difficulty in diagnosing the underlying cause and identifying the optimal treatment accordingly. However, since evidence in the management of hyponatremia is still insufficient, we hope that high-quality evidence based on RCTs comparing specific treatments will accumulate in the near future to enable individualized treatments for patients with hyponatremia. Until such time, we believe that this review will contribute to guiding best clinical practices in the management of hyponatremia.

Conclusion (proposition de traduction) : L'hyponatrémie varie d'un patient à l'autre et présente souvent une physiopathologie hétérogène, ce qui complique le diagnostic de la cause sous-jacente et l'identification du traitement optimal en conséquence. Cependant, comme les preuves de la prise en charge de l'hyponatrémie sont encore insuffisantes, nous espérons que des preuves de haute qualité basées sur des essais contrôlés randomisés comparant des traitements spécifiques s'accumuleront dans un avenir proche pour permettre des traitements individualisés pour les patients souffrant d'hyponatrémie. En attendant, nous pensons que cette revue contribuera à orienter les meilleures pratiques cliniques dans la prise en charge de l'hyponatrémie.

Mean arterial pressure in critically ill adults receiving vasopressors: A multicentre, observational study.
White KC, Quick L, Durkin Z, McCullough J, Laupland KB, Blank S, Attokaran AG, Kumar A, Shekar K, Garrett P, Meyer J, Tabah A, Ramanan M, Luke S, Chaba A, Bellomo R, Lamontagne F, Young PJ; Queensland Critical Care Research Network (QCCRN). | Crit Care Resusc. 2025 Mar 13;27(1):100103
DOI: https://doi.org/10.1016/j.ccrj.2025.100103  | Télécharger l'article au format  
Keywords: Critical care; Hypotension; Mean arterial pressure; Norepinephrine; Vasopressin; Vasopressors.

Research article

Introduction : Mean arterial pressure (MAP) management is a key aspect of treatment in critically ill patients receiving vasopressor therapy. Guidelines in different clinical subgroups have proposed various target MAP values. This study aimed to describe delivered MAP values and corresponding vasopressor doses in such patients.

Méthode : Multicenter, retrospective cohort study of adult intensive care unit (ICU) admissions.
Setting: 12 ICUs in Queensland, Australia, from January 1, 2015, to December 31, 2021.
Participants: Patients receiving vasopressors for at least six continuous hours in the ICU. We studied the delivered MAP values using hourly data based on averaging all validated values obtained from the ICU monitors and average hourly doses of vasopressors.
Main outcome measure: The primary outcome was the mean MAP during the entire cohort's first 72 hours of ICU admission, whilst vasopressors were administered.

Résultats : In 26,519 patients who received vasopressors for at least six continuous hours, the median age was 62 years, and 9,373 (35%) were admitted after elective surgery. The median time from ICU admission to vasopressor commencement was 2 hours, and the median duration of vasopressor therapy was 27 hours. At 72 hours, 6,627 (25.0%) patients remained on vasopressors. The mean hourly MAP was 72 mmHg in the first six hours, then steadily increased to ≈75 mmHg at 72 hours. In the first 72 hours, 11,032 (41.6%) patients had a mean MAP of 70-74 mmHg, and 5,914 (22.3%) had a mean MAP of 75-79 mmHg. For every clinical subgroup, a MAP of 70-74 mmHg was the most common mean MAP, and the proportion of patients with a mean MAP of 60-65mmHg was less than 5%.

Conclusion : In a large, multicenter study of heterogeneous critically ill patients on vasopressors, the mean hourly MAP was > 70 mmHg. This mean hourly MAP was observed consistently over diverse clinical subgroups and is higher than recommended by guidelines.

Conclusion (proposition de traduction) : Dans une vaste étude multicentrique portant sur des patients hétérogènes gravement malades sous vasopresseurs, la PAM horaire moyenne était supérieure à 70 mmHg. Cette PAM horaire moyenne a été observée de manière cohérente dans divers sous-groupes cliniques et est plus élevée que celle recommandée par les directives.

Diagnostic accuracy of prehospital ultrasound in detecting lung injury in patients with trauma: a systematic review and meta-analysis.
Sen JPB, Emerson J, Franklin J. | Emerg Med J. 2025 Mar 25;42(4):256-263
DOI: https://doi.org/10.1136/emermed-2023-213647
Keywords: Ultrasonography; chest; pneumothorax; pre-hospital; research.

Systematic review

Introduction : Ultrasound is now readily available in the prehospital setting and its use has been highlighted as one of the top research priorities in prehospital care. Clinical examination remains the standard care for diagnosing lung injury in the prehospital setting, yet this can be challenging and has poor diagnostic accuracy. This review evaluates the accuracy of prehospital ultrasound for the diagnoses of pneumothorax, haemothorax and pulmonary contusions in patients with trauma.

Méthode :  systematic review and meta-analysis was conducted. MEDLINE/PubMed, CINAHL, Embase and the Cochrane Library were searched. Only papers reporting on the diagnostic accuracy of lung ultrasound for traumatic pneumothorax, haemothorax or pulmonary contusions; in a prehospital or helicopter emergency medical service setting; and with CT or operative findings as a reference standard, were included. Non-English studies or articles that reported on animal studies were excluded. The Quality Assessment of Diagnostic Accuracy Studies-2 was used to assess the methodological quality of the included studies.

Résultats : Six observational studies, four with low risk of bias and two with some concerns, reporting on 1908 thoracic ultrasound examinations in patients with trauma, were included. For pneumothorax, meta-analysis yielded pooled sensitivity of 29% (95% CI 22% to 37%, I²=0%) and pooled specificity of 98% (95% CI 97% to 99%, I²=0%). Insufficient data were reported for a reliable meta-analysis on the presence of haemothorax. Only one study reported on the presence of pulmonary contusions and therefore no analysis was conducted.

Conclusion : Prehospital ultrasound is highly specific but has a lower sensitivity for the presence of pneumothorax when compared with hospital studies. Further research is required, alongside education and training of prehospital providers, to further explore the factors that account for the differences observed in this review.

Conclusion (proposition de traduction) : L'échographie préhospitalière est très spécifique mais a une sensibilité plus faible pour la détection du pneumothorax par rapport aux études hospitalières. Des recherches supplémentaires sont nécessaires, parallèlement à la formation des intervenants préhospitaliers, pour étudier plus en détail les facteurs qui expliquent les différences observées dans cette étude.

Commentaire :  Cette méta-analyse a évalué l'efficacité de l'échographie réalisée avant l'arrivée à l'hôpital pour détecter les lésions pulmonaires chez les patients traumatisés. Les résultats suggèrent que l'échographie préhospitalière est un outil fiable pour la détection précoce des lésions pulmonaires, facilitant ainsi une prise en charge rapide.​

Hyperkalemia management: a multidisciplinary expert panel’s perspective on the role of new potassium binders.
Fonseca C, Garagarza C, Silva G, Caires G, Marques I, Lopes JA, Branco P, Alves R, Ferreira A. | Heart Fail Rev. 2025 Mar;30(2):271-286
DOI: https://doi.org/10.1007/s10741-024-10461-3  | Télécharger l'article au format  
Keywords: Chronic kidney disease; Heart failure; Hyperkalemia; Patiromer; RAASi therapy; Sodium zirconium cyclosilicate.

Article

Editorial : Hyperkalemia is a potentially life-threatening condition frequently encountered in clinical practice, particularly among patients with chronic kidney disease, heart failure, diabetes, and hypertension and those undergoing treatment with renin-angiotensin-aldosterone system inhibitors (RAASi). The management of chronic and acute hyperkalemia is complex and requires timely intervention to prevent severe complications such as cardiac arrhythmias and sudden death. Traditional therapeutic approaches to chronic hyperkalemia, including dietary potassium restriction, use of diuretics, and administration of cation-exchange resins like sodium polystyrene sulfonate, often suffer from limitations like gastrointestinal side effects, variable efficacy, delayed onset of action, and RAASi treatment discontinuation. In recent years, the development of new potassium binders, specifically patiromer and sodium zirconium cyclosilicate (SZC), has revolutionized the management of hyperkalemia. Patiromer, a non-absorbed polymer, binds potassium in the gastrointestinal tract in exchange for calcium, thus facilitating its excretion. SZC operates by exchanging sodium and hydrogen ions for potassium, leading to efficient potassium removal. Both agents have demonstrated rapid and sustained reductions in serum potassium levels, coupled with favorable safety and tolerability profiles, in multiple clinical trials. This review article, authored by a multidisciplinary group of Portuguese experts in hyperkalemia management, provides an in-depth analysis of the efficacy and safety of current therapeutic strategies and highlights the clinical potential of new potassium binders. The introduction of patiromer and SZC offers significant advantages over traditional therapies, providing effective and better-tolerated options for patients. The review highlights the role of these novel agents in contemporary hyperkalemia management and calls for ongoing research to further refine treatment protocols and improve patient outcomes.

Conclusion : Concomitant to the need for well-designed clinical trials, conducting and reporting data from real-world settings is crucial to ensure the true long-term effectiveness and safety of patiromer and SZC. A holistic approach involving the collective expertise of cardiologists, nephrologists, internists, and nutritionists is essential for optimizing HK management and improving the overall quality of care for patients. Clear, evidence-based communication is vital to guide healthcare providers in selecting the most appropriate therapy based on individual patient needs and clinical scenarios, ensuring both effective and safe management of HK across different settings.

Conclusion (proposition de traduction) : Parallèlement à la nécessité de mener des essais cliniques bien conçus, il est essentiel de recueillir et de communiquer des données en situation réelle pour garantir l'efficacité et la sécurité à long terme du patiromère et du cyclosilicate de zirconium sodique. Une approche holistique faisant appel à l'expertise collective des cardiologues, des néphrologues, des internistes et des nutritionnistes est essentielle pour optimiser la prise en charge de l'hyperkaliémie et améliorer la qualité globale des soins prodigués aux patients. Une communication claire et fondée sur des données probantes est essentielle pour guider les professionnels de santé dans le choix du traitement le plus approprié en fonction des besoins individuels des patients et des scénarios cliniques, afin de garantir une prise en charge efficace et sûre de l'hyperkaliémie dans différents contextes.

Prospective Validation and Implementation Pilot Study of an Emergency Department Heart Failure Risk Stratification Tool: STRIDE-HF.
Sax DR, Huang J, Mark DG, Rana JS, Solomon MS, Norris RP, Reed ME. | JACC Heart Fail. 2025 Mar 25:S2213-1779(25)00171-4
DOI: https://doi.org/10.1016/j.jchf.2025.01.018
Keywords: acute heart failure; emergency department; risk stratification.

Original Research

Editorial : The STRIDE-HF (Systematic Tool for Risk Identification and Decision-making in Emergency Heart Failure) emergency department (ED) risk tool was previously found to accurately predict the risk of a 30-day serious adverse event (SAE), including 30-day mortality, cardiopulmonary resuscitation, intra-aortic balloon pump insertion, intubation, new dialysis, myocardial infarction, or coronary revascularization.

Introduction : The aim of this study was to prospectively validate STRIDE-HF across 21 community EDs among patients in the ED with acute heart failure (AHF) from January 1, 2023, to December 31, 2023, and to assess the safety of the real-time use of risk estimates in a 2-ED pilot study.

Méthode : Model area under the receiver operator curve (AUROC) and area under the precision recall curve (AUPRC), sensitivity, specificity, and positive and negative predictive values and likelihood ratios at key clinical thresholds are reported. In the clinical pilot, the rates of 30-day SAEs among patients who were at lower risk by STRIDE-HF and were discharged after ED or observation care were reported.

Résultats : There were 13,274 patients in the ED in the prospective validation; the median age was 76 years, 50.8% were female, and 44.5% were non-White; and 11.4%, 24.8%, 31.9%, and 31.9% of patients were at very low, low, moderate, and high risk, respectively. The 30-day SAE rates among very-low-risk and low-risk patients were 3.4% and 6.7%, respectively, and the 30-day mortality rates were <1% and <2%, respectively. STRIDE-HF was highly sensitive among low-risk patients (97.6%; 95% CI: 96.8%-98.2%); AUROC was 0.75 (95% CI: 0.74-0.76), and AUPRC was 0.43 (95% CI: 0.39-0.44). There were 845 patients in the pilot study; among patients classified by STRIDE-HF criteria as being at very low risk who were discharged, none experienced a 30-day SAE.

Conclusion : STRIDE-HF maintained high predictive accuracy for 30-day SAE in prospective validation in this large, diverse, multicenter cohort; the use of risk estimates in real time safely identified low-risk patients appropriate for discharge.

Conclusion (proposition de traduction) : STRIDE-HF a conservé une grande précision prédictive pour les événements indésirables graves à 30 jours lors de la validation prospective de cette cohorte multicentrique importante et diversifiée ; l'utilisation des estimations de risque en temps réel a permis d'identifier en toute sécurité les patients à faible risque susceptibles d'être autorisés à sortir de l'hôpital.

Commentaire : Cette étude a évalué l'efficacité de l'outil STRIDE-HF pour stratifier le risque des patients se présentant aux urgences avec une insuffisance cardiaque aiguë. Les résultats suggèrent que STRIDE-HF peut aider à identifier les patients à faible risque pouvant être pris en charge en ambulatoire, optimisant ainsi l'utilisation des ressources hospitalières.​

Point-of-care ultrasound diagnosis of acute valvular emergencies.
Stenberg R, Bowling J, Jacquet J, Watkins K, Eggleston J, Hill A, Krizo J. | Am J Emerg Med. 2025 Mar;89:36-50
DOI: https://doi.org/10.1016/j.ajem.2024.11.009  | Télécharger l'article au format  
Keywords: Acute valvular emergency; Critical aortic stenosis; Infective endocarditis; Left ventricular outflow tract obstruction; Mitral regurgitation; Mitral stenosis; Point-of-care ultrasound.

Article

Introduction : Acute valvular emergencies, a time-sensitive diagnosis, are nearly impossible to diagnose without ultrasound, and missing the diagnosis can significantly impact patient outcomes. Many emergency physicians lack access to echo technicians and may be uncomfortable performing the ultrasound themselves. Approaching the paucity of review articles, none of which are focused for the emergency physician, can be quite daunting, even for those with extensive ultrasound training.

Méthode : Our goal is to provide a simple resource for emergency physicians to utilize ultrasound to diagnose acute valvular emergencies. We created a concise review that includes relevance and approach to the diagnosis, complete with live ultrasound images, reference cards, and focused figures for in-the-moment reference.
A team of ultrasound fellowship-trained emergency medicine physicians determined the highest yield emergent conditions and oversaw the project. Each team member reviewed the etiology, incidence, and level of evidentiary support for each condition and then provided a guide to the appropriate procedure and evaluation with relevant additional guidance. An in-house graphics team was consulted to prepare original, concise figures for easy reference. All sections of the manuscript and figures were reviewed for accuracy and ease of use.

Discussion : Critical aortic stenosis, infective endocarditis, left ventricular outflow tract obstruction, mitral stenosis, and mitral regurgitation were identified diagnoses for which ultrasound can provide immediate diagnostic information for emergency physicians.

Conclusion : The use of ultrasound in the emergency department setting is a critical adjunct to care for patients with acute valvular emergencies. One should always consider a comprehensive, cardiology-performed echocardiogram in these scenarios.

Conclusion (proposition de traduction) : L'utilisation de l'échographie dans les services d'urgence est un complément essentiel aux soins prodigués aux patients souffrant d'urgences valvulaires aiguës. Il faut toujours envisager un échocardiogramme complet effectué par un cardiologue dans ces scénarios.