Annales françaises d'anesthèsie et de rèanimation
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Ann Fr Anesth Reanim · May 2011
Review Historical Article[MCAU/MRAU session: point of view of the pre-hospital Emergency Medical Services, costs assessment].
Since the 1970s, it has become possible to handle patients with serious pulmonary and cardiac failure with extracorporeal membrane oxygenation (ECMO) when conventional treatment fails, but only in specialized centers. When the latter were too far away, the risks of such transport were considered too high until the Mobile Cardiac Assistance Unit (MCAU) and Mobile Respiratory Assistance Unit (MRAU) were created. We are first going to expose the point of view of the pre-hospital Emergency Medical Services (EMS). ⋯ D. in need of such assistance should call the cardiac surgeon of the reference center : if the indication is confirmed, they will call the EMS (Service d'Aide Médicale Urgente, SAMU), and decide together which means is the most appropriate for a quick transportation of the team and the ECMO to the patient's bedside, and then back to the ECMO center, depending on the problems raised by ground vehicles on the one hand and aircrafts or helicopters on the other. Then, we are going to evaluate the cost of such transportation, which is quite considerable. As a conclusion, because of its high cost, the mobile inter-hospital ECMO. service should only be used when the patient is considered too ill to be transported on conventional therapy : in that case, this procedure represents huge progress.
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In order to effectively deal with the increase in cardiac and/or respiratory services outside of Lille CHU (University Hospital), an interdisciplinary medical/surgical procedure has been put in place in collaboration with the emergency medical service (SAMU). This organization makes it possible to respond rapidly to a demand outside the University Hospital, while ensuring safe management of patients.
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Ann Fr Anesth Reanim · May 2011
[Post-partum haemorrhage in delivery room: anaesthetists' practioner in Auvergne].
To assess the management of post-partum haemorrhage (PPH) in delivery rooms by the anaesthetists of the Auvergne region. ⋯ This survey, with a good response rate, showed a practice generally fitting to the guidelines, although with some failures depending on the practioner's age and type of hospital.
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Technical success and absence of iatrogenic injury from inadequate myocardial protection are the foremost targets of every cardiac surgical procedure. The current trends of pediatric cardiac surgery are aimed to achieve definitive repair of complex cardiac defects at birth as to avoid the risks related with palliative surgery and to reduce the long term impact of the untreated defect on the cardiac function. Thus, even newborn patients are exposed to a prolonged time of myocardial ischemia. The aim of this paper is to describe the impact of crystalloid HKT Custodiol cardioplegia infusion on myocardial protection in the early and late outcome of newborn patients who underwent arterial switch operation (ASO) for transposition of the great arteries (TGA).
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Ann Fr Anesth Reanim · May 2011
Case Reports[Interest of circulatory assistance mobile unit for cardiovascular surgical pathology support at distance of specialized centers: about a case of papillary muscle rupture].
Papillary muscle rupture is a classical, but not frequent life-threatening complication of myocardial infarction. The only treatment consists in mitral valve surgical replacement. ⋯ We also discuss the interest of mobile unit of cardiac assistance to manage patients in hospital without cardiac surgery then to transfer them. We discuss also the initial management in the cardiac surgery and critical care unit.