Jonathan Charbit

Traumatic pneumothorax is a potentially life-threatening condition requiring timely diagnosis and management, particularly in the prehospital setting where

Background: The goal of the present national survey was to describe the practices and use of resuscitative endovascular balloon occlusion of the aorta (REBOA) in France in level-1 trauma centers. Methods: Between January and December 2023, the ACUTE SFAR (Société Française d’Anesthésie et de Réanimation) committee sent a numeric survey to each French level-1 trauma center. This survey was focused on REBOA in trauma management including: use, protocol (indications, placement, aortic occlusion durations), aortic occlusion location (Zone 1/Zone 3), partial occlusion (pREBOA), device characteristics, operator, specific complications. Results: Among the 41 French level-1 trauma centers, 18 (44%) had incorporated REBOA in their algorithm. In 2022, 78% (14/18) of these centers had experienced between 1 and 5 REBOA placements, 11% (2/18) between 6 and 10, and 6% (1/18) 10 or more placements. The frequency of REBOA procedures increased with the duration of REBOA availability at the center. A protocol for REBOA placement was present in 28% (5/18) of centers. An anesthesiologistintensivist was the operator in 50% (9/18), a surgeon in 28% (5/18), and a radiologist in 22% (4/18) of centers. The proportion of centers using REBOA in Zone 1 was 39% (7/18), and pREBOA 33% (6/18). The maximum duration of complete aortic occlusion was specified in 50% of centers for Zone 1 and 78% for Zone 3. Conclusions: Use of REBOA is modestly spread among the French trauma centers, and in less than half of centers. Specific protocols are present. Anesthesiologist-intensivists are the operators in only half of these centers.

Our objective was to assess the relationship between the pre-/post-oxygenator gradient of the partial pressure of carbon dioxide (∆_EC PCO₂; dissolved form) and CO₂ elimination under extracorporeal respiratory support. All patients who were treated with veno-venous extracorporeal membrane oxygenation and high-flow extracorporeal CO₂ removal in our intensive care unit over 18 months were included. Pre-/post-oxygenator blood gases were collected every 12 h and CO₂ elimination was calculated for each pair of samples (pre-/post-oxygenator total carbon dioxide content in blood [_ctCO₂] × pump flow [extracorporeal pump flow {Q_EC}]). The relationship between ∆_EC PCO₂ and CO₂ elimination, as well as the origin of CO₂ removed. Eighteen patients were analyzed (24 oxygenators and 293 datasets). Each additional unit of ∆_EC PCO₂ × Q_EC was associated with an increase in CO₂ elimination of 5.2 ml (95% confidence interval [CI], 4.7−5.6 ml; p < 0.001). Each reduction of 1 ml STPD/dl of CO₂ across the oxygenator was associated with a reduction of 0.63 ml STPD/dl (95% CI, 0.60−0.66) of CO₂ combined with water, 0.08 ml STPD/dl (95% CI, 0.07−0.09) of dissolved CO₂, and 0.29 ml STPD/dl (95% CI, 0.27−0.31) of CO₂ in erythrocytes. The pre-/post-oxygenator PCO₂ gradient under extracorporeal respiratory support is thus linearly associated with CO₂ elimination; however, most of the CO₂ removed comes from combined CO₂ in plasma, generating bicarbonate.

Background: The aim of this study was to assess the interdependence of extracorporeal blood flow (Qec) and gas flow (GF) in predicting CO₂ removal and reduction of minute mechanical ventilation under extracorporeal respiratory support.Methods: All patients who benefited from V‐V ECMO and high‐flow ECCO₂R in our intensive care unit over a period of 18 months were included. CO₂ removal was calculated from inlet/outlet blood port gases during the first 7 days of oxygenator use. The relationship between the Qec × GF product (named decarboxylation index and expressed in L²/min²) and CO₂ removal or expired minute mechanical ventilation reduction (_ECMV ratio) was studied using linear regression models.Results: Eighteen patients were analyzed, corresponding to 24 oxygenators and 261 datasets. CO₂ removal was 393 ml/min (IQR, 310–526) for 1.8 m² oxygenators and 179 ml/min (IQR, 165–235) for 1.3 m² oxygenators. The decarboxylation index was associated linearly with CO₂ removal (R² = 0.62 and R² = 0.77 for the two oxygenators, respectively) and _ECMV ratio (R² = 0.72 and R² = 0.62, respectively). The 20L²/min² value (considering Qec = 2 L/min and GF = 10 L/min) was associated with an _ECMV ratio between 61% and 29% for 1.8 m² oxygenators, and between 62% and 38% for 1.3 m² oxygenators.Conclusion: The decarboxylation index is a simple parameter to predict CO₂ removal and _ECMV ratio under extracorporeal respiratory support.