Florence Dumas

BACKGROUND: The aim of the DESAC study (Devenir des Survivants d’Arrets Cardiaques) was to describe the survival rate and neurological status of out-of-hospital (out-of-hospital cardiac arrest) survivors, and to assess the influence of prehospital and intrahospital factors. METHODS: Between July 2015 and October 2018, consecutive nontraumatic out-of-hospital cardiac arrest patients aged over 18 years discharged alive from 33 intensive care units in Paris and the suburbs (France) were included. Their neurological status was assessed every 6 months using the Cerebral Performance Category (CPC) scale. Prognostic factors associated with a favorable neurological outcome at 24 months (CPC category of 1 or 2) were assessed by covariate-adjusted logistic regression. Trajectories of CPC level over time were derived using a linear mixed model in survivors with at least 3 repeated assessments. RESULTS: Out of 593 survivors, 525 were followed up for 24 months (mean age, 58.1±15.3 years, 79% males), and 449 of 525 (86%) had a favorable neurological outcome. Initial shockable rhythm (adjusted odds ratio, 3.33 [95% CI, 1.57–7.07]) and previous practice of sport (adjusted odds ratio, 3.13 [95% CI, 1.21–8.12]) were associated with favorable outcome, whereas factors with reduced odds ratio were older age (adjusted odds ratio per 10 years, 0.53 [95% CI, 0.41–0.69]) and prior percutaneous coronary intervention (adjusted odds ratio, 0.38 [95% CI, 0.17–0.85]). Therapeutic hypothermia or acute coronary interventions were not related to prognosis ( P >0.05). Overall, among the 514 patients with at least 3 repeated assessments, 5 distinct CPC trajectories (2 reflecting early death were combined) were derived: 64% remained in CPC1, 13.4% in CPC2, 11% improved from CPC2 to CPC1, and 11.6% died either early or lately (>3 months) during follow-up. CONCLUSIONS: This multicentric prospective study indicates that 86% of out-of-hospital cardiac arrest survivors had a favorable neurological outcome at 24 months. Pre-event and intraevent factors (including previous practice of sport and shockable rhythm), but not in-hospital management (therapeutic hypothermia or acute coronary interventions), were associated with a favorable outcome. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT02494414.

Position du problème. L’arrêt cardiaque extra-hospitalier (ACEH), dont la forme clinique la plus caricaturale correspond à la « mort subite », représenterait la première cause de mortalité à travers le monde. Malgré les améliorations apportées à leur prise en charge, le pronostic de ces patients demeure très péjoratif, y compris chez ceux qui ont bénéficié d’une réanimation initiale avec succès. En effet, la longue période d’ischémie suivie du phénomène de reperfusion secondaire au retour d’une activité circulatoire (RACS) est à l’origine d’une cascade de phénomènes physiopathologiques qui caractérisent le syndrome post-arrêt cardiaque. Plusieurs éléments thérapeutiques, telles que la reperfusion coronaire précoce et l’hypothermie thérapeutique, se sont développés ces dernières années afin de diminuer la morbi-mortalité importante observée dans cette situation. L’intérêt de ces interventions précoces sur le pronostic ultérieur demeure cependant débattu, car il a souvent été établi sur des sous-groupes de patients très sélectionnés. Objectif. L’objectif de ce travail était d’évaluer l’influence de ces interventions thérapeutiques précoces sur le devenir des patients victimes d’ACEH et admis vivants en service de réanimation. Méthode. Depuis 2000, une cohorte de patients survivants d’ACR et admis vivants en réanimation a été constituée dans un centre spécialisé. L’ensemble des caractéristiques démographiques, pré-hospitalières et hospitalières ont été analysées. L’analyse multivariée des facteurs pronostiques dans cette cohorte a utilisé principalement les méthodes de régression logistique. Résultats principaux. Entre 2003 et 2008, 435 patients ont été admis, ne présentaient pas d’étiologie extra-cardiaque évidente et ont bénéficié d’une coronarographie immédiate et systématique. Une lésion coronaire récente a été observée chez près de la moitié d’entre eux. Les moyens de détection d’une étiologie cardiaque sont extrêmement limités que ce soit par des modèles prédictifs simples utilisant des paramètres démographiques ou circonstancielles ou par des paramètres para-cliniques tels que l’électrocardiogramme ou les enzymes cardiaques. En effet, ces derniers possèdent des valeurs prédictives médiocres et ne peuvent être considérés comme outil de triage de ces patients. En revanche, la coronarographie immédiate et systématique (suivie d’une reperfusion coronaire si nécessaire) était associée de manière significative et indépendante à la survie hospitalière (OR ajusté= 2.06 (1.16-3.66)) et ceci quelque soit l’aspect électrocardiographique. Entre 2000 et 2009, 1145 patients ont été admis et 2/3 d’entre eux ont été traités par hypothermie thérapeutique. Parmi eux, 708/1145 (62%) avait initialement un rythme cardiaque choquable et 437/1145 (38%) présentait un rythme non choquable. Après ajustement sur les autres facteurs pronostiques, l’hypothermie thérapeutique avait un rôle protecteur sur le pronostic neurologique des patients à la sortie de réanimation dans le groupe présentant initialement un rythme choquable (OR ajusté= 1.90 (1.18-3.06)). En revanche, l’association entre le pronostic et l’intervention dans le groupe « non-choquable » n’était pas significative (OR ajusté=0.71 (0.37-1.36)). Parmi les facteurs susceptibles d’altérer le bénéfice lié à ce traitement, les complications infectieuses chez les patients traités par hypothermie thérapeutique s’avèrent courantes La plus fréquente est la pneumopathie précoce, dont l’apparition est associée de manière significative au traitement par hypothermie (OR ajusté= 1.90 (1.28-2.80)), mais son rôle sur le pronostic n’est pas démontré.

Aims: The rising popularity of endurance races underscores the need to explore the risks of sports-related sudden cardiac arrest (Sr-SCA). Although rare, Sr-SCA is significantly more prevalent in men than in women. The mechanisms underlying these sex differences remain unclear. We aimed to investigate the incidence rates, clinical characteristics, aetiologies, sex differences, and exercise performances among SCA cases during major endurance races in Paris over a 10-year period. Methods and results: We Analysed the Paris Sudden Death Expertise Centre Registry Data (Covering 2011–2024, excluding 2020). This included SCA cases from the half marathon, full marathon and 20 km Parisian race events. We calculated the incidence rates for men and women, with performance analyses focusing on acceleration patterns and the relative risk of SCA in the final kilometre. Among the 1.2 million participants, 17 SCA cases (88% male) were identified, yielding crude incidences of 16.9 and 5.7 per million for men and women, respectively. Sr-SCA was overrepresented in the final kilometres of short races. Men exhibited twice the acceleration rate that women did. Despite extensive medical investigations, no cause was identified in 47.1% of the cases, underscoring the idiopathic nature of Sr-SCA. After hospitalization, 88% (15/17) of the cases survived, all with excellent neurological outcomes [cerebral performance category (CPC) 1], except for one CPC 2. Conclusion: SCA incidences during endurance races are low, with male predominance, high survival rates, and a high proportion of unexplained cases. The male-specific acceleration in the final kilometre may suggest that physiological and behavioural factors influence SCA risk.

Les Annales françaises de médecine d’urgence, organe officiel de la Société française de médecine d’urgence, s’adressent à tous les professionnels de l’urgence

Data on sports-related sudden cardiac arrest (SrSCA) among young adults in the general population are scarce. We aimed to determine the overall SrSCA incidence, characteristics, and outcomes in young adults. Prospective cohort study of all cases of SrSCA between 2012 and 2019 in Germany and Paris area, France, involving subjects aged 18–35 years. Detection of SrSCA was achieved via multiple sources, including emergency medical services (EMS) reporting and web-based screening of media releases. Cases and aetiologies were centrally adjudicated. Overall, a total of 147 SrSCA (mean age 28.1 ± 4.8 years, 95.2% males) occurred, with an overall burden of 4.77 [95% confidence interval (CI) 2.85–6.68] cases per million-year, including 12 (8.2%) cases in young competitive athletes. While bystander cardiopulmonary resuscitation (CPR) was initiated in 114 (82.6%), automated external defibrillator (AED) use by bystanders occurred only in a minority (7.5%). Public AED use prior to EMS arrival (odds ratio 6.25, 95% CI 1.48–43.20, P = 0.02) was the strongest independent predictor of survival at hospital discharge (38.1%). Among cases that benefited from both immediate bystander CPR and AED use, survival rate was 90.9%. Coronary artery disease was the most frequent aetiology (25.8%), mainly through acute coronary syndrome (86.9%). Sports-related sudden cardiac arrest in the young occurs mainly in recreational male sports participants. Public AED use remains disappointingly low, although survival may reach 90% among those who benefit from both bystander CPR and early defibrillation. Coronary artery disease is the most prevalent cause of SrSCA in young adults.

Aims: Age and sex disparities in out-of-hospital cardiac arrest (OHCA) have been described. Reproductive age may have a protected effect on females vs. males, although results are conflicting. We aimed to clarify this using the Paris Sudden Death Expertise Centre (SDEC) registry. Methods and results: The Paris SDEC registry collects OHCAs occurring in the Greater Paris Area. We included all OHCAs of presumed cardiac causes occurring between 2013 and 2018. Patients were divided into age groups: 1–13, 13–50, 50–75, and >75 years. Sex and age disparities in OHCA incidence and outcomes were analysed using multivariable negative binomial and logistic regression models. There were 19 782 OHCAs meeting inclusion criteria: 0.37% aged 1–13 years, 12.4% aged 13–50 years, 40.4% aged 50–75 years, and 46.9% aged >75 years. Adjusted incidence rate ratios (IRRs) in females vs. males were for the youngest to the older age groups: 1.29 [95% confidence interval (CI) 0.78–2.13], 0.54 [0.49–0.59], 0.60 [0.56–0.64], and 0.75 [0.67–0.84]. At reproductive age, females were more likely than males to have a return of spontaneous circulation [adjusted odds ratio (OR) 1.60 (1.27–2.02)], to be alive at hospital admission [OR: 1.49 (1.18–1.89)]. In both sexes, patients aged 13–50 years were more likely to survive at hospital discharge than those aged 50–75 years [males: OR 1.81 (1.49–2.20), females: 2.24 (1.54–3.25)]. However, at reproductive age, no sex disparity was observed in survival at hospital discharge [OR: 1.16 (0.75–1.80)]. Conclusion: Incidence rate ratios were similar between pre- and post-menopausal aged patients. At reproductive age, no sex disparity in survival at hospital discharge was observed, suggesting that menopausal status may not influence OHCA occurrence and prognosis.