Blood biomarkers for the differentiation between central and peripheral vertigo in the emergency department: a systematic review and meta-analysis.
Klokman VW, Koningstein FN, Dors JWW, Sanders MS, Koning SW, de Kleijn DPV, Jie KE. | Acad Emerg Med.  2024 Apr;31(4):371-385
DOI: https://doi.org/10.1111/acem.14864  | Télécharger l'article au format  
Keywords: biomarker; dizziness; meta‐analysis; stroke; systematic review; vertigo.

SYSTEMATIC REVIEW

Introduction : In patients with acute vestibular syndrome (AVS), differentiating between stroke and nonstroke causes is challenging in the emergency department (ED). Correct diagnosis of vertigo etiology is essential for early optimum treatment and disposition.

Méthode : The aim of this systematic review and meta-analysis was to summarize the published evidence on the potential of blood biomarkers in the diagnosis and differentiation of peripheral from central causes of AVS.
Methods: A literature search was conducted for studies published until January 1, 2023, in PubMed, Ovid Medline, and EMBASE databases analyzing biomarkers for the differentiation between central and peripheral AVS. The Quality Assessment of Diagnostic Accuracy Studies questionnaire 2 was used for quality assessment. Pooled standardized mean difference and 95% confidence intervals were calculated if a biomarker was reported in two or more studies. Heterogeneity among included studies was investigated using the I² metric.

Résultats : A total of 17 studies with 859 central and 4844 peripheral causes of acute dizziness or vertigo, and analysis of 61 biomarkers were included. The general laboratory markers creatinine, blood urea nitrogen, albumin, C-reactive protein, glucose, HbA1c, leukocyte counts, and neutrophil counts and the brain-derived biomarkers copeptin, S100 calcium-binding protein β (S100β), and neuron-specific enolase (NSE) significantly differentiated central from peripheral causes of AVS.

Conclusion : This systematic review and meta-analysis highlights the potential of generalized inflammatory markers and brain-specific blood protein markers of NSE and S100β as diagnostic biomarkers for central from peripheral differentiation in AVS. These results, as a complement to clinical characteristics, provide guidance for future large-scale diagnostic research, in this challenging ED patient population.

Conclusion (proposition de traduction) : Cette revue systématique et cette méta-analyse mettent en évidence le potentiel des marqueurs inflammatoires généralisés et des marqueurs des protéines sanguines spécifiques au cerveau que sont la NSE et la S100β en tant que biomarqueurs diagnostiques permettant de différencier les vertiges centraux des vertiges périphériques dans les services d'urgence. Ces résultats, en complément des caractéristiques cliniques, fournissent des orientations pour de futures recherches diagnostiques à grande échelle, dans cette population difficile de patients des services d'urgence.

Peripheral nervous system and neuromuscular disorders in the emergency department: A review.
Sivadasan A, Cortel-LeBlanc MA, Cortel-LeBlanc A, Katzberg H. | Acad Emerg Med.  2024 Apr;31(4):386-397
DOI: https://doi.org/10.1111/acem.14861  | Télécharger l'article au format  
Keywords: Guillain–Barré syndrome; myasthenia; neuromuscular; respiratory failure.

SPECIAL CONTRIBUTION

Introduction : Acute presentations and emergencies in neuromuscular disorders (NMDs) often challenge clinical acumen. The objective of this review is to refine the reader's approach to history taking, clinical localization and early diagnosis, as well as emergency management of neuromuscular emergencies.

Méthode : An extensive literature search was performed to identify relevant studies. We prioritized meta-analysis, systematic reviews, and position statements where possible to inform any recommendations.

Discussion : The spectrum of clinical presentations and etiologies ranges from neurotoxic envenomation or infection to autoimmune disease such as Guillain-Barré Syndrome (GBS) and myasthenia gravis (MG). Delayed diagnosis is not uncommon when presentations occur "de novo," respiratory failure is dominant or isolated, or in the case of atypical scenarios such as GBS variants, severe autonomic dysfunction, or rhabdomyolysis. Diseases of the central nervous system, systemic and musculoskeletal disorders can mimic presentations in neuromuscular disorders.

Conclusion : Fortunately, early diagnosis and management can improve prognosis. This article provides a comprehensive review of acute presentations in neuromuscular disorders relevant for the emergency physician.

Conclusion (proposition de traduction) : Les maladies du système nerveux central, les troubles systémiques et musculo-squelettiques peuvent imiter les présentations des troubles neuromusculaires. Heureusement, un diagnostic et une prise en charge précoces peuvent améliorer le pronostic. Cet article fournit une revue complète des présentations aiguës des maladies neuromusculaires pertinentes pour le médecin urgentiste.

Emergency resuscitative thoracotomy in severe trauma: Analysis of the nation-wide registry data in Japan.
Okano H, Terayama T, Okamoto H, Yamazaki T. | Acute Med Surg.  2024 Apr 24;11(1):e958
DOI: https://doi.org/10.1002/ams2.958  | Télécharger l'article au format  
Keywords: Japan; cardiac arrest; database; resuscitation; thoracotomy.

ORIGINAL ARTICLE

Introduction : Emergency resuscitative thoracotomy is a potentially lifesaving procedure for patients with cardiac pulmonary arrest and profound circulatory failure resulting from a severe injury. However, survival rate post-emergency resuscitative thoracotomy shows considerable variation, with many studies constrained by limited sample sizes and ambiguous criteria for inclusion. Herein, we assessed the outcomes of emergency r

Méthode : Data of patients aged ≥18 years between 2004 and 2019 were analyzed. The primary outcome measure was survival at discharge. Descriptive statistics were used to compare the survivor and nonsurvivor groups. A multivariable logistic regression analysis was conducted to identify predictors of survival in patien

Résultats : Among patients who underwent emergency resuscitative thoracotomy, 684/5062 (13.5%) survived. Age <65 years (adjusted odds ratio, 1.351; 95% confidence interval, 1.130-1.615; p < 0.001), absence of cardiac pulmonary arrest on emergency department arrival (adjusted odds ratio, 1.694; 95% confidence interval, 1.280-2.243; p < 0.01), Injury Severity Score <16 (adjusted odds ratio, 2.195; 95% confidence interval, 1.611-2.992; p < 0.01), and penetrating injury (adjusted odds ratio, 1.834; 95% confidence interval, 1.384-2.431; p < 0.01) were identified as factors associated with survival at discharge.

Conclusion : The survival rate for emergency resuscitative thoracotomy in Japan stands at approximately 13.5%. Factors contributing to survival include younger age, absence of cardiopulmonary arrest at emergency department arrival, lack of severe trauma, and sustaining penetrating injuries.

Conclusion (proposition de traduction) : Le taux de survie à la thoracotomie de sauvetage d'urgence au Japon est d'environ 13,5 %. Les facteurs contribuant à la survie sont le jeune âge, l'absence d'arrêt cardio-respiratoire à l'arrivée au service des urgences, l'absence de traumatisme grave et de lésions pénétrantes.

Association between eGFR and neurological outcomes among patients with out-of-hospital cardiac arrest: A nationwide prospective study in Japan.
Kandori K, Okada A, Nakajima S, Matsuyama T, Kitamura T, Narumiya H, Iizuka R, Hitosugi M, Okada Y. | Acute Med Surg.  2024 Apr 17;11(1):e952
DOI: https://doi.org/10.1002/ams2.952  | Télécharger l'article au format  
Keywords: cardiac rhythm; comorbidity; estimated glomerular filtration rate; out‐of‐hospital cardiac arrest; renal dysfunction.

ORIGINAL ARTICLE

Introduction : We aimed to investigate the association between estimated glomerular filtration rate and prognosis in out-of-hospital cardiac arrest patients and explore the heterogeneity of the association.

Méthode : Patients experiencing out-of-hospital cardiac arrest due to medical causes and registered in the JAAM-OHCA Registry between June 2014 and December 2019 were stratified into shockable rhythm, pulseless electrical activity, and asystole groups according to the cardiac rhythm at the scene. The primary outcome was a 1-month favorable neurological status. Adjusted odds ratios with 95% confidence intervals were calculated to investigate the association between estimated glomerular filtration rate and outcomes using a logistic model.

Résultats : Of the 19,443 patients included, 2769 had initial shockable rhythm at the scene, 5339 had pulseless electrical activity, and 11,335 had asystole. As the estimated glomerular filtration rate decreased, the adjusted odds ratio for a 1-month favorable neurological status decreased among those with initial shockable rhythm (estimated glomerular filtration rate, adjusted odds ratio [95% CI]: 45-59 mL/min/1.73 m², 0.61 [0.47-0.79]; 30-44 mL/min/1.73 m², 0.45 [0.32-0.62]; 15-29 mL/min/1.73 m², 0.35 [0.20-0.63]; and <15 mL/min/1.73 m², 0.14 [0.07-0.27]). Estimated glomerular filtration rate was associated with neurological outcomes in patients aged <65 years with initial shockable rhythm but not in those aged >65 years or patients with initial pulseless electrical activity or asystole.

Conclusion : The estimated glomerular filtration rate is associated with neurological prognosis in out-of-hospital cardiac arrest patients with initial shockable rhythm at the scene but not in those with initial non-shockable rhythm.

Conclusion (proposition de traduction) : Le débit de filtration glomérulaire estimé est associé au pronostic neurologique chez les patients ayant présenté un arrêt cardiaque extrahospitalier avec un rythme initial choquable sur le lieu de l'accident, mais pas chez ceux dont le rythme initial n'était pas choquable.

Etomidate versus Ketamine as Prehospital Induction Agent in Patients with Suspected Severe Traumatic Brain Injury.
Mansvelder FJ, Bossers SM, Loer SA, Bloemers FW, Van Lieshout EMM, Den Hartog D, Hoogerwerf N, van der Naalt J, Absalom AR, Peerdeman SM, Bulte CSE, Schwarte LA, Schober P; BRAIN-PROTECT collaborators. | Anesthesiology.  2024 Apr 1;140(4):742-751
DOI: https://doi.org/10.1097/aln.0000000000004894  | Télécharger l'article au format  
Keywords: Aucun

Critical Care Medicine

Introduction : Severe traumatic brain injury is a leading cause of morbidity and mortality among young people around the world. Prehospital care focuses on the prevention and treatment of secondary brain injury and commonly includes tracheal intubation after induction of general anesthesia. The choice of induction agent in this setting is controversial. This study therefore investigated the association between the chosen induction medication etomidate versus S(+)-ketamine and the 30-day mortality in patients with severe traumatic brain injury who received prehospital airway management in the Netherlands.

Méthode : This study is a retrospective analysis of the prospectively collected observational data of the Brain Injury: Prehospital Registry of Outcomes, Treatments and Epidemiology of Cerebral Trauma (BRAIN-PROTECT) cohort study. Patients with suspected severe traumatic brain injury who were transported to a participating trauma center and who received etomidate or S(+)-ketamine for prehospital induction of anesthesia for advanced airway management were included. Statistical analyses were performed with multivariable logistic regression and inverse probability of treatment weighting analysis.

Résultats : In total, 1,457 patients were eligible for analysis. No significant association between the administered induction medication and 30-day mortality was observed in unadjusted analyses (32.9% mortality for etomidate versus 33.8% mortality for S(+)-ketamine; P = 0.716; odds ratio, 1.04; 95% CI, 0.83 to 1.32; P = 0.711), as well as after adjustment for potential confounders (odds ratio, 1.08; 95% CI, 0.67 to 1.73; P = 0.765; and risk difference 0.017; 95% CI, -0.051 to 0.084; P = 0.686). Likewise, in planned subgroup analyses for patients with confirmed traumatic brain injury and patients with isolated traumatic brain injury, no significant differences were found. Consistent results were found after multiple imputations of missing data.

Conclusion : The analysis found no evidence for an association between the use of etomidate or S(+)-ketamine as an anesthetic agent for intubation in patients with traumatic brain injury and mortality after 30 days in the prehospital setting, suggesting that the choice of induction agent may not influence the patient mortality rate in this population.

Conclusion (proposition de traduction) : L'analyse n'a pas mis en évidence de lien entre l'utilisation de l'étomidate ou de la S(+)-kétamine comme agent anesthésique pour l'intubation chez les patients souffrant de lésions cérébrales traumatiques et la mortalité après 30 jours en milieu préhospitalier, ce qui suggère que le choix de l'agent d'induction peut ne pas influencer le taux de mortalité des patients dans cette population.

Adenosine Should Be First-Line Treatment for Supraventricular Tachycardia.
McDowell M, Lyons N. | Ann Emerg Med.  2024 Apr;83(4):395-397
DOI: https://doi.org/10.1016/j.annemergmed.2023.10.017
Keywords: Aucun

Controverses cliniques

Editorial : Les inhibiteurs calciques et l'adénosine constituent tous deux des moyens efficaces pour traiter la tachycardie supraventriculaire paroxystique. Dans cette édition de « Clinical Controversies », des intervenants présentent des argumentaires opposés sur les questions que les cliniciens doivent prendre en compte lors du choix d'un agent de première intention pour leurs patients.

Conclusion : In conclusion, adenosine is efficacious in narrow QRS- complex tachycardias as both a diagnostic aid when the underlying rhythm is uncertain and as definitive treatment for established SVT in nearly all patient populations. Not only is adenosine recommended over calcium channel blockers for adults in the American Heart Association and European Society of Cardiology guidelines, the data for use in special populations exceed that of calcium channel blockers.1,2 The ultra-short-acting duration and ease of administration shown in the recent literature make adenosine an optimal therapy for SVT. Emergency medicine clinicians should continue to utilize adenosine as the first-line agent over calcium channel blockers for SVT.

Conclusion (proposition de traduction) : En conclusion, l'adénosine est efficace dans les tachycardies à QRS fins, à la fois comme aide au diagnostic lorsque le rythme sous-jacent est incertain et comme traitement définitif de la TSV établie dans presque toutes les populations de patients. Non seulement l'adénosine est recommandée par rapport aux inhibiteurs calciques chez les adultes dans les lignes directrices de l'American Heart Association et de la Société européenne de cardiologie, mais les données relatives à son utilisation dans des populations particulières dépassent celles des inhibiteurs calciques. La durée d'action ultra-courte et la facilité d'administration démontrées dans la littérature récente font de l'adénosine un traitement optimal de la TSV. Les médecins urgentistes devraient continuer à utiliser l'adénosine comme agent de première intention par rapport aux inhibiteurs calciques pour le traitement de la TSV.

Commentaire : On pourrait conclure que dans la TSV chez les enfants, les patients atteints de malformations cardiaques congénitales et les femmes enceintes ont pourrait préférer l’adénosine et chez tous les autres patients hémodynamiquement stables, les inhibiteurs calciques (diltiazem) comme agents de première intention par rapport à l'adénosine.

Calcium channel blockers should be first-line treatment for hemodynamically stable supraventricular tachycardia.
Rech MA, Gottlieb M. | Ann Emerg Med.  2024 Apr;83(4):394-395
DOI: https://doi.org/10.1016/j.annemergmed.2023.09.003
Keywords: Aucun

Controverses cliniques

Editorial : Les inhibiteurs calciques et l'adénosine constituent tous deux des moyens efficaces pour traiter la tachycardie supraventriculaire paroxystique. Dans cette édition de « Clinical Controversies », des intervenants présentent des argumentaires opposés sur les questions que les cliniciens doivent prendre en compte lors du choix d'un agent de première intention pour leurs patients.

Conclusion : In conclusion, calcium channel blockers are efficacious treatment options recommended by current guidelines for paroxysmal supraventricular tachycardia that spare the distressing adverse effects and clinically relevant drug interactions associated with adenosine. Emergency clinicians should consider calcium channel blockers as first-line agents over adenosine in hemodynamically stable patients with paroxysmal supraventricular tachycardia.

Conclusion (proposition de traduction) : En conclusion, les inhibiteurs calciques sont une option thérapeutique efficace recommandée par les lignes directrices actuelles dans la tachycardie supraventriculaire paroxystique qui évitent les effets indésirables pénibles et les interactions médicamenteuses cliniquement pertinentes associées à l'adénosine. Les urgentistes devraient considérer les inhibiteurs calciques comme des agents de première intention par rapport à l'adénosine chez les patients hémodynamiquement stables souffrant de tachycardie supraventriculaire paroxystique.

Commentaire : On pourrait conclure que dans la TSV chez les enfants, les patients atteints de malformations cardiaques congénitales et les femmes enceintes ont pourrait préférer l’adénosine et chez tous les autres patients hémodynamiquement stables, les inhibiteurs calciques (diltiazem) comme agents de première intention par rapport à l'adénosine.

The chain of survival and rehabilitation for sepsis: concepts and proposals for healthcare trajectory optimization.
Jouffroy R, Djossou F, Neviere R, Jaber S, Vivien B, Heming N, Gueye P. | Ann Intensive Care.  2024 Apr 16;14(1):58
DOI: https://doi.org/10.1186/s13613-024-01282-6  | Télécharger l'article au format  
Keywords: Early therapy; Healthcare trajectory; Network; Shock; sepsis.

Review

Editorial : This article describes the structures and processes involved in healthcare delivery for sepsis, from the prehospital setting until rehabilitation. Quality improvement initiatives in sepsis may reduce both morbidity and mortality. Positive outcomes are more likely when the following steps are optimized: early recognition, severity assessment, prehospital emergency medical system activation when available, early therapy (antimicrobials and hemodynamic optimization), early orientation to an adequate facility (emergency room, operating theater or intensive care unit), in-hospital organ failure resuscitation associated with source control, and finally a comprehensive rehabilitation program. Such a trajectory of care dedicated to sepsis amounts to a chain of survival and rehabilitation for sepsis. Implementation of this chain of survival and rehabilitation for sepsis requires full interconnection between each link. To date, despite regular international recommendations updates, the adherence to sepsis guidelines remains low leading to a considerable burden of the disease. Developing and optimizing such an integrated network could significantly reduce sepsis related mortality and morbidity.

Conclusion : Early access to the “chain of survival and rehabilitation for sepsis” ensures the early initiation of life saving treatments followed by the orientation of the patient to the adequate facility for advanced care. Earlier warning will be ensured by raising awareness of the condition among general practitioners, nurses, paramedics, prehospital caregivers and the general public. Earlier advanced care, based mainly on early antibiotic therapy and hemodynamic optimization, is possible independently of the pre- hospital emergency medical service organization even for primary health care when no ambulance can be dispatch to the scene. Triaging and admission to the adequate facility are essential for adequate source control. Advanced in hospital care helps overcome organ failure while waiting for the cause of sepsis to be treated. Rehabilitation is essential for survivors to recover an acceptable quality of life.
The ongoing public health challenge appears to be the development of coordinated actions, starting at the prehospital setting right through to rehabilitation, to be delivered as quickly as possible, thereby enhancing successful recovery for patients suffering from sepsis.

Conclusion (proposition de traduction) : L'accès précoce à la "chaîne de survie et de réadaptation pour la septicémie" garantit l'initiation rapide des traitements vitaux, suivie de l'orientation du patient vers l'établissement adéquat pour des soins avancés. La sensibilisation des médecins généralistes, des infirmières, du personnel paramédical, du personnel soignant préhospitalier et du grand public à cette pathologie permettra de donner l'alerte plus tôt. Des soins avancés plus précoces, basés principalement sur une antibiothérapie précoce et une optimisation hémodynamique, sont possibles indépendamment de l'organisation du service médical d'urgence pré-hospitalier, même pour les soins de santé primaires lorsqu'aucune ambulance ne peut être dépêchée sur les lieux. Le triage et l'admission dans l'établissement adéquat sont essentiels pour un contrôle adéquat de la source. Les soins hospitaliers avancés permettent de surmonter la défaillance des organes en attendant que la cause de la septicémie soit traitée. La rééducation est essentielle pour que les survivants retrouvent une qualité de vie acceptable.
Le défi actuel en matière de santé publique semble être le développement d'actions coordonnées, depuis le milieu préhospitalier jusqu'à la réadaptation, à mettre en œuvre le plus rapidement possible, afin d'améliorer le rétablissement des patients souffrant de septicémie.

Hypotension during intensive care stay and mortality and morbidity: a systematic review and meta-analysis.
Schuurmans J, van Rossem BTB, Rellum SR, Tol JTM, Kurucz VC, van Mourik N, van der Ven WH, Veelo DP, Schenk J, Vlaar APJ. | Intensive Care Med.  2024 Apr;50(4):516-525
DOI: https://doi.org/10.1007/s00134-023-07304-4  | Télécharger l'article au format  
Keywords: Hypotension; Intensive care unit; Meta-analysis; Morbidity; Mortality.

Systematic Review

Introduction : The aim of this study is to provide a summary of the existing literature on the association between hypotension during intensive care unit (ICU) stay and mortality and morbidity, and to assess whether there is an exposure-severity relationship between hypotension exposure and patient outcomes.

Méthode : CENTRAL, Embase, and PubMed were searched up to October 2022 for articles that reported an association between hypotension during ICU stay and at least one of the 11 predefined outcomes. Two independent reviewers extracted the data and assessed the risk of bias. Results were gathered in a summary table and studies designed to investigate the hypotension-outcome relationship were included in the meta-analyses.

Résultats : A total of 122 studies (176,329 patients) were included, with the number of studies varying per outcome between 0 and 82. The majority of articles reported associations in favor of 'no hypotension' for the outcomes mortality and acute kidney injury (AKI), and the strength of the association was related to the severity of hypotension in the majority of studies. Using meta-analysis, a significant association was found between hypotension and mortality (odds ratio: 1.45; 95% confidence interval (CI) 1.12-1.88; based on 13 studies and 34,829 patients), but not for AKI.

Conclusion : Exposure to hypotension during ICU stay was associated with increased mortality and AKI in the majority of included studies, and associations for both outcomes increased with increasing hypotension severity. The meta-analysis reinforced the descriptive findings regarding mortality but did not yield similar support for AKI.

Conclusion (proposition de traduction) : Dans la plupart des études incluses, le fait d'être hypotendu pendant le séjour en USI était associé à une augmentation de la mortalité et des lésions rénales aiguës, et les associations pour les deux résultats augmentaient avec la gravité de l'hypotension. La méta-analyse a renforcé les résultats descriptifs concernant la mortalité, mais n'a pas apporté de preuves similaires pour les lésions rénales aiguës.

Commentaire : Les associations entre l'hypotension et les résultats pour les patients étaient particulièrement prononcées lorsque la pression artérielle moyenne (PAM) tombait en dessous de 60 mmHg et la pression artérielle systolique (PA systolique) en dessous de 90 mmHg pour la mortalité, et lorsque la pression artérielle moyenne (PAM) tombait en dessous de 55 mmHg pour l'insuffisance rénale aiguë.

Oxygenation and ventilation during prolonged experimental cardiopulmonary resuscitation with either continuous or 30:2 compression-to-ventilation ratios together with 10 cmH₂0 positive end-expiratory pressure.
Kopra J, Litonius E, Pekkarinen PT, Laitinen M, Heinonen JA, Fontanelli L, Skrifvars MB. | Intensive Care Med Exp.  2024 Apr 12;12(1):36
DOI: https://doi.org/10.1186/s40635-024-00620-z  | Télécharger l'article au format  
Keywords: Arterial oxygen pressure; Cardiac arrest; Cardiopulmonary resuscitation; Computed tomography; Electrical impedance tomography; Hypoxaemia; Mechanical chest compression; Ventilation.

Research Articles

Introduction : In refractory out-of-hospital cardiac arrest, the patient is commonly transported to hospital with mechanical continuous chest compressions (CCC). Limited data are available on the optimal ventilation strategy. Accordingly, we compared arterial oxygenation and haemodynamics during manual asynchronous continuous ventilation and compressions with a 30:2 compression-to-ventilation ratio together with the use of 10 cmH₂O positive end-expiratory pressure (PEEP).

Méthode : Intubated and anaesthetized landrace pigs with electrically induced ventricular fibrillation were left untreated for 5 min (n = 31, weight ca. 55 kg), after which they were randomized to either the CCC group or the 30:2 group with the the LUCAS® 2 piston device and bag-valve ventilation with 100% oxygen targeting a tidal volume of 8 ml/kg with a PEEP of 10 cmH₂O for 35 min. Arterial blood samples were analysed every 5 min, vital signs, near-infrared spectroscopy and electrical impedance tomography (EIT) were measured continuously, and post-mortem CT scans of the lungs were obtained.

Résultats : The arterial blood values (median + interquartile range) at the 30-min time point were as follows: PaO2: 180 (86-302) mmHg for the 30:2 group; 70 (49-358) mmHg for the CCC group; PaCO2: 41 (29-53) mmHg for the 30:2 group; 44 (21-67) mmHg for the CCC group; and lactate: 12.8 (10.4-15.5) mmol/l for the 30:2 group; 14.7 (11.8-16.1) mmol/l for the CCC group. The differences were not statistically significant. In linear mixed models, there were no significant differences between the groups. The mean arterial pressures from the femoral artery, end-tidal CO2, distributions of ventilation from EIT and mean aeration of lung tissue in post-mortem CTs were similar between the groups. Eight pneumothoraces occurred in the CCC group and 2 in the 30:2 group, a statistically significant difference (p = 0.04).

Conclusion : The 30:2 and CCC protocols with a PEEP of 10 cmH₂O resulted in similar gas exchange and vital sign outcomes in an experimental model of prolonged cardiac arrest with mechanical compressions, but the CCC protocol resulted in more post-mortem pneumothoraces.

Conclusion (proposition de traduction) : Les protocoles de compressions thoraciques 30:2 et continues avec une PEP de 10 cmH₂O ont donné des résultats similaires en matière d'échange gazeux et de signes vitaux dans un modèle expérimental d'arrêt cardiaque prolongé avec compressions mécaniques, mais le protocole de compressions thoraciques continues a entraîné davantage de pneumothorax post-mortem.