Destiné a des personnes ou des groupes du monde médical ou paramédical, contribuant sur le terrain au perfectionnement des trois premiers maillons de la chaîne de survie, en conséquence à l’amélioration de la prise en charge de la ressuscitation cardio-pulmonaire dans le cadre spécifique de la mort subite d’origine cardiaque.
LAUREAT : 1er prix : Dr Jean-Pierre RIFLER
Nice, le 14 juin 2006
Dr F. HESSEL, Président de la Fondation
CARDIAC DEATH IN
Rifler JP, Service des Urgences UPATOU-SMUR, Centre Hospitalier intercommunal de Chatillon sur Seine et de Montbard, France
Cardio-respiratory arrest (CRA) requires
immediate resuscitation maneuvers. The « avoidable death » terminology should be
used rather than sudden death. Life support should include : immediate
alert, basic maneuvers within 4 min, defibrillation within 8 min, and specialized
ressuscitation within 12 min. Revisiting life support procedures means the use
of the Automatic External Defibrillator within the first 5 min after symptoms
occurrence. In France, the unique advantage of the life support chain is the
presence of a Medicine Doctor in the emergency services ambulance, the French «
wait and play », in opposition to the Anglo-Saxon « scoop and run ». Today the
survival rate without sequellae after sudden cardiac death is only 2 to 5% in
Our experience started in Montbard in 1997 with the collaboration of the Emergency Ward staff, and then, in 2001, we worked with the Red Cross. We educated more than 30 % of the population. All CRAs which triggered Cardio-Pulmonary Resuscitation (CPR) were systematically reported for the last three years. The neurologic patient status was assessed at hospital discharge, and a success was defined as a patient alive at one year follow-up. There were 8 successes out of 43 CPR attempts (18%). 3 patients were treated in the hospital, 5 were out of the hospital. All patients who survived more than 1 year were treated with AED less than 6 minutes after sudden death.
The use of AED without training is possible, so the key point is the AED disponibility. The chain of survival must become : AED first, emergency call, CPR, Emergency ambulance
Information and short training for young people is the good way. Fully AED is asy to use, it is the « Game Boy » generation.
With the Fully Automated Defibrillator, the witness do not need pushing a button, it means : reduce time to shock ; reduce the feeling of responsibility ; the witness can call the emergency when the electrode pads are applied.
The best actor is the one who’s on site !
Without training but with AED,
The only solution in rural places is the Public
Acces Defibrillation and better coverage of the emergency services. For the
city with PAD (
In conclusion : Buffon, the naturalist of Montbard said « Le génie n'est qu'une plus grande aptitude à la patience. »
1752 : Buffon first Key Opinion Leader in the area of electricity
2005 : Montbard first french city equipped with fully AED