CARDIOSTIM 2006

 

PRIX DE LA FONDATION LUCIEN DREYFUS

-MULHOUSE (France)-

 

 

 

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

 

 

http://www.cardiodiac.net/cdr_catFondation.htm

 

http://defibrilateur.free.fr/

 

http://www.cardiostim.fr/

 

 

 

 

 

ABSTRACT

 

 

SUDDEN CARDIAC DEATH IN FRANCE : THE NEW FRENCH PARADOX

 

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 France versus 30 to 50% in the countries which applied Public Access Defibrillation. Initially, the target of a 30 % rate of educated French was looking reasonable, and would have led to a significant improvement of   sudden cardiac death management. However, our experience demonstrates that we’re far from this result. Our suggestion is to impose training at school, access to external defibrillators, and better coverage of the emergency services. The best actor is the one who’s on site ! It’s better to act, even in a bad way, rather than doing nothing. In France the unique advantage is doctors in the ambulance so the delay of the AED arrival is always too long.

 

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 (Seattle for example), results are five more effective than best french medical system…

 

 

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