Papers by Dominique Savary
Journal Européen des Urgences, Mar 1, 2004
Journal Européen des Urgences, May 1, 2007
EMC, 2010
L'altitude peut être à l'origine d'affections spécifiques causées par l'hypoxie. Cette hypoxie es... more L'altitude peut être à l'origine d'affections spécifiques causées par l'hypoxie. Cette hypoxie est liée à une baisse de la pression barométrique, dont le niveau est fonction de l'altitude atteinte. L'hypoxémie induite par cette hypoxie est à l'origine de phénomènes compensateurs complexes comme l'augmentation du débit cardiaque et de la ventilation. En cas d'exposition brutale à l'altitude, les mécanismes compensateurs qui se mettent naturellement en place après un séjour d'acclimatation sont insuffisants et les sujets développent un syndrome de maladaptation à l'altitude : le mal aigu des montagnes. Si ce syndrome est bénin et évolue souvent favorablement avec l'acclimatation, les symptômes peuvent s'intensifier et se compliquer d'un oedème cérébral ou d'un oedème pulmonaire de haute altitude qui sont des urgences vitales. L'altitude peut également entraîner des troubles physiques peu spécifiques liés au froid : les gelures de montagne. Ces cryotraumatismes correspondent à un véritable gel des tissus et l'urgence est au réchauffement précoce. Le pronostic fonctionnel est basé sur l'extension initiale des lésions et sur les données de la scintigraphie osseuse.
Thrombosis Research, Dec 1, 2021
Conclusion: Pulmonary sequestration is a rare disease with multiple theoretical aetiologies, ofte... more Conclusion: Pulmonary sequestration is a rare disease with multiple theoretical aetiologies, often misdiagnosed due to its variable and nonspecific presentation. CT scan/angiography and other imaging modalities which can accurately identify the arterial supply and venous drainage of the sequestered segment, are essential for diagnosis and preoperative planning.
EMC - Urgenze, Aug 1, 2022
Resuscitation, May 1, 2022
Resuscitation, Jun 1, 2021
International audienc
Annales De Cardiologie Et D Angeiologie, Nov 1, 2012
1 % > 0,001). L'analyse de la mortalité globale de l'ensemble de la population n'a pas montré de ... more 1 % > 0,001). L'analyse de la mortalité globale de l'ensemble de la population n'a pas montré de différence significative sur les trois périodes (7 %). Cependant, on observe une baisse significative de la mortalité dans le sous-groupe d'IDM ST+ avec choc cardiogénique (62 % P1, 48 % P2, P3 23 % > 0,001). Conclusion.-Les patients pris en charge en hémodynamique interventionnelle dans notre centre dans les 12 premières heures d'un IDM ST+ apparaissent de plus en plus jeune et porteur de maladie coronarienne de plus en plus sévère. Malgré les progrès techniques, la mortalité globale est stable depuis 1997, sauf chez les patients présentant un état de choc cardiogénique dont le pronostic ne cesse de s'améliorer. Une analyse critique systématique de nos pratiques apparaît essentielle afin d'optimiser la prise en charge de nos patients.
Annales De Cardiologie Et D Angeiologie, Nov 1, 2014
Background Rapid reperfusion is crucial in the treatment of acute ST-elevation myocardial infarct... more Background Rapid reperfusion is crucial in the treatment of acute ST-elevation myocardial infarction (STEMI). The latest STEMI guidelines from the European Society of Cardiology (ESC) recommend primary percutaneous coronary intervention (PPCI) if the delay between first medial contact (FMC) and wire passage is ≤ 120 min and fibrinolysis for delays > 120 min. With a ≤ 120 min delay from FMC to wire acceptable for PPCI, it appears that most patients would be eligible for/have access to PPCI. We sought to assess time to reperfusion in STEMI patients in a real-life registry and according to ESC guidelines. Methods RESURCOR is an ongoing registry of all cases of acute STEMI in the north French Alps, an area that covers three French departments (Isere, Savoie, Haute-Savoie), with 1.8 million inhabitants, and a population that doubles during the summer and winter holidays. In RESURCOR, delays and care pathway for STEMI patients, from symptoms onset to reperfusion, were recorded by the physicians. Results Between October 2002 and December 2011, 6169 patients were enrolled in the RESURCOR registry. Of these, 2573 patients were treated with PPCI and had data recorded for delay from FMC to artery puncture; 329 patients had a contraindication to fibrinolysis and 556/2244 (25%) of the PPCI patients without a contraindication to fibrinolysis had a delay from FMC-to-artery puncture > 120 min. A total of 2768 patients were treated with fibrinolysis with recorded delays and 1381/2768 (50%) were admitted to a PCI-capable hospital with a delay from FMC-to-admission (or artery puncture in case of urgent coronary angiogram) Conclusion When the latest ESC STEMI guidelines are applied to a real-world population, it appears that one-quarter of patients treated with PPCI would have been recommended for fibrinolysis and half of those who received fibrinolysis would have been recommended for PPCI.
Research Square (Research Square), Jun 5, 2020
In the context of the COVID-19 pandemic and overloaded hospitals, a central issue is the need to ... more In the context of the COVID-19 pandemic and overloaded hospitals, a central issue is the need to de ne reliable and consensual criteria for hospitalization or outpatient management in mild cases of COVID-19. Our aim was to de ne an easy-to-use clinical rule aiming to help emergency physicians in hospitalization or outpatient management decision-making for patients with suspected or con rmed SARS-CoV-2 infection (the HOME-CoV Rule). The Delphi method was used to reach a consensus of a large panel of 51 experts: emergency physicians, geriatricians, infectious disease specialists, and ethical consultants. A preliminary list of eligible criteria was compiled based on a literature review. Four rounds of anonymized expert consultations were performed. The experts were asked to score each item as relevant, possibly relevant and non-relevant, as major or minor, and to choose the cutoff. They were also able make suggestions and remarks. Eight criteria constituting the HOME-CoV were selected: six correspond to the severity of clinical signs, one to the clinical course (clinically signi cant worsening within the last 24 hours), and the last corresponds to the association of a severe comorbidity and an inadequate living context. Hospitalization is deemed necessary if a patient meets one or more of the criteria. In the end, 94.4% of the experts agreed with the de ned rule. Thanks to the Delphi method, an absolute consensus was obtained of a large panel of experts on the HOME-CoV rule, a decision-making support mechanism for clinicians to target patients with suspected or con rmed COVID-19 requiring hospitalization. Trial registration: NCT04338841
HAL (Le Centre pour la Communication Scientifique Directe), Sep 1, 2006
Registers of the management of infarction can complement information obtained from randomised tri... more Registers of the management of infarction can complement information obtained from randomised trials evaluating the methods and practice of treatment. In order to do this, the quality of the registers must be assured, and in particular the accuracy of the recorded cases. The objective of this study was to evaluate the accuracy of a register for the in-hospital and pre-hospital management of acute coronary syndromes with ST segment elevation of less than 12 hours' duration. Using a capture-recapture method, the study compared cases in the register with eligible cases present in the hospital and emergency ambulance service databases at two establishments, giving a recruitment rate of 61%. The rate of accuracy was estimated at 84% (95% CI [82 ; 86]). The independent factors associated with failure of notification were female sex (ORa=6.65 [2.04-21.69]), presentation at nights, weekends or bank holidays (ORa=4.13 [1.33-12.85]), direct admission to hospital without passing by the emergency ambulance service (ORa=2.85 [1.03-7.69]), primary angioplasty (ORa=6.18 [1.60-23.79]) and the absence of reperfusion (ORa=40.38 [6.21-262.40]). With more than 80% accuracy, the results produced by the register are robust. The selection bias linked to the under-representation of certain subgroups, while real, has only a marginal impact on estimates derived from the register. Factors associated with failure of notification should be taken into account when operating such a register.
HAL (Le Centre pour la Communication Scientifique Directe), 2007
The aim of this study was to compare the mortality associated to primary angioplasty and thrombol... more The aim of this study was to compare the mortality associated to primary angioplasty and thrombolysis in patients managed for an elevated ST-segment acute coronary syndrome in less than or more than 3 hours after the onset of symptoms. We analyzed the in-hospital mortality of 846 patients (including 276 [33%] treated by primary angioplasty, 511 [60%] by thrombolysis, and 59 [7%] without revascularisation) included from October 2002 to December 2003 in a registry of patients with an elevated ST-segment acute coronary syndrome managed in less than 12 hours in Northern Alps districts. The overall in-hospital mortality was at 6.0% (51/846). For the 631 managed in <3 hours, the mortality rates were respectively at 5.0%, 4.6% and 11.1% respectively in case of primary angioplasty, thrombolysis and without revascularisation (p=0.21). For the 215 patients with pain lasting more than 3 hours, the mortality rates were at 2.7%, 10.3% and 21.7% in case of primary angioplasty, thrombolysis and no revascularisation, respectively (p=0.01). In the multivariable analysis, the OR of death in case of thrombolysis compared to primary angioplasty was at 1.65 (95% IC: 0.73 - 3.75) for patients with pain " 3 hours, and 4.98 (95% IC: 1.32-18.37) for those with pain > 3 hours. These results are in line with randomized trials conclusions and confirm the international guidelines suggesting primary angioplasty for patients with a chest pain >3 hours and either angioplasty or thrombolysis in case of chest pain < 3 hours.
HAL (Le Centre pour la Communication Scientifique Directe), Feb 1, 2007
The aim of this study was to describe the changes in strategy of revascularisation in acute coron... more The aim of this study was to describe the changes in strategy of revascularisation in acute coronary syndromes with ST elevation (ACS ST+) since setting up a health care network. The authors analysed the incidence of coronary angioplasty and of intravenous thrombolysis from a prospective permanent hospital register of patients with ACS ST+ in the three Northern Alps departments from october 1st 2002 to december 31st 2004. Respectively, 171 patients were enrolled in 2002 and 675 in 2003, and 588 in 2004. The use of percutaneous coronary intervention increased (57, 69, and 78% in 2002, 2003, 2004, p< 0.01) in relation to the increased use of immediate secondary percutaneous coronary intervention (27, 36, 43%, p< 0.01) although the use of primary percutaneous coronary intervention did not changed (30, 33, 35%, p= 0.17). These results were observed in hospitals with and without Percutaneous Coronary Intervention facilities. An increase in prehospital (49, 67, 68%, p= 0.02) and hospital thrombolysis (48, 68, 73%, p= 0.03) was only observed in patients managed in institutions without Percutaneous Coronary Intervention facilities. The average delay to arterial punction (120. 124, 100 minutes, p< 0.01) and to intravenous thrombolysis (40, 30, 25 minutes, p< 0.01) decreased during the same period. Patients with ACS ST+ more commonly benefit from coronary revascularisation at increasingly shorter intervals to treatment. This would seem to be related to the better coordination of practitioners after the implantation of a health care network.
Resuscitation, Oct 1, 2017
Aim: Intense physical activity, cold and altitude make mountain sports a cause of increased risk ... more Aim: Intense physical activity, cold and altitude make mountain sports a cause of increased risk of outof-hospital cardiac arrest (OHCA). The difficulties of pre-hospital management related to this challenging environment could be mitigated by the presence of ski-patrollers in ski areas and use of helicopters for medical rescue. We assess whether this particular situation positively impacts the chain of survival compared to the general population. Methods: Analysis of prospectively collected data from the cardiac arrest registry of the Northern French Alps Emergency Network (RENAU) from 2004 to 2014. Results: 19,341 OHCAs were recorded during the period, including 136 on-slope events. Compared to other OHCAs, on-slope patients were younger (56 [40-65] vs. 66 [52-79] years, p < 0.001) and more often in shockable initial rhythm (41.2% vs 20.1%, p < 0.001). Resuscitation was more frequently started by a witness (43.4% vs 26.8%, p < 0.001) and the time to the first electric shock was shorter (7.5 min vs 14 min, p < 0.001), whereas time to the advanced life support (ALS) rescue arrival did not differ. The 30-day survival rate was higher for on-slope arrests (21.3% vs 5.9%, p < 0.001, RR = 3.61). In multivariate analysis, on-slope CA remained a positive 30-day survival factor with a 2.6 odds ratio (95% confidence interval, 1.42-4.81, p = 0.002). Conclusion: Despite difficult access and management conditions, patients undergoing OHCAs on ski slopes presented a higher survival rate, possibly explained by a healthier population, the efficiency of resuscitation by ski-patrols and similar time to ALS facilities compared to other cardiac arrests.
European Journal of Emergency Medicine
Resuscitation
All authors have made substantial contributions to all of the following: (1) the conception and d... more All authors have made substantial contributions to all of the following: (1) the conception and design of the letter (2) drafting the article or revising it critically for important intellectual content, (3) final approval of the version to be submitted and (4) agreement to be accountable for all aspects of the work.
European Journal of Emergency Medicine
European Journal of Emergency Medicine, 2020
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Papers by Dominique Savary