Implementation of the ALERT algorithm, a new dispatcher-assisted telephone cardiopulmonary resuscitation protocol, in non-Advanced Medical Priority Dispatch System (AMPDS) Emergency Medical Services centres.
STIPULANTE, Samuel ; ; et al
in Resuscitation (2014), 85(2), 177-181
Objectives: Early bystander cardiopulmonary resuscitation (CPR) is a key factor in improving survival from out-of-hospital cardiac arrest (OHCA). The ALERT (Algorithme Liegeois d'Encadrement a la ... [more ▼]
Objectives: Early bystander cardiopulmonary resuscitation (CPR) is a key factor in improving survival from out-of-hospital cardiac arrest (OHCA). The ALERT (Algorithme Liegeois d'Encadrement a la Reanimation par Telephone) algorithm has the potential to help bystanders initiate CPR. This study evaluates the effectiveness of the implementation of this protocol in a non-Advanced Medical Priority Dispatch System area. Methods: We designed a before and after study based on a 3-month retrospective assessment of victims of OHCA in 2009, before the implementation of the ALERT protocol in Liege emergency medical communication centre (EMCC), and the prospective evaluation of the same 3 months in 2011, immediately after the implementation. Results: At the moment of the call, dispatchers were able to identify 233 OHCA in the first period and 235 in the second. Victims were predominantly male (59%, both periods), with mean ages of 64.1 and 63.9 years, respectively. In 2009, only 9.9% victims benefited from bystander CPR, this increased to 22.5% in 2011 (p<0.0002). The main reasons for protocol under-utilisation were: assistance not offered by the dispatcher (42,3%), caller physically remote from the victim (20.6%). Median time from call to first compression, defined here as no flow time, was 253sec in 2009 and 168sec in 2011 (NS). Ten victims were admitted to hospital after ROSC in 2009 and 13 in 2011 (p=0.09). Conclusion: From the beginning and despite its under-utilisation, the ALERT protocol significantly improved the number of patients in whom bystander CPR was attempted. [less ▲]Detailed reference viewed: 56 (20 ULg)
“A QUICK HIGH BEFORE IMMERSION INTO THE DEEP BLUE: THE FALL OF ICARUS REVISED.”
; BRASSEUR, Edmond ; GHUYSEN, Alexandre et al
Poster (2014, January 18)Detailed reference viewed: 7 (2 ULg)
UTILITY OF ALVARADO’S SCORE IN DIAGNOSTIC APPROACH OF THE ACUTE APPENDICITIS IN EMERGENCY DEPARTMENT?
SZECEL, Julien ; Timmermans, Grégory ; BRASSEUR, Edmond et al
Poster (2014, January 18)Detailed reference viewed: 14 (2 ULg)
LA CITY PARADE 2013 A LIEGE : BILAN DU DISPOSITIF PREVENTIF.
BRASSEUR, Edmond ; MASTRODICASA, Adrian ; GILLARD, Florence et al
Poster (2014, January 18)Detailed reference viewed: 8 (1 ULg)
To see or not to see: does video CPR perform better than telephone CPR?
Ghuysen, Alexandre ; DELFOSSE, Anne-sophie ; Stipulante, Samuel et al
in Critical Care (2014), 18(Suppl 1)Detailed reference viewed: 19 (2 ULg)
Le cas clinique du mois. Syndrome du bebe bleu: la verite cachee au fond du puits.
PIAZZA, Justine ; ; Bodson, Liliane et al
in Revue medicale de Liege (2014), 69(4), 175-9
Methemoglobinemia is a rare disorder preferentially affecting children. The outcome may be dramatic when the disorder remains unidentified, however early recognition using unspecific exams allows prompt ... [more ▼]
Methemoglobinemia is a rare disorder preferentially affecting children. The outcome may be dramatic when the disorder remains unidentified, however early recognition using unspecific exams allows prompt therapy. We report the case of a 14-month-old baby who presented with a sudden access of cyanosis resulting from acute methemoglobinemia. Careful investigation identified contamination of familial food by an excess of nitrates related to the use of well water from rural location. [less ▲]Detailed reference viewed: 18 (3 ULg)
Simulation en pédagogie médicale: état des lieux.
BETZ, Romain ; Ghuysen, Alexandre ; D'Orio, Vincenzo
in Revue medicale de Liege (2014), 69(3), 132-8
Training methodology having emerged primarily over the last two decades, simulation in health care has arisen from the idea that students should never practice on the patient for their "first time ... [more ▼]
Training methodology having emerged primarily over the last two decades, simulation in health care has arisen from the idea that students should never practice on the patient for their "first time". Simulation makes it possible to try out the errors and to repeat the skills over and over, in a reproducible way and in the most realistic possible environment, but with no harm to the patients, a risk socially intolerable. Simulation implies multiple methods from simple role-playing schemes to most powerful experiments on high-fidelity mannequins. In all cases, simulation implies a strictly codified structure: briefing, scenario, then debriefing. Indeed, debriefing represents the cornerstone of the teaching process allowing, both technical and non-technical skills acquisition through a work based on self-criticism. It should be noticed however that, although medical simulation has very clearly provided evidence of its effectiveness in skills acquisition, appropriate behaviours or application of algorithms, it has not demonstrated any benefit in terms of patients' care quality. Further research is therefore needed to validate this last assumption, which represents the very objective of any evolution in medicine. [less ▲]Detailed reference viewed: 24 (0 ULg)
L'algorithme ALERT. Pourquoi, qui, comment, quand?
; STIPULANTE, Samuel ; DELFOSSE, Anne-sophie et al
in Revue Médicale de Liège (2014), 69(synthèse 2014), 19-24
La réanimation guidée par téléphone consiste à guider le témoin d'un arrêt cardiaque, formé ou non à la réanimation cardio-pulmonaire, en lui donnant des consignes standardisées par téléphone. Ces ... [more ▼]
La réanimation guidée par téléphone consiste à guider le témoin d'un arrêt cardiaque, formé ou non à la réanimation cardio-pulmonaire, en lui donnant des consignes standardisées par téléphone. Ces instructions lui permettent de vérifier l'état de conscience de la victime, de dégager ses voies aériennes, d'apprécier la présence d'une respiration efficace et de mettre en train des compressions thoraciques en cas d'état de mort apparente. L'Algorithme Liégeois d'Encadrement à la Réanimation par Téléphone (ALERT) est un protocole original permettant aux dispatchers 112 de notre pays d'encadrer l'appelant durant la fenêtre de temps qui débute avec l'appel à l'aide pour se terminer à l'arrivée des équipes de secours spécialisés sur place. Son emploi est associé à un accroissement significatif de la fréquence et de la qualité des gestes de réanimation mis en train par le témoin permettant d'accroître les chances de survie de la victime d'un arrêt cardio-respiratoire extra-hospitalier (ACREH) [less ▲]Detailed reference viewed: 8 (2 ULg)
Age-adjusted D-dimer cutoff levels to rule out pulmonary embolism: the ADJUST-PE study.
; ; et al
in JAMA (2014), 311(11), 1117-24
IMPORTANCE: D-dimer measurement is an important step in the diagnostic strategy of clinically suspected acute pulmonary embolism (PE), but its clinical usefulness is limited in elderly patients. OBJECTIVE ... [more ▼]
IMPORTANCE: D-dimer measurement is an important step in the diagnostic strategy of clinically suspected acute pulmonary embolism (PE), but its clinical usefulness is limited in elderly patients. OBJECTIVE: To prospectively validate whether an age-adjusted D-dimer cutoff, defined as age x 10 in patients 50 years or older, is associated with an increased diagnostic yield of D-dimer in elderly patients with suspected PE. DESIGN, SETTINGS, AND PATIENTS: A multicenter, multinational, prospective management outcome study in 19 centers in Belgium, France, the Netherlands, and Switzerland between January 1, 2010, and February 28, 2013. INTERVENTIONS: All consecutive outpatients who presented to the emergency department with clinically suspected PE were assessed by a sequential diagnostic strategy based on the clinical probability assessed using either the simplified, revised Geneva score or the 2-level Wells score for PE; highly sensitive D-dimer measurement; and computed tomography pulmonary angiography (CTPA). Patients with a D-dimer value between the conventional cutoff of 500 microg/L and their age-adjusted cutoff did not undergo CTPA and were left untreated and formally followed-up for a 3-month period. MAIN OUTCOMES AND MEASURES: The primary outcome was the failure rate of the diagnostic strategy, defined as adjudicated thromboembolic events during the 3-month follow-up period among patients not treated with anticoagulants on the basis of a negative age-adjusted D-dimer cutoff result. RESULTS: Of the 3346 patients with suspected PE included, the prevalence of PE was 19%. Among the 2898 patients with a nonhigh or an unlikely clinical probability, 817 patients (28.2%) had a D-dimer level lower than 500 microg/L (95% CI, 26.6%-29.9%) and 337 patients (11.6%) had a D-dimer between 500 microg/L and their age-adjusted cutoff (95% CI, 10.5%-12.9%). The 3-month failure rate in patients with a D-dimer level higher than 500 microg/L but below the age-adjusted cutoff was 1 of 331 patients (0.3% [95% CI, 0.1%-1.7%]). Among the 766 patients 75 years or older, of whom 673 had a nonhigh clinical probability, using the age-adjusted cutoff instead of the 500 microg/L cutoff increased the proportion of patients in whom PE could be excluded on the basis of D-dimer from 43 of 673 patients (6.4% [95% CI, 4.8%-8.5%) to 200 of 673 patients (29.7% [95% CI, 26.4%-33.3%), without any additional false-negative findings. CONCLUSIONS AND RELEVANCE: Compared with a fixed D-dimer cutoff of 500 microg/L, the combination of pretest clinical probability assessment with age-adjusted D-dimer cutoff was associated with a larger number of patients in whom PE could be considered ruled out with a low likelihood of subsequent clinical venous thromboembolism. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT01134068. [less ▲]Detailed reference viewed: 4 (0 ULg)
A fatal case of Perthes syndrome
JOBE, Jérôme ; Ghuysen, Alexandre ; Hartstein, Gary et al
in Journal of Emergencies, Trauma and Shock (2013), 6(4), 296-297
Perthes syndrome, or traumatic asphyxia, is a clinical syndrome associating cervicofacial cyanosis with cutaneous petechial haemorrhages and subconjonctival bleeding resulting from severe sudden ... [more ▼]
Perthes syndrome, or traumatic asphyxia, is a clinical syndrome associating cervicofacial cyanosis with cutaneous petechial haemorrhages and subconjonctival bleeding resulting from severe sudden compressive chest trauma. Deep inspiration and a Valsalva maneuver just prior to rapid and severe chest compression, are responsible for the development of this syndrome. Current treatment is symptomatic: urgent relief of chest compression and cardiopulmonary resuscitation if needed. Outcome may be satisfactory depending on the duration and severity of compression. Prolonged thoracic compression may sometimes lead to cerebral anoxia, irreversible neurologic damage and death. We report a fatal case of Perthes syndrome resulting from an industrial accident. [less ▲]Detailed reference viewed: 32 (3 ULg)
Evaluating the psychological impact of practice dispatch-assisted cardiopulmonary instructions using the ALERT protocol: preliminary results in Liege dispatching centre.
; Ghuysen, Alexandre ; STIPULANTE, Samuel et al
Poster (2013, July)
ABSTRACT Background. The ALERT algorithm, an effective compression-only phone cardiopulmonary resuscitation (CPR) protocol has the potential to help bystanders initiate CPR. This study evaluates the ... [more ▼]
ABSTRACT Background. The ALERT algorithm, an effective compression-only phone cardiopulmonary resuscitation (CPR) protocol has the potential to help bystanders initiate CPR. This study evaluates the psychological impact of the CPR’s practice on untrained persons (UP). Methods. This is a quasi experimental longitudinal study (n = 153). We used: demographics data, CPR’ emotional characteristics; the Peritraumatic Dissociative Experiences Questionnaire ; the Way of Coping Check List and the Impact of Event Scale. Findings. Two psychological profiles: UP at high risk to develop a post traumatic disorder (higher average scores ; high emotional distress during the CPR) versus UP at low risk. Discussion. These preliminary results highlight the importance of identifying the psychological profile of the UP. For a CPR, UP at high risk should be treated differently: first, take the time to reduce emotional distress and then only talk about the CPR. This step could reduce the risk for PTSD [less ▲]Detailed reference viewed: 47 (7 ULg)
Medical communication at shift change and human error: Could a cognitive support make health care safer?
Gillet, Aline ; Ghuysen, Alexandre ; D'Orio, Vincenzo et al
Conference (2013, May 24)Detailed reference viewed: 47 (5 ULg)
Evaluation of a Model-Based Hemodynamic Monitoring Method in a Porcine Study of Septic Shock
; ; et al
in Computational and Mathematical Methods in Medicine (2013)Detailed reference viewed: 25 (7 ULg)
ALGORITHMES DE RÉGULATION DES APPELS DE MÉDECINE GÉNÉRALE
BRASSEUR, Edmond ; PAQUES, Florence ; GHUYSEN, Alexandre et al
Poster (2013, January 19)Detailed reference viewed: 9 (5 ULg)
Prospective study of an advanced nurse triage for a target pathology at the admission in the emergency department
JOBE, Jérôme ; ; Ghuysen, Alexandre et al
Poster (2013, January 18)Detailed reference viewed: 43 (10 ULg)
Implementation of dispatcher-assisted cardiopulmonary instructions using the ALERT protocol: preliminary results in Belgium
GHUYSEN, Alexandre ; Stipulante, Samuel ; El Fassi, Mehdi et al
in Critical Care (2013), 17(Suppl 2),Detailed reference viewed: 15 (1 ULg)
ALGORITHMES DE RÉGULATION DES APPELS DE MÉDECINE GÉNÉRALE
BRASSEUR, Edmond ; PAQUES, Florence ; GHUYSEN, Alexandre et al
in Acta Clinica Belgica (2013), 68(6), 487Detailed reference viewed: 15 (4 ULg)
Assessment of ventricular contractility and ventricular-arterial coupling with a model-based sensor.
Desaive, Thomas ; LAMBERMONT, Bernard ; JANSSEN, Nathalie et al
in Computer Methods & Programs in Biomedicine (2013), 109(2),
Estimation of ventricular contractility and ventricular arterial coupling is clinically important in diagnosing and treating cardiac dysfunction in the critically ill. However, experimental assessment of ... [more ▼]
Estimation of ventricular contractility and ventricular arterial coupling is clinically important in diagnosing and treating cardiac dysfunction in the critically ill. However, experimental assessment of indexes of ventricular contractility, such as the end-systolic pressure-volume relationship, requires a highly invasive maneuver and measurements that are not typical in an intensive care unit (ICU). This research describes the use of a previously validated cardiovascular system model and parameter identification process to evaluate the right ventricular arterial coupling in septic shock. Model-based ventricular arterial coupling is defined by the ratio of the end systolic right ventricular elastance (E(esrvf)) over the pulmonary artery elastance (E(pa)) or the mean pulmonary inflow resistance (R(pulin)). Results are compared to the clinical gold-standard assessment (conductance catheter method). Six anesthetized healthy pigs weighing 20-30kg received a 0.5mgkg(-1) endotoxin infusion over a period of 30min from T0 to T30, to induce septic shock and veno-venous hemofiltration was used from T60 onward. The results show good agreement with the gold-standard experimental assessment. In particular, the model-based right ventricular elastance (E(esrvf)) correlates well with the clinical gold standard (R(2)=0.69) and the model-based non-invasive coupling (E(esrvf)/R(pulin)) follow the same trends and dynamics (R(2)=0.37). The overall results show the potential to develop a model-based sensor to monitor ventricular-arterial coupling in clinical real-time. [less ▲]Detailed reference viewed: 38 (12 ULg)