Signalement du cas au Dr VERGEZ HONTA et/ou au Dr JARDEL
81
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86
RESUME
Dans le but d’améliorer les pratiques de prise en charge des patients en arrêt cardiaque réfractaire par la SMUR de Rouen, nous proposons de formaliser, au CHU de Rouen, une filière de relais de la réanimation cardio-pulmonaire spécialisée débutée sur le terrain et poursuivie pendant le transport par l’implantation d’un système d’assistance circulatoire à l’admission du patient.
Pour optimiser la prise de décision médicale, nous fixons des critères d’éligibilités basés sur la durée du No Flow, les comorbidités du patient, le délai de mise en route de la réanimation cardio-pulmonaire spécialisée, le rythme cardiaque électrique initial, le dioxyde de carbone expiré et le délai prévisible de la mise en route de l’assistance circulatoire, dont nous vérifions rétrospectivement la pertinence à partir de 819 interventions de la SMUR de Rouen entre janvier 2012 et juillet 2014 saisies dans le registre national des arrêts cardiaques « RéAC ». Sur un total de 819 arrêts cardiaques prise en charge par la SMUR de Rouen, 40 patients présentaient les critères d’éligibilité à la mise en place d’une assistance circulatoire. Parmi ces patients, 11 ont survécu sans séquelles neurologiques, 1 a survécu avec des séquelles neurologiques sévères et 28 sont décédés. On peut légitimement penser que parmi les 28 patients décédés, notamment ceux en arrêt cardiaque réfractaire, certains aurait pu bénéficier, en termes de survie, d’une assistance circulatoire.
Un patient récemment traité avec succès selon ce protocole nous encourage à poursuivre cette démarche.
MOTS CLES :
ARRET CARDIAQUE PRE-HOSPITALIER, SAMU, SMUR, ECLS, MASSAGE CARDIAQUE EXTERNE MECANIQUE.