Background

Early and easy to do detection of left ventricular (LV) failure is crucial to improve following and outcomes of patients with right ventricular (RV) overload in congenital heart diseases. Electrical cardiometry is easy handling, even in medical office or in pre-hospital condition, and can provide cardiac output, and a new contractility index (ICON) (Osypka medical) supposed to be independent from load conditions. ICON have never been previoulsy challenged to our knowledge.

Objectives

We aim to compare ICON with the only contractility parameter independent from load conditions : the elastance slope (Emax).

Methods

Using porcine models of Fallot repaired and pulmonary hypertension (PH), we assess LV function using conductance catheter and electrical cardiometry devices over 4 months after surgery. We measured ICON, Emax, Contractile reserve (ΔE_max) and VIC (respiratory variations of ICON) at basal state and after adrenergic stimulation (Dobutamine).

Results

3 animals of each group were compared with 6 controls. Non parametric correlation (spearman) hightlights at basal state a non significant and low correlation between ICON and Emax and ΔEmax (r=0.5). However after Dobutamine, correlation is important and strong with r=0.98 between ICON/Emax (0.05) and 0.89 between VIC/Emax. We did not find strong correlation between ΔEmax and VIC or ΔICON.

Conclusion

These results obtain on a small in vivo /animal cohort highlight than electrical cardiometry device could be a usefull and easy handling (4 skin patchs) tool for LV failure and loss of contractility early screening, specially after adrenergic stimulation and stress conditions. It could provide precious help in patients following.

Background

It is not yet consensual whether parents should accompany their child during interfacility transport and during primary transport to the hospital. However new guidelines have been recently published for neonatal transport encouraging this policy.

Our emergency transport team has accepted to ride with parents in our ambulances for more than ten years, with various results.

Objectives

The aim of this study was to assess the perception of this policy by the members of our team.

Methods

An anonymous survey was sent via an internet link to all driving, nursing and medical staff. Through 4 closed questions, they were asked to assess their perception of parental presence during retrieval. They could also underline the potential advantages and challenges of such policy.

Results

Thirty members (out of 31) of the team answered the survey. Parental presence during retrieval was perceived as “an opportunity” to ease the retrieval for 50% of the staff, compared to 3% considering parental presence as a “burden”. Twenty five percent thought that parental presence had “no influence”.

The most dreadful event (among 7 proposals) which may occur during the ride was an inappropriate parental behavior. The staff's expectation was that parents reassure their child during transfer.

Conclusion

As both medical, nursing and driving staff are ready to allow parental presence during retrieval, it should be included in the routine policy. A further study is needed to check if it doesn’t increase risks during retrieval.

Background

Parental presence during critical care was a major concern a few years ago. The problem is now solved, but there is little evidence about it during interfacility transport and primary intervention.

Objectives

We decided to conduct a study to assess and understand our current policy.

Methods

The prospective monocentric study was conducted from April 2018 to October 2018. Nursing staff was asked to state and rate the parents’ presence during retrieval by means of a standardized questionnaire. We used one answer only questions from a larger survey: “Have you transported one of the parents?” They had to choose one answer out of four: Yes, on their request, Yes on our demand, No they declined, No it wasn’t an option.

Results

Staff questionnaire was returned for 333/709 of the retrievals (47% response rate)

There was a major difference between neonates and older children accompaniment.

Forty percent of the newborns’ parents and 12% of the older children’s parents were not even asked to come with the ambulance. Respectively 17% and 77% of the parents accompanied the ride but 80% and 20% of those who were asked to accompany declined the proposal.

Conclusion

The difference of parental presence during neotate’s or older children’s retrieval is a concern even if the mother’s absence could be partially explained by the fact they needed medical attention after birth. It could be interesting to perform the same type of study in different countries in order to have the advice of caregivers.

Background

Early detection of left ventricular (LV) failure is crucial to improve prognosis of patients with right ventricular (RV) overload.

Objectives

We aim to assess whether LV function is precociously affected in 2 surgical porcine models of moderate (Fallot repaired) and severe RV dysfunction (progressive pulmonary hypertension HP) at in vivo and in vitro levels.

Methods

3 animals of each surgical group were compared with 6 controls/Sham. 4 months after surgeries, LV function was evaluated using echocardiography/strain compared with conductance catheter. At cellular level using isolated cardiomyocytes, calcium transients amplitude with relaxation time associated and sarcomere shortening were recorded using Ionoptix system. T-tubules network integrity (DI-4-ANEPPS) and colocalization (Immunofluorescence) between main Excitation/Contraction (EC) actors (Ca^2+v1.2-Ryr) were analyzed. Contractile reserve was evaluated by adrenergic stimulation in-vivo and in-vitro (Dobutamine-isoproterenol).

Results

Despite RV dysfunctions in both groups, LV present hemodynamic impairment only in HP group (Longitudinal strain 9 versus 18%. Conductance catether with dobutamin: Elastance arterial 7.7 versus 1,32, SV 14 versus 75ml and tau (relaxation) 49 versus 27, p<0.05).In cardiomyocytes, we observe decrease of Ca²⁺ transient amplitude and cardiomyocytes contraction, acceleration of Ca²⁺ relaxation time, T-tubule network desorganisation and Cav1.2/Ryr decoupling(fig1). In vivo and in vitro, adrenergic stimulations increase dysfunction.

Conclusion

In vitro experiments pointed early abnormalities in LV EC particularly after adrenergic stimulation. A better understanding of cellular alterations could lead to survival improvement.