Obstetric anaesthesia manpower and service provision issues (introduction and European perspective).

En France, 272 morts maternelles sont survenues durant la période 2016–2018 parmi lesquelles 131 ont été pris en charge initialement par des professionnels de santé non spécialisés dans la maternité. Cinquante-six dossiers ont été exclus car ne concernant pas les services d'urgence ou en raison de données insuffisantes pour permettre l'analyse. Soixante-quinze cas de décès maternels initialement pris en en charge par les services d'urgence (service d'accueil des urgences [SAU] ou service d'aide médicale d'urgence [SAMU]) ont été analysés. Cinquante-six cas ont été pris en charge par le SAMU, 22 par un SAU (les deux dans 3 cas). Les diagnostics retenus comme mécanisme ou cause principale du décès sont 20 causes cardiovasculaires, 18 embolies pulmonaires, 9 défaillances neurologiques et 8 chocs hémorragiques. L'évènement retenu comme cause principale du décès est survenu pendant la grossesse dans 48 cas (64 %) et en per- ou post-partum dans 27 cas (36 %). Les motifs de consultation au SAU étaient principalement des syndromes douloureux (n = 9), des détresses respiratoires (n = 6) ou des malaises (n = 3). Les motifs d'appel du SAMU étaient un arrêt cardiorespiratoire (ACR) dans 32 cas (57 %) et une défaillance neurologique (coma ou état de mal) dans 6 cas (11 %). Parmi les 56 patientes prise en charge en extra hospitalier, 17 sont décédées sur place et 39 autres ont été transportées dans un déchocage (n = 13), dans un service spécialisé (n = 13), en obstétrique (n = 8) et plus rarement au SAU (n =2). Concernant les 75 dossiers retenus (SAU, SAMU, SMUR), le décès a été considéré comme inévitable dans 37 cas (49 %) et potentiellement évitable dans 29 cas (38 %) (peut être = 23, probablement = 6). L'évitabilité n'a pu être établie dans 9 cas. Parmi les 29 décès potentiellement évitables (38 %), un des critères d'évitabilité concernait les services d'urgence dans 14 cas (SAU = 9, SAMU/SMUR = 5) soit 18 % des dossiers étudiés (n = 75). L'orientation a été jugé appropriée dans 35 cas sur 39 (90 %). La prise en charge au SAU a été jugée optimale dans 11 cas (50 %) et non optimale dans 11 cas (50 %). La prise en charge par le SAMU (régulation + SMUR) a été considérée comme optimale dans 45 cas (80 %). In France, 272 maternal deaths occurred during the period 2016–2018, of which 131 were initially treated by healthcare professionals not specialized in obstetric. Fifty-six files were excluded because they did not concern emergency services or because there was insufficient data to allow analysis. Seventy-five cases of maternal deaths initially treated by emergency services [in-hospital emergency department (ED) or emergency medical ambulance (SAMU)] were analyzed. Fifty-six cases were treated by the SAMU and 22 by an ED (both in 3 cases). The causes of death were 20 cardiovascular events, 18 pulmonary embolisms, 9 neurological failures and 8 hemorrhagic shocks. The event occurred during pregnancy in 48 cases (64%) and during per- or postpartum period in 27 cases (36%). The motivations for consultation at the ED were mainly pain (n = 9), respiratory distress (n = 6) or faintness (n = 3). The reasons for calling emergency dispatching service (SAMU) were cardiorespiratory arrest in 32 cases (57%) and neurological failure (coma or status epilepticus) in 6 cases (11%). Among the 56 patients treated outside the hospital, 17 died on scene and 39 were transported to a resuscitation room (n = 13), a specialized department (n = 13), an obstetrics department (n = 8) and less often in the ED (n = 2). This was considered appropriate in 35 out of 39 cases (90%). Concerning the 75 files analyzed (ED and SAMU), death was considered unavoidable in 37 cases (49%) and potentially avoidable in 29 cases (38%) (maybe = 23, probably = 6). Avoidability could not be established in 9 cases. Among the 29 potentially avoidable deaths (38%), one of the criteria of avoidability concerned emergency services in 14 cases (ED = 9, SAMU/SMUR = 5, 18% of the files studied). ED's cares were considered optimal in 11 cases (50%) and non-optimal in 11 cases (50%). SAMU's cares were considered optimal in 45 cases (80%). 

Morts maternelles en France : prise en charge par les services d’urgence

En France, 272 morts maternelles sont survenues durant la période 2016-2018 parmi lesquelles 131 ont été pris en charge initialement par des professionnels de santé non spécialisés dans la maternité. Cinquante-six dossiers ont été exclus car ne concernant pas les services d'urgence ou en raison de données insuffisantes pour permettre l'analyse. Soixante-quinze cas de décès maternels initialement pris en en charge par les services d'urgence (Service d'Accueil des Urgences (SAU) ou Service d'Aide Médicale d'Urgence (SAMU)) ont été analysés. Cinquante-six cas ont été pris en charge par le SAMU, 22 par un SAU (les deux dans 3 cas). Les diagnostics retenus comme mécanisme ou cause principale du décès sont 20 causes cardiovasculaires, 18 embolies pulmonaires, 9 défaillances neurologiques et 8 chocs hémorragiques. L'évènement retenu comme cause principale du décès est survenu pendant la grossesse dans 48 cas (64%) et en per ou post partum dans 27 cas (36%). Les motifs de consultation au SAU étaient principalement des syndromes douloureux (n = 9), des détresses respiratoires (n = 6) ou des malaises (n = 3). Les motifs d'appel du SAMU étaient un arrêt cardiorespiratoire (ACR) dans 32 cas (57%) et une défaillance neurologique (coma ou état de mal) dans 6 cas (11%). Parmi les 56 patientes prise en charge en extra hospitalier, 17 sont décédées sur place et 39 autres ont été transportées dans un déchocage (n = 13), dans un service spécialisé (n = 13), en obstétrique (n = 8) et plus rarement au SAU (n =2). Concernant les 75 dossiers retenus (SAU, SAMU, SMUR), le décès a été considéré comme inévitable dans 37 cas (49%) et potentiellement évitable dans 29 cas (38%) (peut être = 23, probablement = 6). L'évitabilité n'a pu être établie dans 9 cas. Parmi les 29 décès potentiellement évitables (38%), un des critères d'évitabilité concernait les services d'urgence dans 14 cas (SAU = 9, SAMU/SMUR = 5) soit 18% des dossiers étudiés (n = 75). L'orientation a été jugé appropriée dans 35 cas sur 39 (90%). La prise en charge au SAU a été jugée optimale dans 11 cas (50%) et non optimale dans 11 cas (50%). La prise en charge par le SAMU (régulation + SMUR) a été considérée comme optimale dans 45 cas (80%). In France, 272 maternal deaths occurred during the period 2016-2018, of which 131 were initially treated by healthcare professionals not specialized in obstetric. Fifty-six files were excluded because they did not concern emergency services or because there was insufficient data to allow analysis. Seventy-five cases of maternal deaths initially treated by emergency services (in-hospital emergency department (ED) or emergency medical ambulance (SAMU)) were analyzed. Fifty-six cases were treated by the SAMU and 22 by an ED (both in 3 cases). The causes of death were 20 cardiovascular events, 18 pulmonary embolisms, 9 neurological failures and 8 hemorrhagic shocks. The event occurred during pregnancy in 48 cases (64%) and during per or postpartum period in 27 cases (36%). The motivations for consultation at the ED were mainly pain (n = 9), respiratory distress (n = 6) or faintness (n = 3). The reasons for calling emergency dispatching service (SAMU) were cardiorespiratory arrest in 32 cases (57%) and neurological failure (coma or status epilepticus) in 6 cases (11%). Among the 56 patients treated outside the hospital, 17 died on scene and 39 were transported to a resuscitation room (n = 13), a specialized department (n = 13), an obstetrics department (n = 8) and less often in the ED (n =2). This was considered appropriate in 35 out of 39 cases (90%). Concerning the 75 files analyzed (ED and SAMU), death was considered unavoidable in 37 cases (49%) and potentially avoidable in 29 cases (38%) (maybe = 23, probably = 6). Avoidability could not be established in 9 cases. Among the 29 potentially avoidable deaths (38%), one of the criteria of avoidability concerned emergency services in 14 cases (ED = 9, SAMU/SMUR = 5, 18% of the files studied). ED's cares were considered optimal in 11 cases (50%) and non-optimal in 11 cases (50%). SAMU's cares were considered optimal in 45 cases (80%). 

Mortalité maternelle et prise en charge par les services d’urgence en France 2016-2018

Paramedicine Literature Search: September-November 2022

Evidence-based guidelines (EBGs) are widely recognized as valuable tools to aggregate and translate scientific knowledge into clinical care. High-quality EBGs can also serve as important components of dissemination and implementation efforts focused on educating emergency medical services (EMS) clinicians about current evidence-based prehospital clinical care practices and operations. We aimed to perform the third biennial systematic review of prehospital EBGs to identify and assess the quality of prehospital EBGs published since 2021. 

2024 Systematic Review of Evidence-Based Guidelines for Prehospital Care

To provide recommendations on the management of urgent obstetrical emergencies outside the maternity ward.A group of 24 experts from the French Society of Emergency Medicine (SFMU), the French Society of Anaesthesia and Intensive Care Medicine (SFAR) and the French College of Gynaecologists and Obstetricians (CNGOF) was convened. Potential conflicts of interest were formally declared at the outset of the guideline development process, which was conducted independently of industry funding. The authors followed the GRADE (Grading of Recommendations Assessment, Development and Evaluation) method to assess the level of evidence in the literature. The potential drawbacks of strong recommendations in the presence of low-level evidence were highlighted. Some recommendations with an insufficient level of evidence were not graded.Eight areas were defined: imminent delivery, postpartum haemorrhage (prevention and management), threat of premature delivery, hypertensive disorders in pregnancy, trauma, imaging, cardiopulmonary arrest, and emergency obstetric training. For each field, the expert panel formulated questions according to the PICO model (population, intervention, comparison, outcomes) and an extensive literature search was conducted. Analysis of the literature and formulation of recommendations were conducted according to the GRADE method.Fifteen recommendations on the management of obstetrical emergencies were issued by the SFMU/SFAR/CNGOF panel of experts, and 4 recommendations from formalised expert recommendations (RFE) established by the same societies were taken up to answer 4 PICO questions dealing with the pre-hospital context. After two rounds of voting and several amendments, strong agreement was reached for all the recommendations. For two questions (cardiopulmonary arrest and inter-hospital transfer), no recommendation could be made.There was significant agreement among the experts on strong recommendations to improve practice in the management of urgent obstetric complications in emergency medicine. 

Guidelines for the management of urgent obstetric situations in emergency medicine, 2022.

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Guidelines for the management of urgent obstetric situations in emergency medicine, 2022.