Des scientifiques viennent de mettre à jour notre conception de la mort cellulaire et, de ce fait, perturber notre approche dans la réanimation cardio-respiratoire.
As recently as 1993, when Dr. Sherwin Nuland wrote the best seller “How We Die,” the conventional answer was that it was his cells that had died. The patient couldn’t be revived because the tissues of his brain and heart had suffered irreversible damage from lack of oxygen. This process was understood to begin after just four or five minutes. If the patient doesn’t receive cardiopulmonary resuscitation within that time, and if his heart can’t be restarted soon thereafter, he is unlikely to recover. That dogma went unquestioned until researchers actually looked at oxygen-starved heart cells under a microscope. What they saw amazed them, according to Dr. Lance Becker, an authority on emergency medicine at the University of Pennsylvania. “After one hour,” he says, “we couldn’t see evidence the cells had died. We thought we’d done something wrong.” In fact, cells cut off from their blood supply died only hours later.
Mais ce qui inquiète, c’est que la procédure habituelle de réanimation va à l’encontre des phénomènes biologiques nouvellement observés.
With this realization came another: that standard emergency-room procedure has it exactly backward. When someone collapses on the street of cardiac arrest, if he’s lucky he will receive immediate CPR, maintaining circulation until he can be revived in the hospital. But the rest will have gone 10 or 15 minutes or more without a heartbeat by the time they reach the emergency department. And then what happens? “We give them oxygen,” Becker says. “We jolt the heart with the paddles, we pump in epinephrine to force it to beat, so it’s taking up more oxygen.” Blood-starved heart muscle is suddenly flooded with oxygen, precisely the situation that leads to cell death. Instead, Becker says, we should aim to reduce oxygen uptake, slow metabolism and adjust the blood chemistry for gradual and safe reperfusion.
Ça va prendre des renouvellements de cartes de l’Ambulance St-Jean pour tout le monde…
Doctors Change the Way They Think About Death – Newsweek Health – MSNBC.com
Y a-t-il des statistiques prouvant l’efficacité des manoeuvres apprises pour le RCR?
En plus, les normes, façons de faire, changent tellement qu’on se demande si ça sert à quelque chose.