N 441 Dr Thierry FEHR, AIR FRANCE CHICAGO 16 MAY 2013

Transcription

1 IS THE NUMBER OF PULMONARY EMBOLISMS DECREASED BY BEFORE AND IN FLIGHT PREVENTION MEASURES? N 441 Dr Thierry FEHR, AIR FRANCE CHICAGO 16 MAY 2013 Dr PARIS jf Dr PICHEREAU p Dr BARGAIN p Dr CAILLARD g 1

2 Disclosure Information 84th Annual AsMA Scientific Meeting Thierry FEHR I have no financial relationships to disclose I will not discuss off-label use and/or investigational use in my presentation 2

3 Pulmonary embolisms at the Parisian airports on arrival 1/ 2,9 Million passengers 1/ 200,000 for flights of more than 12 h 19 % of the serious emergencies 10 % of cardiovascular arrests Under estimation of the diagnosis as only counting cases identified at disembarkation Most pulmonary embolisms that occur during the next hours or the next days are not be listed The deaths are not counted (difficult to know the cause)

4 RISK FACTORS 4 Recent surgical operation Immobilization of the inferiors limbs Cancer Contraception Tobacco Age pregnancy Genetic factor sex

5 PRESENTATION OF THE PULMONARY EMBOLISM AT THE AIRPORT - Early morning Emergency on the footbridge - Faintness after ambulation at the exit of a long haul flight - tachycardia - Fall of the oxygen saturation - Cyanosis; dyspnoea; chest pain - ECG : tachycardia; right bundle-branch block; right axis; S1Q3 - Heart failure - hardly resssussitable heart arrest 5

6 Thromboembolism and Air Travel 96 serious emergencies at Roissy airport (Passengers ) EP

7 Pulmonary embolisms at airports 7

8 Pulmonary embolisms at airports 8

9 PREVENTION Mobilization of the inferiors limbs during the flight Avoid tight clothes and pressure points on the inferiors limbs Wearing compression stocking Hydration Avoid alcohol and sleeping drugs Low weight molecular heparin according to medical history All these recommendations are in agreement with the BEH (weekly epidemiological bulletin recommendations for the travelers) May 2012, or The ACCP (American college of chest physician)

10 STUDY The purpose of the study is to find if there is a correlation between the prevention measures and the evolution of the number of pulmonary embolisms The study concerns Orly airport (27 millions of pax) and Roissy airport (60 millions of pax) comparing two 5 year series of cases, separated by a 10 year interval à 2001 Study of Dr Caillard à 2011 Results that I extracted from the emergencies records at the 2 airports, excluding unconfirmed embolisms 10

11 RESULTS Study Orly= 28 cases, Roissy = 52 cases Study Orly =18 cases, Roissy = 62 cases Very little evolution of the percentage of long haul flights at the 2 airports during these 10 years The following result have been adjusted for the increase in passengers number at Orly (9 %) and Roissy (27 %) 45 % reduction at Orly airport 7 % reduction at Roissy airport 11

12 EVOLUTION OF THE PREVENTION IN FRANCE SINCE 2000 Good information of the physicians and the passengers about the dangers of an immobility extended during long haul flights Advice of prevention is given aboard aircraft in the form of video movie inciting the passengers to make muscle exercises of the inferiors limbs (Air France) A study made in Orly airport by Dr HURET Mathilde in 2012 showed that on 500 passengers leaving on long haul flights150 consulted a physician before the flight. 50 % received prescriptions in accordance with the recommendation of the ACCP or the BEH, and 5 % of the passengers used compression stocking without having consulted any physician There was increased demand by PAX for low weight molecular heparin administration at the airports 12

13 DISCUSSION At Orly airport the majority of long haul flights are bound for French overseas destinations (Antilles ; Réunion ; Guyane and also Madagascar ). The carriers are thus French airlines with a majority of French passengers. As we saw previously prevention measures are applied well. The results suggest that there is a relation with the important reduction in the number of pulmonary embolisms at Orly airport and the application of those measures 13

14 DISCUSSION At Roissy airport only a part of the flights are operated by French companies. The passengers thus represent all possible nationalities. Even if numerous countries apply preventions measures it remains probably a lot to be done to inform about this pathology in the rest of the world. This seems to explain the lower decrease in the incidence of pulmonary embolisms at Roissy airport compared with Orly airport. 14

15 conclusion The spectacular decrease in the number of pulmonary embolisms at Orly airport suggest that the means of prevention are effective Even if certain countries communicated with their physicians or their population on the subject. It remains probably a lot to be done at the level of the prevention in the rest of the world. We are in the presence of a pathology which represents 19 % of the serious airports medical emergencies and which is fatal in more than 10 % of the cases. It is necessary to generalize the application of the preventions measures. 15

16 THANK YOU FOR YOUR ATTENTION 16