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Papers by Guillaume Lebreton

Open Forum Infectious Diseases

Background Postsurgical infections due to Mycobacterium chimaera appeared as a novel nosocomial t... more Background Postsurgical infections due to Mycobacterium chimaera appeared as a novel nosocomial threat in 2015, with a worldwide outbreak due to contaminated heater-cooler units used in open chest surgery. We report the results of investigations conducted in France including whole-genome sequencing comparison of patient and heater-cooler unit isolates. Methods We sought M. chimaera infection cases from 2010 onwards through national epidemiological investigations in health care facilities performing cardiopulmonary bypass, together with a survey on good practices and systematic heater-cooler unit microbial analyses. Clinical and heater-cooler unit isolates were subjected to whole-genome sequencing analyzed with regard to the reference outbreak strain Zuerich-1. Results Only 2 clinical cases were shown to be related to the outbreak, although 23% (41/175) of heater-cooler units were declared positive for M. avium complex. Specific measures to prevent infection were applied in 89% (50/5...

Thrombosis and Haemostasis

Hemostatic changes induced by extracorporeal membrane oxygenation (ECMO) support have been yet po... more Hemostatic changes induced by extracorporeal membrane oxygenation (ECMO) support have been yet poorly documented in coronavirus-19 (COVID-19) patients who have a baseline complex hypercoagulable state. In this prospective monocentric study of patients with severe acute respiratory distress syndrome (ARDS) rescued by ECMO, we performed longitudinal measurements of coagulation and fibrinolysis markers throughout the course of ECMO support in 20 COVID-19 and 10 non-COVID-19 patients. Blood was sampled before and then 24 hours, 7, and 14 days after ECMO implantation. Clinical outcomes were prospectively assessed until discharge from the intensive care unit or death. The median age of participants was 47 (35–56) years, with a median body mass index of 30 (27–35) kg/m2, and a Sepsis-related Organ Failure Assessment score of 12 (8–16). Baseline levels of von Willebrand factor, fibrinogen, factor VIII, prothrombin F1 + 2, thrombin–antithrombin, D-dimer, and plasminogen activator inhibitor-1...

Intensive Care Medicine

Full author information is available at the end of the article Members of the EuroECMO COVID-19 W... more Full author information is available at the end of the article Members of the EuroECMO COVID-19 Working Group and of the Euro-ELSO Steering Committee are listed in the Acknowledgements Section.

Annals of Cardiothoracic Surgery

Surgical technique for the implantation of mechanical circulatory support with the Impella 5.0 pu... more Surgical technique for the implantation of mechanical circulatory support with the Impella 5.0 pump in a patient with post-cardiotomy cardiogenic shock.

Journal of Integrative Cardiology Open Access

Management of out-of-hospital cardiac arrest (OHCA) remains challenging, particularly in young pa... more Management of out-of-hospital cardiac arrest (OHCA) remains challenging, particularly in young patients. Takayasu arteritis is a rare large-vessel vasculitis relatively. Coronary involvement has been previously described; we provided the first intracoronary images by OCT. We report the first case of OHCA with shockable rhythm revealing chronic total occlusion of the left main in a 41-year-old lady. The coronary anomaly made it possible to diagnose the vasculitis and to treat it by corticosteroid and immunosuppressive treatment. Vasculitis should be evoked in atypical coronary syndrome in young patients. A collaborative multidisciplinary approach permits optimal care for this complex patient.

Archives of Cardiovascular Diseases

Frontiers in Plant Science

The Journal of Heart and Lung Transplantation

Annals of Intensive Care

Background Prone positioning (PP) during veno-venous ECMO is feasible, but its physiological effe... more Background Prone positioning (PP) during veno-venous ECMO is feasible, but its physiological effects have never been thoroughly evaluated. Our objectives were to describe, through electrical impedance tomography (EIT), the impact of PP on global and regional ventilation, and optimal PEEP level. Methods A monocentric study conducted on ECMO-supported severe ARDS patients, ventilated in pressure-controlled mode, with 14-cmH2O driving pressure and EIT-based “optimal PEEP”. Before, during and after a 16-h PP session, EIT-based distribution and variation of tidal impedance, VTdorsal/VTglobal ratio, end-expiratory lung impedance (EELI) and static compliance were collected. Subgroup analyses were performed in patients who increased their static compliance by ≥ 3 mL/cmH2O after 16 h of PP. Results For all patients (n = 21), tidal volume and EELI were redistributed from ventral to dorsal regions during PP. EIT-based optimal PEEP was significantly lower in PP than in supine position. Median (...

Critical Care

Background: Amikacin infusion requires targeting a peak serum concentration (C max) 8-10 times th... more Background: Amikacin infusion requires targeting a peak serum concentration (C max) 8-10 times the minimal inhibitory concentration, corresponding to a C max of 60-80 mg/L for the least susceptible bacteria to theoretically prevent therapeutic failure. Because drug pharmacokinetics on extracorporeal membrane oxygenation (ECMO) are challenging, we undertook this study to assess the frequency of insufficient amikacin C max in critically ill patients on ECMO and to identify relative risk factors. Methods: This was a prospective, observational, monocentric study in a university hospital. Patients on ECMO who received an amikacin loading dose for suspected Gram-negative infections were included. The amikacin loading dose of 25 mg/kg total body weight was administered intravenously and C max was measured 30 min after the end of the infusion. Independent predicators of C max < 60 mg/L after the first amikacin infusion were identified with mixed-model multivariable analyses. Various dosing simulations were performed to assess the probability of reaching 60 mg/L < C max < 80 mg/L. Results: A total of 106 patients on venoarterial ECMO (VA-ECMO) (68%) or venovenous-ECMO (32%) were included. At inclusion, their median (1st; 3rd quartile) Sequential Organ-Failure Assessment score was 15 (12; 18) and 54 patients (51%) were on renal replacement therapy. Overall ICU mortality was 54%. C max was < 60 mg/L in 41 patients (39%). Independent risk factors for amikacin under-dosing were body mass index (BMI) < 22 kg/m 2 and a positive 24-h fluid balance. Using dosing simulation, increasing the amikacin dosing regimen to 30 mg/kg and 35 mg/kg of body weight when the 24-h fluid balance is positive and the BMI is ≥ 22 kg/m 2 or < 22 kg/m 2 (Table 3), respectively, would have potentially led to the therapeutic target being reached in 42% of patients while reducing under-dosing to 23% of patients. Conclusions: ECMO-treated patients were under-dosed for amikacin in one third of cases. Increasing the dose to 35 mg/ kg of body weight in low-BMI patients and those with positive 24-h fluid balance on ECMO to reach adequate targeted concentrations should be investigated.

Archives of Cardiovascular Diseases

Anaesthesia Critical Care & Pain Medicine

PloS one, 2018

Atrial fibrillation is associated with an atrial cardiomyopathy composed mainly of fibrosis and a... more Atrial fibrillation is associated with an atrial cardiomyopathy composed mainly of fibrosis and adipose tissue accumulation. We hypothesized that MRI, when used in an optimal ex vivo setting allowing high spatial resolution without motion artifacts, can help characterizing the complex 3D left atrial (LA) wall composition in human myocardial samples, as compared to histology. This prospective case-control study was approved by the institutional review board. 3D MRI acquisitions including saturation-recovery T1 mapping and DIXON imaging was performed at 4.0 T on 9 human LA samples collected from patients who underwent cardiac surgery. Histological quantification of fibrosis and fat was obtained. MRI T1 maps were clustered based on a Gaussian Mixture Model allowing quantification of total, interstitial and fatty fibrosis components. Fat maps were computed from DIXON images and fat fractions were calculated. MRI measurements were performed on the same location as the histological analys...

Journal of visualized experiments : JoVE, Mar 26, 2018

Aortic valve stenosis has become the most prevalent valvular heart disease in developed countries... more Aortic valve stenosis has become the most prevalent valvular heart disease in developed countries, and is due to the aging of these populations. The incidence of the pathology increases with growing age after 65 years. Conventional surgical aortic valve replacement through median sternotomy has been the gold standard of patient care for symptomatic aortic valve stenosis. However, as the risk profile of patients worsens, other therapeutic strategies have been introduced in an attempt to maintain the excellent results obtained by the established surgical treatment. One of these approaches is represented by transcatheter aortic valve implantation. Although the outcomes of high-risk patients undergoing treatment for symptomatic aortic valve stenosis have improved with transcatheter aortic valve replacement, many patients with this condition remain candidates for surgical aortic valve replacement. In order to reduce the surgical trauma in patients who are candidates for surgical aortic v...

Journal of Thoracic Disease

Open Forum Infectious Diseases

Background Postsurgical infections due to Mycobacterium chimaera appeared as a novel nosocomial t... more Background Postsurgical infections due to Mycobacterium chimaera appeared as a novel nosocomial threat in 2015, with a worldwide outbreak due to contaminated heater-cooler units used in open chest surgery. We report the results of investigations conducted in France including whole-genome sequencing comparison of patient and heater-cooler unit isolates. Methods We sought M. chimaera infection cases from 2010 onwards through national epidemiological investigations in health care facilities performing cardiopulmonary bypass, together with a survey on good practices and systematic heater-cooler unit microbial analyses. Clinical and heater-cooler unit isolates were subjected to whole-genome sequencing analyzed with regard to the reference outbreak strain Zuerich-1. Results Only 2 clinical cases were shown to be related to the outbreak, although 23% (41/175) of heater-cooler units were declared positive for M. avium complex. Specific measures to prevent infection were applied in 89% (50/5...

Thrombosis and Haemostasis

Hemostatic changes induced by extracorporeal membrane oxygenation (ECMO) support have been yet po... more Hemostatic changes induced by extracorporeal membrane oxygenation (ECMO) support have been yet poorly documented in coronavirus-19 (COVID-19) patients who have a baseline complex hypercoagulable state. In this prospective monocentric study of patients with severe acute respiratory distress syndrome (ARDS) rescued by ECMO, we performed longitudinal measurements of coagulation and fibrinolysis markers throughout the course of ECMO support in 20 COVID-19 and 10 non-COVID-19 patients. Blood was sampled before and then 24 hours, 7, and 14 days after ECMO implantation. Clinical outcomes were prospectively assessed until discharge from the intensive care unit or death. The median age of participants was 47 (35–56) years, with a median body mass index of 30 (27–35) kg/m2, and a Sepsis-related Organ Failure Assessment score of 12 (8–16). Baseline levels of von Willebrand factor, fibrinogen, factor VIII, prothrombin F1 + 2, thrombin–antithrombin, D-dimer, and plasminogen activator inhibitor-1...

Intensive Care Medicine

Full author information is available at the end of the article Members of the EuroECMO COVID-19 W... more Full author information is available at the end of the article Members of the EuroECMO COVID-19 Working Group and of the Euro-ELSO Steering Committee are listed in the Acknowledgements Section.

Annals of Cardiothoracic Surgery

Surgical technique for the implantation of mechanical circulatory support with the Impella 5.0 pu... more Surgical technique for the implantation of mechanical circulatory support with the Impella 5.0 pump in a patient with post-cardiotomy cardiogenic shock.

Journal of Integrative Cardiology Open Access

Management of out-of-hospital cardiac arrest (OHCA) remains challenging, particularly in young pa... more Management of out-of-hospital cardiac arrest (OHCA) remains challenging, particularly in young patients. Takayasu arteritis is a rare large-vessel vasculitis relatively. Coronary involvement has been previously described; we provided the first intracoronary images by OCT. We report the first case of OHCA with shockable rhythm revealing chronic total occlusion of the left main in a 41-year-old lady. The coronary anomaly made it possible to diagnose the vasculitis and to treat it by corticosteroid and immunosuppressive treatment. Vasculitis should be evoked in atypical coronary syndrome in young patients. A collaborative multidisciplinary approach permits optimal care for this complex patient.

Archives of Cardiovascular Diseases

Frontiers in Plant Science

The Journal of Heart and Lung Transplantation

Annals of Intensive Care

Background Prone positioning (PP) during veno-venous ECMO is feasible, but its physiological effe... more Background Prone positioning (PP) during veno-venous ECMO is feasible, but its physiological effects have never been thoroughly evaluated. Our objectives were to describe, through electrical impedance tomography (EIT), the impact of PP on global and regional ventilation, and optimal PEEP level. Methods A monocentric study conducted on ECMO-supported severe ARDS patients, ventilated in pressure-controlled mode, with 14-cmH2O driving pressure and EIT-based “optimal PEEP”. Before, during and after a 16-h PP session, EIT-based distribution and variation of tidal impedance, VTdorsal/VTglobal ratio, end-expiratory lung impedance (EELI) and static compliance were collected. Subgroup analyses were performed in patients who increased their static compliance by ≥ 3 mL/cmH2O after 16 h of PP. Results For all patients (n = 21), tidal volume and EELI were redistributed from ventral to dorsal regions during PP. EIT-based optimal PEEP was significantly lower in PP than in supine position. Median (...

Critical Care

Background: Amikacin infusion requires targeting a peak serum concentration (C max) 8-10 times th... more Background: Amikacin infusion requires targeting a peak serum concentration (C max) 8-10 times the minimal inhibitory concentration, corresponding to a C max of 60-80 mg/L for the least susceptible bacteria to theoretically prevent therapeutic failure. Because drug pharmacokinetics on extracorporeal membrane oxygenation (ECMO) are challenging, we undertook this study to assess the frequency of insufficient amikacin C max in critically ill patients on ECMO and to identify relative risk factors. Methods: This was a prospective, observational, monocentric study in a university hospital. Patients on ECMO who received an amikacin loading dose for suspected Gram-negative infections were included. The amikacin loading dose of 25 mg/kg total body weight was administered intravenously and C max was measured 30 min after the end of the infusion. Independent predicators of C max < 60 mg/L after the first amikacin infusion were identified with mixed-model multivariable analyses. Various dosing simulations were performed to assess the probability of reaching 60 mg/L < C max < 80 mg/L. Results: A total of 106 patients on venoarterial ECMO (VA-ECMO) (68%) or venovenous-ECMO (32%) were included. At inclusion, their median (1st; 3rd quartile) Sequential Organ-Failure Assessment score was 15 (12; 18) and 54 patients (51%) were on renal replacement therapy. Overall ICU mortality was 54%. C max was < 60 mg/L in 41 patients (39%). Independent risk factors for amikacin under-dosing were body mass index (BMI) < 22 kg/m 2 and a positive 24-h fluid balance. Using dosing simulation, increasing the amikacin dosing regimen to 30 mg/kg and 35 mg/kg of body weight when the 24-h fluid balance is positive and the BMI is ≥ 22 kg/m 2 or < 22 kg/m 2 (Table 3), respectively, would have potentially led to the therapeutic target being reached in 42% of patients while reducing under-dosing to 23% of patients. Conclusions: ECMO-treated patients were under-dosed for amikacin in one third of cases. Increasing the dose to 35 mg/ kg of body weight in low-BMI patients and those with positive 24-h fluid balance on ECMO to reach adequate targeted concentrations should be investigated.

Archives of Cardiovascular Diseases

Anaesthesia Critical Care & Pain Medicine

PloS one, 2018

Atrial fibrillation is associated with an atrial cardiomyopathy composed mainly of fibrosis and a... more Atrial fibrillation is associated with an atrial cardiomyopathy composed mainly of fibrosis and adipose tissue accumulation. We hypothesized that MRI, when used in an optimal ex vivo setting allowing high spatial resolution without motion artifacts, can help characterizing the complex 3D left atrial (LA) wall composition in human myocardial samples, as compared to histology. This prospective case-control study was approved by the institutional review board. 3D MRI acquisitions including saturation-recovery T1 mapping and DIXON imaging was performed at 4.0 T on 9 human LA samples collected from patients who underwent cardiac surgery. Histological quantification of fibrosis and fat was obtained. MRI T1 maps were clustered based on a Gaussian Mixture Model allowing quantification of total, interstitial and fatty fibrosis components. Fat maps were computed from DIXON images and fat fractions were calculated. MRI measurements were performed on the same location as the histological analys...

Journal of visualized experiments : JoVE, Mar 26, 2018

Aortic valve stenosis has become the most prevalent valvular heart disease in developed countries... more Aortic valve stenosis has become the most prevalent valvular heart disease in developed countries, and is due to the aging of these populations. The incidence of the pathology increases with growing age after 65 years. Conventional surgical aortic valve replacement through median sternotomy has been the gold standard of patient care for symptomatic aortic valve stenosis. However, as the risk profile of patients worsens, other therapeutic strategies have been introduced in an attempt to maintain the excellent results obtained by the established surgical treatment. One of these approaches is represented by transcatheter aortic valve implantation. Although the outcomes of high-risk patients undergoing treatment for symptomatic aortic valve stenosis have improved with transcatheter aortic valve replacement, many patients with this condition remain candidates for surgical aortic valve replacement. In order to reduce the surgical trauma in patients who are candidates for surgical aortic v...

Journal of Thoracic Disease