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Vol. 67. Issue 1.
Pages 71-72 (January 2014)
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Vol. 67. Issue 1.
Pages 71-72 (January 2014)
Letter to the Editor
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On the Characteristics of Out-of-hospital Sudden Cardiac Death Survivors. Response
Sobre las características de los supervivientes de muerte súbita cardiaca extrahospitalaria. Respuesta
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Pablo Loma-Osorio
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plomaosorio@gmail.com

Corresponding author:
Servicio de Cardiología, Hospital Universitario Josep Trueta, Girona, Spain
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Rev Esp Cardiol. 2014;67:70-110.1016/j.rec.2013.09.005
Juan B. Lopez-Messa, José I. Alonso-Fernández
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To the Editor,

We appreciate the interest aroused by our article. Having carefully read your letter, we would like to make the following comments.

We consider that the nature of the report in itself, a registry of patients with sudden cardiac death who arrived alive at cardiac intensive care units, explains the predominantly cardiac etiology, as well as the frequent finding of a first shockable rhythm or a lower incidence of sudden cardiac death occurring in the home than in other series. We agree that any other approach to the problem, such as the inclusion of patients who die prior to hospital admission and of those with noncardiac etiology, or study of the length of time that patients received prehospital care in an emergency medical service, constitutes another highly interesting view of the same problem.

Despite the lack of a common protocol, as we mentioned in the section on limitations, a consensus document on postresuscitation care was available at all the centers.1 This document includes not only therapeutic hypothermia (the criteria for the application of which are explained in detail in the methods section), but also a systematized approach, agreed by consensus, to the comprehensive management of these patients. We consider that, as indicated on other occasions,2 this is one of the aspects that may have contributed to our promising results, despite the seriousness of the patients’ condition at the time of admission.

We take note of the interesting comment on the performance of catheterizations in patients without ST-elevation myocardial infarction: in addition to its use in acute reperfusion therapy, coronary angiography is a tool of unquestionable utility in the study of the etiology in many other patients. We also agree that we should have referred specifically to the Utstein style,3 since our variables adapt to its recommendations, as is the case of the use of the Cerebral Performance Category score, which we do mention in the methods section.

In our series, half of the patients included had a good vital and functional prognosis at discharge and 6 months later. As is well known, the first links in the chain of survival are those that have the greatest impact on prognosis, whereas the importance of the steps taken for management following resuscitation is relative.4 Given that, in our registry, 92% of the cases of sudden cardiac death occurred in the presence of bystanders and only 29% were attended to by these witnesses, we feel that it would be interesting to support health education programs that encourage the general population to receive training in basic cardiopulmonary resuscitation maneuvers.

References
[1]
R.O. Cummins, D.A. Chamberlain, N.S. Abramson, M. Allen, P.J. Baskett, L. Becker, et al.
Recommended guidelines for uniform reporting of data from out-of-hospital cardiac arrest: the Utstein Style. A statement for health professionals from a task force of the American Heart Association, the European Resuscitation Council, the Heart and Stroke Foundation of Canada, and the Australian Resuscitation Council.
Circulation, 84 (1991), pp. 960-975
[2]
K. Sunde, M. Pytte, D. Jacobsen, A. Mangschau, L.P. Jensen, C. Smedsrud, et al.
Implementation of a standardised treatment protocol for post resuscitation care after out-of-hospital cardiac arrest.
[3]
I. Jacobs, V. Nadkarni, J. Bahr, R.A. Berg, J.E. Billi, L. Bossaert, et al.
Cardiac arrest and cardiopulmonary resuscitation outcome reports: update and simplification of the Utstein templates for resuscitation registries: a statement for healthcare professionals from a task force of the International Liaison Committee on Resuscitation (American Heart Association, European Resuscitation Council, Australian Resuscitation Council, New Zealand Resuscitation Council, Heart and Stroke Foundation of Canada, InterAmerican Heart Foundation, Resuscitation Councils of Southern Africa).
Circulation, 110 (2004), pp. 3385-3397
[4]
I.G. Stiell, G.A. Wells, B.J. Field, D.W. Spaite, V.J. De Maio, R. Ward, et al.
Improved outof-hospital cardiac arrest survival through the inexpensive optimization of an existing defibrillation program: OPALS study phase II. Ontario Prehospital Advanced Life Support.
JAMA, 281 (1999), pp. 1175-1181
Copyright © 2013. Sociedad Española de Cardiología
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