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Vol. 55. Issue 3.
Pages 320 (March 2002)
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Vol. 55. Issue 3.
Pages 320 (March 2002)
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José López-Sendóna, Verónica Escorial Hernándeza, Telma Meizoso Latovaa, Enrique Alday Muñoza, Esteban López de Sáa
a Servicio de Cardiología. Hospital Gregorio Marañón. Madrid. Spain.
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To the Editor:

We have read with attention the letter signed by Dr. Fernández Bergés, and we agree with his suggestions. We would like to add some comments.

1. In spite of the fact that there is constant improvement, in Spain the training of doctors, medical students, paramedics and the general public to identify and treat a witnessed cardiopulmonary arrest is insufficient; it is neither regulated nor controlled. It could and must be improved.1,2 This same problem exists in almost all countries.

2. The correct education of the bystander who witnesses cardiopulmonary arrest and the quality and speed of the outpatient emergency systems are not sufficient to improve the patient prognosis.3 New strategies are needed that are more effective that the current ones. Among these are:

­ Identification and adequate treatment of high risk patients, principally through the use of myocardial revascularization, implantable defibrillators and beta-blockers.4-8

­ Consider all patients with precordial pain as potential immediate victims of sudden death, until the diagnosis of acute myocardial infarct is made.9 This implies immediate electrocardiographic monitoring of all the patients who come to the emergency room with precordial pain.

­ Instruct the public on the danger of sudden death in the setting of certain symptoms (precordial pain) and how to ask for adequate help.10,11 This strategy includes the recognition of the need to know how seek help before it is needed.

­ The availability of semiautomatic defibrillators in public places, together with the education of adequate medical and non-medical personnel.12 This measure, still controversial, could be converted into one of the most effective strategies in the battle against witnessed sudden death.

Some of the measures may seem extreme, but the present measures are insufficient, which is not to downplay the importance and quality of the efforts made by outpatient emergency systems, which in most cases simply cannot get there in time.

Curós Abadal A..
Parada cardíaca extrahospitalaria, nuestra asignatura pendiente..
Rev Esp Cardiol, 54 (2001), pp. 827-30
Circulation 2000;102(Suppl):I22??I59.
Zheng ZJ, Croft JB, Giles WH, Mensah GA..
Sudden cardiac death in the United States, 1989 to 1998..
Circulation, 104 (2001), pp. 2158-63
Weintraub WS..
Revascularization versus implantable cardioverter-defibrillators to prevent sudden death in patients with severe left ventricular dysfunction..
Circulation, 104 (2001), pp. 1457-8
Exner DV, Klein GJ, Prystowsky EN..
Primary prevention of sudden death with implantable defibrillator therapy in patients with cardiac disease: can we afford to do it?.
(Can we afford not to?) Circulation, 104 (2001), pp. 1564-70
CIBIS II Investigators and Committees..
The Cardiac Insufficiency Bisoprolol Study (CIBIS-II): a randomized trial..
Lancet, 353 (1999), pp. 9-13
MERIT-HF Study Group..
Effect of metoprolol CR/XL in chronic heart failure: Metoprolol CR/XL Randomised Intervention Trial in Congestive Heart Failure (MERIT-HF)..
Lancet, 353 (1999), pp. 2001-7
Packer M, Coats AJ.S, Fowler MB, Katus HA, Krum H, Mohacsi P..
Effect of carvedilol on survival in severe chronic congestive heart failure..
N Engl J Med, 344 (2001), pp. 1651-8
Disponible en:
Ornato JP, Hand MM..
Warning signs of a heart attack..
Circulation, 104 (2001), pp. 1212-3
Zipez D..
Saving time saves lives..
Circulation, 104 (2001), pp. 2506-8
Marenco JP, Wang PJ, Link MS, Homoud MK, Estes NA..
Improving survival from sudden cardiac arrest: the role of the automated external defibrillator..
JAMA, 285 (2001), pp. 1193-200
Revista Española de Cardiología (English Edition)

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