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Vol. 63. Issue 1.
Pages 125 (January 2010)
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DOI: 10.1016/S1885-5857(10)70026-8
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Sergio Castrejóna, Marcelino Cortésb, Pedro L. Sáncheza, Rafael Rubioa
a Servicio de Cardiología, Hospital General Univesitario Gregorio Marañón, Madrid, Spain
b Servicio de Cardiología, Fundación Jiménez Díaz, Madrid, Spain
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To the Editor,

We appreciate that, in commenting on our study,1 Lopez-Mesa et al have provided some very valuable information on the multidisciplinary approach to cardiac arrest and its consequences.

The post-cardiac arrest syndrome therapy2 should result in specific protocols for each critical care unit, as these tools are effective in improving the prognosis of these patients and provide a more standard and regulated treatment. Furthermore, they would promote a more widespread use of hypothermia treatment (HT) in Spain.

The initial collaboration of the cardiologist is crucial, given the high proportion of cases of cardiogenic shock, severe ventricular dysfunction and arrhythmias.1-3 The causes of cardiac arrest are mainly cardiac and require a specific approach to the underlying condition.

The proportion of patients whose first rhythm is asystole or who require electromechanical dissociation exceeds 50%; survival is low (0.15%-12.6%) and the causes are mostly cardiac.4,5 The prognosis in this group relies almost exclusively on the out-patient survival chain,6,7 but HT has a place here: it should start after resuscitation and not be systematically stopped until reaching hospital.2 In addition, the work of Moon et al8 shows better survival and prognosis in groups treated with HT. Others, however, have failed to demonstrate any benefit due to the very low total survival.3

From our point of view, every comatose patient after cardiac arrest with no formal contraindication can benefit from HT.

Bibliography
[1]
Castrejón S, Cortés M, Salto ML, Benittez LC, Rubio R, Juárez M, et al..
Mejora del pronóstico tras parada cardiorrespiratoria de causa cardiaca mediante el empleo de hipotermia moderada: comparación con un grupo control..
Rev Esp Cardiol, 62 (2009), pp. 733-41
[2]
Neumar RW, Nolan JP, Adrie C, Aibiki M, Berg RA, Böttiger BW, et al..
Post-cardiac arrest syndrome: epidemiology, pathophysiology, treatment, and prognostication. A Consensus Statement from the International Liaison Committee on Resuscitation..
Circulation, 118 (2008), pp. 2452-83
[3]
Arrich J..
Clinical application of mild therapeutic hypothermia after cardiac arrest..
Crit Care Med, 35 (2007), pp. 1041-7
[4]
Pleskot M, Hazukova R, Stritecka H, Cermakova E, Pudil R..
Long-term prognosis after out-of hospital cardiac arrest with/ without ST myocardial infarction..
Resuscitation, 80 (2009), pp. 795-804
[5]
Herlitz J, Svensson L, Engdahl J, Silfverstolpe J..
Characteristics and outcome in out-of-hospital cardiac arrest when patients are found in a non-shockable rhythm..
[6]
Martín-Hernández H, López-Messa JB, Pérez-Vela JL, Molina-Latorre R, Cárdenas-Cruz A, Lesmes-Serrano A, et al..
Manejo del síndrome posparada cardiaca. Med Intensiva. 2009.. doi:10.1016/j.medin.2009..
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[7]
Iwami T, Nichol G, Hiraide A, Hayasi Y, Nishiuchi T, Kajino K, et al..
Continuous improvement in "Chain of Survival" increased survival after out-of-hospital cardiac arrest. A large-scale population-based study..
Circulation, 119 (2009), pp. 728-34
[8]
Moon J, Chun B, Min Y, Moon J..
The effect of mild therapeutic hypothermia on asystole..
Ann Emerg Med, 52 (2008), pp. S58-9
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Revista Española de Cardiología (English Edition)

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