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.