Article
Go to the members area of the website of the SEMICYUC (www.semicyuc.org )and click the link to the magazine.
array:23 [ "pii" => "S2173572724002005" "issn" => "21735727" "doi" => "10.1016/j.medine.2024.07.010" "estado" => "S300" "fechaPublicacion" => "2024-10-01" "aid" => "2073" "copyright" => "Elsevier España, S.L.U. and SEMICYUC" "copyrightAnyo" => "2024" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "edi" "cita" => "Med Intensiva. 2024;48:563-4" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "Traduccion" => array:1 [ "en" => array:19 [ "pii" => "S0210569124002456" "issn" => "02105691" "doi" => "10.1016/j.medin.2024.07.001" "estado" => "S300" "fechaPublicacion" => "2024-10-01" "aid" => "2073" "copyright" => "Elsevier España, S.L.U. y SEMICYUC" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "edi" "cita" => "Med Intensiva. 2024;48:563-4" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Editorial</span>" "titulo" => "ECPR … Ready for it?" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "563" "paginaFinal" => "564" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "ECMO-RCP… ¿Estamos listos?" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Sara Alcántara Carmona, Héctor Villanueva Fernández" "autores" => array:2 [ 0 => array:2 [ "nombre" => "Sara" "apellidos" => "Alcántara Carmona" ] 1 => array:2 [ "nombre" => "Héctor" "apellidos" => "Villanueva Fernández" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2173572724002005" "doi" => "10.1016/j.medine.2024.07.010" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173572724002005?idApp=WMIE" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0210569124002456?idApp=WMIE" "url" => "/02105691/0000004800000010/v1_202409270613/S0210569124002456/v1_202409270613/en/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S2173572724001759" "issn" => "21735727" "doi" => "10.1016/j.medine.2024.06.021" "estado" => "S300" "fechaPublicacion" => "2024-10-01" "aid" => "2063" "copyright" => "Elsevier España, S.L.U. and SEMICYUC" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Med Intensiva. 2024;48:565-74" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:14 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>" "titulo" => "Outcomes of an extracorporeal cardiopulmonary resuscitation (ECPR) program for in- and out-of-hospital cardiac arrest in a tertiary hospital in Spain" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:3 [ 0 => "en" 1 => "en" 2 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "565" "paginaFinal" => "574" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Resultados de un programa de reanimación cardiopulmonar extracorpórea para la parada intra y extrahospitalaria en un hospital terciario español" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 1 "multimedia" => array:5 [ "identificador" => "fig0010" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => false "mostrarDisplay" => true "figura" => array:1 [ 0 => array:4 [ "imagen" => "fx1.jpeg" "Alto" => 733 "Ancho" => 1333 "Tamanyo" => 148268 ] ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "María Martínez-Martínez, María Vidal-Burdeus, Jordi Riera, Aitor Uribarri, Elisabet Gallart, Laia Milà, Pau Torrella, Irene Buera, Luis Chiscano-Camon, Bruno García del Blanco, Carlota Vigil-Escalera, José A. Barrabés, Jordi Llaneras, Juan Carlos Ruiz-Rodríguez, Cristopher Mazo, Jorge Morales, Ricard Ferrer, Ignacio Ferreira-Gonzalez, Eduard Argudo" "autores" => array:19 [ 0 => array:2 [ "nombre" => "María" "apellidos" => "Martínez-Martínez" ] 1 => array:2 [ "nombre" => "María" "apellidos" => "Vidal-Burdeus" ] 2 => array:2 [ "nombre" => "Jordi" "apellidos" => "Riera" ] 3 => array:2 [ "nombre" => "Aitor" "apellidos" => "Uribarri" ] 4 => array:2 [ "nombre" => "Elisabet" "apellidos" => "Gallart" ] 5 => array:2 [ "nombre" => "Laia" "apellidos" => "Milà" ] 6 => array:2 [ "nombre" => "Pau" "apellidos" => "Torrella" ] 7 => array:2 [ "nombre" => "Irene" "apellidos" => "Buera" ] 8 => array:2 [ "nombre" => "Luis" "apellidos" => "Chiscano-Camon" ] 9 => array:2 [ "nombre" => "Bruno" "apellidos" => "García del Blanco" ] 10 => array:2 [ "nombre" => "Carlota" "apellidos" => "Vigil-Escalera" ] 11 => array:2 [ "nombre" => "José A." "apellidos" => "Barrabés" ] 12 => array:2 [ "nombre" => "Jordi" "apellidos" => "Llaneras" ] 13 => array:2 [ "nombre" => "Juan Carlos" "apellidos" => "Ruiz-Rodríguez" ] 14 => array:2 [ "nombre" => "Cristopher" "apellidos" => "Mazo" ] 15 => array:2 [ "nombre" => "Jorge" "apellidos" => "Morales" ] 16 => array:2 [ "nombre" => "Ricard" "apellidos" => "Ferrer" ] 17 => array:2 [ "nombre" => "Ignacio" "apellidos" => "Ferreira-Gonzalez" ] 18 => array:2 [ "nombre" => "Eduard" "apellidos" => "Argudo" ] ] ] ] "resumen" => array:1 [ 0 => array:3 [ "titulo" => "Graphical abstract" "clase" => "graphical" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall"><elsevierMultimedia ident="fig0010"></elsevierMultimedia></p></span>" ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S0210569124002353" "doi" => "10.1016/j.medin.2024.06.007" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0210569124002353?idApp=WMIE" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173572724001759?idApp=WMIE" "url" => "/21735727/0000004800000010/v1_202409270531/S2173572724001759/v1_202409270531/en/main.assets" ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Editorial</span>" "titulo" => "ECPR … Ready for it?" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "563" "paginaFinal" => "564" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Sara Alcántara Carmona, Héctor Villanueva Fernández" "autores" => array:2 [ 0 => array:4 [ "nombre" => "Sara" "apellidos" => "Alcántara Carmona" "email" => array:1 [ 0 => "saralcanta@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Héctor" "apellidos" => "Villanueva Fernández" "email" => array:1 [ 0 => "hvf84@msn.com" ] ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Medicina Intensiva, Hospital Universitario Puerta de Hierro Majadahonda, Majadahonda, Madrid, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "ECMO-RCP… ¿Estamos listos?" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">In this issue of Medicina Intensiva, Martínez-Martínez et al. present the most extensive series of cardiac arrest patients treated with extracorporeal cardiopulmonary resuscitation (ECPR) in Spain.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> In this retrospective single-center study, 54 patients received ECPR over four years. At the 180-day mark, 16 patients (29.6%) were alive, and 15 achieved good neurological performance. Overall, the results described by Martínez-Martínez et al. are comparable with previously published experiences.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2–4</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">According to the Extracorporeal Life Support Organization, ECPR is defined as the application of rapid-deployment veno-arterial extracorporeal membrane oxygenation (VA-ECMO) to provide circulatory support in patients in whom conventional CPR is unsuccessful in obtaining a sustained return of spontaneous circulation.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> Although international recommendations on CPR include ECPR in their algorithms, there are still no universally agreed indications to start ECPR, and even though inclusion criteria vary among studies, the time between cardiac arrest identification, the onset of resuscitation maneuvers, and the start of ECPR are crucial.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> As with any other aspect of CPR, ECPR is very time-sensitive.</p><p id="par0015" class="elsevierStylePara elsevierViewall">In the performing arts world, it is well known that practice makes perfect, and we think that ECPR is no exception. The existence of ECMO centers, with highly skilled and well-trained ECMO teams, is the cornerstone of an ECPR program. This training should be simulation-based and should not only include in-hospital but also out-of-hospital healthcare professionals who need to implement scoop-and-run policies when managing cardiac arrest patients if an ECPR scenario is possible.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> Particular attention should be paid to cannulation skills since, as described by Martínez-Martínez et al., cannulation complications can affect up to 25% of the patients. These ECMO centers should work on standard protocols for ECPR management to homogenize aspects like criteria for ECPR initiation. They should also establish appropriate pathways for post-cardiac arrest care in the ECPR setting.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> Although the available data does not support the broad use of ECPR, the chances of seeing benefits will be scarce if we do not deploy adequate ECMO programs nationwide. The INCEPTION trial, performed in the Netherlands, could be an example of this.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> This study, published in 2023, failed to demonstrate any differences when comparing conventional CPR to ECPR (16 % vs 20% survival for each group). Still, when analyzing the data, patients were enrolled at ten different cardiosurgical centers served by 12 emergency medical services, and eight out of those ten centers included less than 15 ECPR patients over four years.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Also, due to the complexity of ECPR, initial efforts might need to be directed towards in-hospital cardiac arrest (IHCA). Chico-Carballa et al. reported the first experience of a Spanish IHCA ECPR program during the first year of its implementation at a tertiary care hospital.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> This retrospective analysis included seven patients. In all cases, bystander CPR was initiated in less than 1 min, and the median time between bystander CPR and advanced ICU CPR was 5 min (IQR 5–10 min) with median low-flow times of 55 min (IQR 36.25–62.5 min). Overall hospital survival was 42.9% (3 patients), and all survivors achieved a good neurological recovery. In Martínez-Martínez et al.’s experience, survival with good neurological outcomes in IHCA was 32% (8 out of 25), whereas in OHCA, 24.1% (7 out of 29).</p><p id="par0025" class="elsevierStylePara elsevierViewall">Although ECPR programs are contributing to increased cardiac arrest survival with good neurological prognosis, the number of patients that die after ECPR is still high, with casualties reaching 70–85% according to the different published data. The most common causes of death described by Martínez-Martínez et al. in this population were anoxic encephalopathy (17 patients, 51.5%) followed by brain death (10 patients, 30.3%). Ten deceased patients (30.3%) became organ donors after neuroprognostication in their study. Even though this is an undesired outcome, the potential benefits of organ donation are undeniable. ECPR might raise the number of potential donors, either after the determination of death by neurological criteria (brain death) or by circulatory criteria (both uncontrolled and controlled scenarios).<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> For this reason, ECPR teams and donor coordination units should all be part of a complex network led by intensivists, with clearly defined roles at each point.</p><p id="par0030" class="elsevierStylePara elsevierViewall">While we wait for further data regarding ECPR results, it seems reasonable to start training and organizing for what the future might bring. Change takes time, and time is something the cardiac arrest patient does not have.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Outcomes of an extracorporeal cardiopulmonary resuscitation (ECPR) program for in- and out-of-hospital cardiac arrest in a tertiary hospital in Spain" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Martínez-Martínez" 1 => "M. Vidal-Burdeus" 2 => "J. Riera" 3 => "A. Uribarri" 4 => "E. Gallart" 5 => "L. Milá" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.medin.2024.06.007" "Revista" => array:2 [ "tituloSerie" => "Med Intensiva." "fecha" => "2024" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Advanced reperfusion strategies for patients with out-of-hospital cardiac arrest and refractory ventricular fibrillation (ARREST): a phase 2, single centre, open-label, randomised controlled trial" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "D. Yannopoulos" 1 => "J. Bartos" 2 => "G. Raveendran" 3 => "E. Walser" 4 => "J. Connett" 5 => "T.A. Murray" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/s0140-6736(20)32338-2" "Revista" => array:5 [ "tituloSerie" => "The Lancet." "fecha" => "2020" "volumen" => "396" "paginaInicial" => "1807" "paginaFinal" => "1816" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Effect of intra-arrest transport, extracorporeal cardiopulmonary resuscitation, and immediate invasive assessment and treatment on functional neurologic outcome in refractory out-of-hospital cardiac arrest: a randomized clinical trial" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J. Belohlavek" 1 => "J. Smalcova" 2 => "D. Rob" 3 => "O. Franek" 4 => "O. Smid" 5 => "M. Pokorna" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1001/jama.2022.1025" "Revista" => array:5 [ "tituloSerie" => "JAMA." "fecha" => "2022" "volumen" => "327" "paginaInicial" => "737" "paginaFinal" => "747" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Early extracorporeal CPR for refractory out-of-hospital cardiac arrest" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M.M. Suverein" 1 => "T.S.R. Delnoij" 2 => "R. Lorusso" 3 => "G.J. Brandon Bravo Bruinsma" 4 => "L. Otterspoor" 5 => "C.V. Elzo Kraemer" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJMoa2204511" "Revista" => array:6 [ "tituloSerie" => "N Engl J Med." "fecha" => "2023" "volumen" => "388" "paginaInicial" => "299" "paginaFinal" => "309" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/36720132" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Extracorporeal cardiopulmonary resuscitation in adults. interim guideline consensus statement from the extracorporeal life support organization" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A.S.C. Richardson" 1 => "J.E. Tonna" 2 => "V. Nanjayya" 3 => "P. Nixon" 4 => "D.C. Abrams" 5 => "L. Raman" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/MAT.0000000000001344" "Revista" => array:6 [ "tituloSerie" => "ASAIO J." "fecha" => "2021" "volumen" => "67" "paginaInicial" => "221" "paginaFinal" => "228" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/33627592" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "European Resuscitation Council Guidelines 2021: adult advanced life support" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J. Soar" 1 => "B.W. Böttiger" 2 => "P. Carli" 3 => "K. Couper" 4 => "C.D. Deakin" 5 => "T. Djärv" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.resuscitation.2021.02.010" "Revista" => array:6 [ "tituloSerie" => "Resuscitation." "fecha" => "2021" "volumen" => "161" "paginaInicial" => "115" "paginaFinal" => "151" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/33773825" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0035" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Patient safety, what does clinical simulation and teaching innovation contribute" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "M.J. Broch Porcar" 1 => "Á. Castellanos-Ortega" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.medine.2024.04.012" "Revista" => array:2 [ "tituloSerie" => "Med Intensiva (Engl Ed)" "fecha" => "2024" ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0040" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The use of ECMO in ICU. Recommendations of the Spanish society of critical care medicine and coronary units" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "E. Fernández-Mondéjar" 1 => "M.P. Fuset-Cabanes" 2 => "T. Grau-Carmona" 3 => "M. López-Sánchez" 4 => "Ó Peñuelas" 5 => "J.L. Pérez-Vela" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.medin.2018.09.017" "Revista" => array:6 [ "tituloSerie" => "Med Intensiva (Engl Ed)" "fecha" => "2019" "volumen" => "43" "paginaInicial" => "108" "paginaFinal" => "120" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30482406" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0045" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The first year of experience with an extracorporeal resuscitation program for refractory in-hospital cardiac arrest" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "J.I. Chico-Carballas" 1 => "A. Touceda-Bravo" 2 => "S. Freita-Ramos" 3 => "D. Mosquera-Rodriguez" 4 => "V. Gómez-Casal" 5 => "M. Piñon-Esteban" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.medin.2020.03.011" "Revista" => array:6 [ "tituloSerie" => "Med Intensiva." "fecha" => "2021" "volumen" => "45" "paginaInicial" => "e7" "paginaFinal" => "e10" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/34563346" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0050" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "An integrated program of extracorporeal membrane oxygenation (ECMO) assisted cardiopulmonary resuscitation and uncontrolled donation after circulatory determination of death in refractory cardiac arrest" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "R. Roncon-Albuquerque" 1 => "S. Gaião" 2 => "P. Figueiredo" 3 => "N. Príncipe" 4 => "C. Basílio" 5 => "P. Mergulhão" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.resuscitation.2018.10.016" "Revista" => array:6 [ "tituloSerie" => "Resuscitation." "fecha" => "2018" "volumen" => "133" "paginaInicial" => "88" "paginaFinal" => "94" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30321624" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21735727/0000004800000010/v1_202409270531/S2173572724002005/v1_202409270531/en/main.assets" "Apartado" => array:4 [ "identificador" => "406" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Editorial" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21735727/0000004800000010/v1_202409270531/S2173572724002005/v1_202409270531/en/main.pdf?idApp=WMIE&text.app=https://medintensiva.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173572724002005?idApp=WMIE" ]