was read the article
array:24 [ "pii" => "S2173572717300346" "issn" => "21735727" "doi" => "10.1016/j.medine.2016.08.002" "estado" => "S300" "fechaPublicacion" => "2017-04-01" "aid" => "970" "copyrightAnyo" => "2017" "documento" => "article" "crossmark" => 1 "subdocumento" => "sco" "cita" => "Med Intensiva. 2017;41:188-90" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 4680 "formatos" => array:3 [ "EPUB" => 178 "HTML" => 3625 "PDF" => 877 ] ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S0210569116301802" "issn" => "02105691" "doi" => "10.1016/j.medin.2016.08.004" "estado" => "S300" "fechaPublicacion" => "2017-04-01" "aid" => "970" "copyright" => "Elsevier España, S.L.U. y SEMICYUC" "documento" => "article" "crossmark" => 1 "subdocumento" => "sco" "cita" => "Med Intensiva. 2017;41:188-90" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 13573 "formatos" => array:3 [ "EPUB" => 221 "HTML" => 11458 "PDF" => 1894 ] ] "es" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Punto de vista</span>" "titulo" => "¿Cuál debe ser la duración apropiada de los intentos de resucitación cardiopulmonar?" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "188" "paginaFinal" => "190" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "What should be the appropriate duration of cardiopulmonary resuscitation?" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "J.B. López-Messa" "autores" => array:1 [ 0 => array:2 [ "nombre" => "J.B." "apellidos" => "López-Messa" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2173572717300346" "doi" => "10.1016/j.medine.2016.08.002" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173572717300346?idApp=WMIE" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0210569116301802?idApp=WMIE" "url" => "/02105691/0000004100000003/v1_201703290106/S0210569116301802/v1_201703290106/es/main.assets" ] ] "itemSiguiente" => array:18 [ "pii" => "S2173572717300334" "issn" => "21735727" "doi" => "10.1016/j.medine.2016.02.006" "estado" => "S300" "fechaPublicacion" => "2017-04-01" "aid" => "900" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Med Intensiva. 2017;41:191-3" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 2302 "formatos" => array:3 [ "EPUB" => 152 "HTML" => 1542 "PDF" => 608 ] ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Scientific Letter</span>" "titulo" => "Leukapheresis in the management of drug rash with eosinophilia and systemic symptoms syndrome" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "191" "paginaFinal" => "193" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Leucoaféresis en el tratamiento del síndrome de <span class="elsevierStyleItalic">drug rash with eosinophilia and systemic symptoms</span>" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1162 "Ancho" => 500 "Tamanyo" => 51199 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Patient skin rash.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "I. Martínez de Lagrán, P. Marcos, M. Batlle, E. Alonso, A. Plana, T. Tomasa" "autores" => array:6 [ 0 => array:2 [ "nombre" => "I." "apellidos" => "Martínez de Lagrán" ] 1 => array:2 [ "nombre" => "P." "apellidos" => "Marcos" ] 2 => array:2 [ "nombre" => "M." "apellidos" => "Batlle" ] 3 => array:2 [ "nombre" => "E." "apellidos" => "Alonso" ] 4 => array:2 [ "nombre" => "A." "apellidos" => "Plana" ] 5 => array:2 [ "nombre" => "T." "apellidos" => "Tomasa" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0210569116000577" "doi" => "10.1016/j.medin.2016.02.005" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0210569116000577?idApp=WMIE" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173572717300334?idApp=WMIE" "url" => "/21735727/0000004100000003/v1_201704120039/S2173572717300334/v1_201704120039/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S2173572717300541" "issn" => "21735727" "doi" => "10.1016/j.medine.2016.10.005" "estado" => "S300" "fechaPublicacion" => "2017-04-01" "aid" => "996" "copyright" => "Elsevier España, S.L.U. and SEMICYUC" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Med Intensiva. 2017;41:174-87" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 5988 "formatos" => array:3 [ "EPUB" => 212 "HTML" => 4199 "PDF" => 1577 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Special article</span>" "titulo" => "Plasmapheresis and other extracorporeal filtration techniques in critical patients" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "174" "paginaFinal" => "187" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Plasmaféresis y otras técnicas de depuración extracorpórea en pacientes críticos" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1044 "Ancho" => 1375 "Tamanyo" => 113685 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Changes in blood volume in plasmapheresis with albumin replacement fluid using an online volume monitor. Variation in blood volume (Crit-Line<span class="elsevierStyleSup">®</span>). Starting plasmapheresis in a patient with a myasthenic crisis and replacement with 5% albumin solution. There is an abrupt drop in blood volume (about 10%), probably mediated by the transfer of fluids from the vascular space to the interstitial space due to the drop in the colloid osmotic pressure.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "D. Daga Ruiz, F. Fonseca San Miguel, F.J. González de Molina, A. Úbeda-Iglesias, A. Navas Pérez, R. Jannone Forés" "autores" => array:6 [ 0 => array:2 [ "nombre" => "D." "apellidos" => "Daga Ruiz" ] 1 => array:2 [ "nombre" => "F." "apellidos" => "Fonseca San Miguel" ] 2 => array:2 [ "nombre" => "F.J." "apellidos" => "González de Molina" ] 3 => array:2 [ "nombre" => "A." "apellidos" => "Úbeda-Iglesias" ] 4 => array:2 [ "nombre" => "A." "apellidos" => "Navas Pérez" ] 5 => array:2 [ "nombre" => "R." "apellidos" => "Jannone Forés" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S0210569116302455" "doi" => "10.1016/j.medin.2016.10.005" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0210569116302455?idApp=WMIE" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173572717300541?idApp=WMIE" "url" => "/21735727/0000004100000003/v1_201704120039/S2173572717300541/v1_201704120039/en/main.assets" ] "asociados" => array:1 [ 0 => array:19 [ "pii" => "S2173572717301637" "issn" => "21735727" "doi" => "10.1016/j.medine.2017.08.003" "estado" => "S300" "fechaPublicacion" => "2017-11-01" "aid" => "1071" "copyright" => "Elsevier España, S.L.U. and SEMICYUC" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Med Intensiva. 2017;41:506" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 1663 "formatos" => array:3 [ "EPUB" => 137 "HTML" => 1040 "PDF" => 486 ] ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Decisions after irreversible cardiopulmonary arrest: Ends and opportunities" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:1 [ "paginaInicial" => "506" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Decisiones tras parada cardíaca irreversible: finales y oportunidades" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Z. Ruiz de Azúa-López, L. Martín-Villén, J.J. Egea-Guerrero" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Z." "apellidos" => "Ruiz de Azúa-López" ] 1 => array:2 [ "nombre" => "L." "apellidos" => "Martín-Villén" ] 2 => array:2 [ "nombre" => "J.J." "apellidos" => "Egea-Guerrero" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0210569117301730" "doi" => "10.1016/j.medin.2017.05.001" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0210569117301730?idApp=WMIE" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173572717301637?idApp=WMIE" "url" => "/21735727/0000004100000008/v1_201710301314/S2173572717301637/v1_201710301314/en/main.assets" ] ] "en" => array:16 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Point of view</span>" "titulo" => "What should be the appropriate duration of cardiopulmonary resuscitation?" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "188" "paginaFinal" => "190" ] ] "autores" => array:1 [ 0 => array:3 [ "autoresLista" => "J.B. López-Messa" "autores" => array:1 [ 0 => array:3 [ "nombre" => "J.B." "apellidos" => "López-Messa" "email" => array:1 [ 0 => "jlopezme@saludcastillayleon.es" ] ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Medicina Intensiva, Complejo Asistencial Universitario de Palencia, Palencia, Spain" "identificador" => "aff0005" ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "¿Cuál debe ser la duración apropiada de los intentos de resucitación cardiopulmonar?" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Resuscitators often face serious difficulties in making decisions when dealing with cardiac arrest (CA) victims. In general, cardiopulmonary resuscitation (CPR) is started and subsequently suspended if the patient shows evidence of a poor prior condition. However, in the absence of such evidence, and after some time has elapsed, we face the dilemma of whether to continue the maneuvers in an attempt to achieve patient recovery, or whether continuation is futile and should be suspended.</p><p id="par0010" class="elsevierStylePara elsevierViewall">The interest of this subject has been evidenced by a number of studies that have attempted to establish the most appropriate duration of CPR<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">1–6</span></a> (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>). We conduct an analysis of different aspects relating to prolonged CPR and to elements that seem to be necessary in this context.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">The 2015 ethical recommendations of the European Resuscitation Council (ERC) specify a maximum of 20<span class="elsevierStyleHsp" style=""></span>min of CPR in the case of non-defibrillable rhythms in which the recovery of spontaneous circulation (ROSC) has not been achieved in any moment—though they also underscore the need to identify cases of refractory CA that might benefit from more prolonged interventions. The advances in resuscitation may change the established limits of the duration of CPR, modifying “established concepts”.</p><p id="par0020" class="elsevierStylePara elsevierViewall">On the other hand, we must consider elements involved in CPR such as the feedback devices used to control resuscitation quality, mechanical chest compression, extracorporeal life support (ECLS) techniques,<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">7</span></a> echocardiography to discard reversible processes, and “pseudo-CA” situations in patients presenting pulseless electrical activity (PEA),<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">8</span></a> as well as transfer to hospital of some patients with ongoing CPR.</p><p id="par0025" class="elsevierStylePara elsevierViewall">The monitoring of physiological parameters during CPR appears to be relevant to decision making. Endotracheal CO<span class="elsevierStyleInf">2</span> values of <10<span class="elsevierStyleHsp" style=""></span>mmHg after 20<span class="elsevierStyleHsp" style=""></span>min of maneuvering advise CPR cessation, while cases of survival have been reported with prolonged CPR maintaining values beyond those mentioned.<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">9</span></a> The effectiveness of CPR and the possibilities for satisfactory patient recovery have also been associated to sustained brain oximetry readings of over 60%.<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">10</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">The need to prolong CPR should be estimated based on the capacity of the abovementioned procedures to identify patients with a greater chance for survival, in which continuation of the resuscitation efforts would be indicated.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Although it has been reported that 90% of the cases recovered under good neurological conditions reach ROSC within a maximum of 16<span class="elsevierStyleHsp" style=""></span>min,<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">11</span></a> the optimum duration of CPR for incrementing survival has not been established. A very recent prospective study<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">1</span></a> of 1617 patients with out-hospital CA (OHCA), evaluating the relationship between survival and the Cerebral Performance Category at discharge, versus the time from CPR onset to ROSC, has concluded that effort should be continued for 45<span class="elsevierStyleHsp" style=""></span>min, whether CPR has been performed by witnesses or not, and regardless of whether the rhythm is defibrillable or not.</p><p id="par0040" class="elsevierStylePara elsevierViewall">A study of 64,339 patients pertaining to the American in-hospital CA (IHCA) registry<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">2</span></a> found longer CPR to be associated to higher percentages of ROSC and greater survival at discharge, suggesting that longer CPR could improve survival, and recommending at least 30<span class="elsevierStyleHsp" style=""></span>min of maneuvering under any type of rhythm.</p><p id="par0045" class="elsevierStylePara elsevierViewall">On the other hand, a retrospective study of OHCA cases has demonstrated an independent correlation between shorter CPR to ROSC and patient survival – the latter being less than 1% when CPR is prolonged up to 48<span class="elsevierStyleHsp" style=""></span>min in defibrillable rhythms and 15<span class="elsevierStyleHsp" style=""></span>min in non-defibrillable rhythms. The authors suggest that beneficial effects could be obtained by transferring patients with ongoing CPR to hospital for the application of more advanced techniques, and finally recommend maintaining CPR for 48<span class="elsevierStyleHsp" style=""></span>minutes in young patients, with a defibrillable rhythm and witnessed CA, versus at least 30<span class="elsevierStyleHsp" style=""></span>minutes in non-defibrillable rhythms.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">3</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">A retrospective study of 17,238 patients with OHCA recorded the time from CA onset to ROSC, and documented a survival rate with good neurological status of 21.8%. Over 99% of the patients with a good outcome had undergone CPR during 35<span class="elsevierStyleHsp" style=""></span>min. In relation to the initial rhythm, ROSC was achieved after 35<span class="elsevierStyleHsp" style=""></span>min in defibrillable rhythms and PEA, and after 42<span class="elsevierStyleHsp" style=""></span>min in asystolia. The authors concluded that CPR should be prolonged for at least these time periods, depending on the type of rhythm.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">4</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">More recently, a retrospective study of 1316 cases of OHCA evaluating outcomes according to the CPR times to ROSC has demonstrated a correlation between greater percentage ROSC and shorter CPR times – though a CPR duration of over 25<span class="elsevierStyleHsp" style=""></span>min was also seen to be associated to a percentage ROSC of over 20% and to acceptable percentage survival figures. The authors concluded that prolonged CPR should not be regarded as futile.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">5</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">Lastly, a retrospective study<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">6</span></a> of 858 patients recovered after OHCA analyzed the influence of the time from CA to ROSC upon patient survival with good neurological status. Favorable outcomes were recorded in 22.2% of the cases with CPR times of over 20<span class="elsevierStyleHsp" style=""></span>min (7.1% with CPR times of >60<span class="elsevierStyleHsp" style=""></span>min).</p><p id="par0065" class="elsevierStylePara elsevierViewall">In conclusion:<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">1.</span><p id="par0070" class="elsevierStylePara elsevierViewall">Although the duration of CPR is an independent predictor of poorer survival and neurological status, recent publications suggest that maneuvering should continue for over 20<span class="elsevierStyleHsp" style=""></span>min, reaching even 40<span class="elsevierStyleHsp" style=""></span>min, with application of the new procedures referred to CPR quality and the use of diagnostic tools based on physiological parameters that can contribute to detect reversible cases and offer help in decision making.<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">12</span></a></p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">2.</span><p id="par0075" class="elsevierStylePara elsevierViewall">In the case of IHCA, where we can know the patient history, most cases of ROSC occur in the first 30<span class="elsevierStyleHsp" style=""></span>min. The recommendation could be to continue CPR in cases of defibrillable rhythms, for as long as these rhythms are maintained, while in the case of asystolia CPR should not be continued beyond 30<span class="elsevierStyleHsp" style=""></span>min if no response has been elicited, after discarding reversible causes. If the hospital has the required resources, and with due case selection, ECLS measures or coronary intervention techniques could be decided with ongoing CPR.</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">3.</span><p id="par0080" class="elsevierStylePara elsevierViewall">In the case of OHCA it is more difficult to establish the optimum duration of CPR, for in general we have less information about the patient. The recommendation would be to not continue CPR for more than 30<span class="elsevierStyleHsp" style=""></span>min in the case of asystolia and the absence of reversible causes. Patient transfer to hospital with ongoing CPR should be evaluated in cases of CA witnessed by the emergency care team, ROSC in some moment, an initial defibrillable rhythm and possible reversible causes, where ECLS measures and coronary intervention even with ongoing CPR might be indicated. In this context, a strategy of patient transfer to a useful center (OHCA code)<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">13</span></a> should be contemplated, depending on the characteristics and condition of the patient, and the hospital resources.</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">4.</span><p id="par0085" class="elsevierStylePara elsevierViewall">Continuous monitoring of the quality of CPR is a necessary element for resuscitation teams at both in- and out-hospital level.</p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">5.</span><p id="par0090" class="elsevierStylePara elsevierViewall">The availability of mechanical chest compression is essential for maintaining the quality of CPR when resuscitation needs to be prolonged. It is necessary for the transfer of patients subjected to ongoing CPR with either recovery intent or for inclusion in non-heart beating donation programs.</p></li><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">6.</span><p id="par0095" class="elsevierStylePara elsevierViewall">Continuous monitoring of endotracheal CO<span class="elsevierStyleInf">2</span> should be used by all resuscitation teams. Such monitoring is available in the great majority of emergency care settings, though not so at hospital level, where a recent survey found that 70% of the teams lacked this option.</p></li><li class="elsevierStyleListItem" id="lsti0035"><span class="elsevierStyleLabel">7.</span><p id="par0100" class="elsevierStylePara elsevierViewall">The availability of ultrasound for use during CPR is essential, since it helps in deciding the prolongation of CPR, discarding reversible causes or assessing situations with greater chances of recovery.</p></li></ul></p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0105" class="elsevierStylePara elsevierViewall">The author declares that he has no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflicts of interest" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2016-07-20" "fechaAceptado" => "2016-08-08" "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: López-Messa JB. ¿Cuál debe ser la duración apropiada de los intentos de resucitación cardiopulmonar? Med Intensiva. 2017;41:188–190.</p>" ] ] "multimedia" => array:1 [ 0 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">PEA: pulseless electrical activity; VF: ventricular fibrillation; OHCA: out-hospital cardiac arrest; IHCA: in-hospital cardiac arrest; CPR: cardiopulmonary resuscitation; VTWP: ventricular tachycardia without pulse.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td-with-role" title="table-head ; entry_with_role_rowhead " align="left" valign="top" scope="col">Study \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col">Type of study/population \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " colspan="4" align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Initial rhythm</th></tr><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Any \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Asystolia \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">PEA \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">VF/VTWP \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Nagao K, et al.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">1</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Prospective/OHCA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">40 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Goldberger ZD, et al.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">2</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Retrospective/IHCA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">30 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Grunau B, et al.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">3</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Retrospective/OHCA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">30 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">30 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">48 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Goto Y, et al.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">4</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Prospective/OHCA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">42 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">35 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">35 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Rajan C, et al.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">5</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Retrospective/OHCA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">>25 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Kin WY, et al.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">6</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Retrospective/OHCA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">>45 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1391732.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Recommendations on the duration (min) of cardiopulmonary resuscitation in different studies.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:13 [ 0 => array:3 [ "identificador" => "bib0070" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Duration of prehospital resuscitation efforts after out-of-hospital cardiac arrest" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "K. Nagao" 1 => "H. Nonogi" 2 => "N. Yonemoto" 3 => "D.F. Gaieski" 4 => "N. Ito" 5 => "M. Takayama" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1161/CIRCULATIONAHA.115.018788" "Revista" => array:6 [ "tituloSerie" => "Circulation" "fecha" => "2016" "volumen" => "133" "paginaInicial" => "1386" "paginaFinal" => "1396" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26920493" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0075" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Duration of resuscitation efforts and survival after in-hospital cardiac arrest: an observational study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "Z.D. Goldberger" 1 => "P.S. Chan" 2 => "R.A. Berg" 3 => "S.L. Kronick" 4 => "C.R. Cooke" 5 => "M. Lu" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S0140-6736(12)60862-9" "Revista" => array:6 [ "tituloSerie" => "Lancet" "fecha" => "2012" "volumen" => "380" "paginaInicial" => "1473" "paginaFinal" => "1481" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22958912" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0080" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Comparing the prognosis of those with initial shockable and non-shockable rhythms with increasing durations of CPR: informing minimum durations of resuscitation" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "B. Grunau" 1 => "J.C. Reynolds" 2 => "F.X. Scheuermeyera" 3 => "R. Stenstroma" 4 => "S. Pennington" 5 => "C. Cheung" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.resuscitation.2016.01.021" "Revista" => array:6 [ "tituloSerie" => "Resuscitation" "fecha" => "2016" "volumen" => "101" "paginaInicial" => "50" "paginaFinal" => "56" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26851705" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0085" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Relationship between the duration of cardiopulmonary resuscitation and favorable neurological outcomes after out-of-hospital cardiac arrest: a prospective, nationwide, population-based cohort study" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "Y. Goto" 1 => "A. Funada" 2 => "Y. Goto" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1161/JAHA.115.002819" "Revista" => array:5 [ "tituloSerie" => "J Am Heart Assoc" "fecha" => "2016" "volumen" => "5" "paginaInicial" => "e002819" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26994129" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0090" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prolongued cardiopulmonary resuscitation and outcomes after out-of-hospital cardiac arrest" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "C. Rajan" 1 => "F. Folke" 2 => "K. Kragholm" 3 => "C.M. Hansen" 4 => "C.B. Granger" 5 => "S.M. Hansen" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.resuscitation.2016.05.004" "Revista" => array:6 [ "tituloSerie" => "Resuscitation" "fecha" => "2016" "volumen" => "105" "paginaInicial" => "45" "paginaFinal" => "51" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27224447" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0095" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The impact of downtime on neurologic intact survival in patients with targeted temperature management after out-of-hospital cardiac arrest: Nacional multicenter cohort study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "W.Y. Kin" 1 => "S. Ahn" 2 => "J.S. Hong" 3 => "G.C. Cho" 4 => "D.W. Seo" 5 => "K.W. Jeung" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.resuscitation.2016.03.020" "Revista" => array:7 [ "tituloSerie" => "Resuscitation" "fecha" => "2016" "volumen" => "105" "paginaInicial" => "203" "paginaFinal" => "208" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27060537" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0302283809011518" "estado" => "S300" "issn" => "03022838" ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0100" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Extracorporeal resuscitation for refractory out-of-hospital cardiac arrest in adults: a systematic review of international practices and outcomes" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "I. Ortega-Deballon" 1 => "L. Hornbyf" 2 => "S.D. Shemieg" 3 => "F. Bhanji" 4 => "E. Guadagno" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.resuscitation.2016.01.018" "Revista" => array:6 [ "tituloSerie" => "Resuscitation" "fecha" => "2016" "volumen" => "101" "paginaInicial" => "12" "paginaFinal" => "20" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26836946" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0105" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Echocardiography for prognostication during the resuscitation of intensive care unit patients with non-shockable rhythm cardiac arrest" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "U.A. Flato" 1 => "E.F. Paiva" 2 => "M.T. Carballo" 3 => "A.M. Buehler" 4 => "R. Marco" 5 => "A. Timerman" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.resuscitation.2015.03.024" "Revista" => array:7 [ "tituloSerie" => "Resuscitation" "fecha" => "2015" "volumen" => "92" "paginaInicial" => "1" "paginaFinal" => "6" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25891961" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0302283809005867" "estado" => "S300" "issn" => "03022838" ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0110" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Neurologic recovery following prolonged out-of-hospital cardiac arrest with resuscitation guided by continuous capnography" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "R.D. White" 1 => "B.W. Goodman" 2 => "M.A. Svoboda" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.4065/mcp.2011.0229" "Revista" => array:7 [ "tituloSerie" => "Mayo Clin Proc" "fecha" => "2011" "volumen" => "86" "paginaInicial" => "544" "paginaFinal" => "548" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21508320" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0302283809001511" "estado" => "S300" "issn" => "03022838" ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0115" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cerebral oximetry during cardiac arrest: a multicenter study of neurologic outcomes and survival" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "S. Parnia" 1 => "J. Yang" 2 => "R. Nguyen" 3 => "A. Ahn" 4 => "J. Zhu" 5 => "L. Inigo-Santiago" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/CCM.0000000000001723" "Revista" => array:7 [ "tituloSerie" => "Crit Care Med" "fecha" => "2016" "volumen" => "44" "paginaInicial" => "1663" "paginaFinal" => "1674" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27071068" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0302283806008426" "estado" => "S300" "issn" => "03022838" ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0120" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Applying the termination of resuscitation rules to out-of-hospital cardiac arrests of both cardiac and non-cardiac etiologies: a prospective cohort study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Kashiura" 1 => "Y. Hamabe" 2 => "A. Akashi" 3 => "A. Sakurai" 4 => "Y. Tahara" 5 => "N. Yonemoto" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1186/s13054-016-1226-4" "Revista" => array:6 [ "tituloSerie" => "Crit Care" "fecha" => "2016" "volumen" => "20" "paginaInicial" => "49" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26926006" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0302283809000499" "estado" => "S300" "issn" => "03022838" ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0125" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cardiopulmonary resuscitation quality and beyond: the need to improve real-time feedback and physiologic monitoring" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "S. Lin" 1 => "D.C. Scales" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1186/s13054-016-1371-9" "Revista" => array:5 [ "tituloSerie" => "Crit Care" "fecha" => "2016" "volumen" => "20" "paginaInicial" => "182" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27349642" "web" => "Medline" ] ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0130" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Minnesota resuscitation consortium's advanced perfusion and reperfusion cardiac life support strategy for out-of-hospital refractory ventricular fibrillation" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "D. Yannopoulos" 1 => "J.A. Bartos" 2 => "C. Martin" 3 => "G. Raveendran" 4 => "E. Missov" 5 => "M. Conterato" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1161/JAHA.116.003732" "Revista" => array:6 [ "tituloSerie" => "J Am Heart Assoc" "fecha" => "2016" "volumen" => "5" "paginaInicial" => "e003732" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27412906" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0022534708027341" "estado" => "S300" "issn" => "00225347" ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21735727/0000004100000003/v1_201704120039/S2173572717300346/v1_201704120039/en/main.assets" "Apartado" => array:4 [ "identificador" => "402" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Point of view" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21735727/0000004100000003/v1_201704120039/S2173572717300346/v1_201704120039/en/main.pdf?idApp=WMIE&text.app=https://medintensiva.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173572717300346?idApp=WMIE" ]
Year/Month | Html | Total | |
---|---|---|---|
2024 November | 18 | 6 | 24 |
2024 October | 370 | 73 | 443 |
2024 September | 350 | 49 | 399 |
2024 August | 333 | 60 | 393 |
2024 July | 466 | 45 | 511 |
2024 June | 411 | 76 | 487 |
2024 May | 491 | 56 | 547 |
2024 April | 331 | 65 | 396 |
2024 March | 401 | 41 | 442 |
2024 February | 299 | 53 | 352 |
2024 January | 362 | 48 | 410 |
2023 December | 495 | 54 | 549 |
2023 November | 294 | 55 | 349 |
2023 October | 306 | 47 | 353 |
2023 September | 329 | 43 | 372 |
2023 August | 342 | 22 | 364 |
2023 July | 437 | 53 | 490 |
2023 June | 439 | 41 | 480 |
2023 May | 592 | 57 | 649 |
2023 April | 278 | 42 | 320 |
2023 March | 432 | 63 | 495 |
2023 February | 420 | 52 | 472 |
2023 January | 410 | 54 | 464 |
2022 December | 322 | 67 | 389 |
2022 November | 519 | 62 | 581 |
2022 October | 473 | 87 | 560 |
2022 September | 489 | 88 | 577 |
2022 August | 295 | 111 | 406 |
2022 July | 295 | 65 | 360 |
2022 June | 265 | 50 | 315 |
2022 May | 273 | 73 | 346 |
2022 April | 227 | 64 | 291 |
2022 March | 301 | 98 | 399 |
2022 February | 230 | 54 | 284 |
2022 January | 238 | 35 | 273 |
2021 December | 168 | 71 | 239 |
2021 November | 179 | 55 | 234 |
2021 October | 248 | 86 | 334 |
2021 September | 172 | 60 | 232 |
2021 August | 185 | 55 | 240 |
2021 July | 205 | 46 | 251 |
2021 June | 206 | 43 | 249 |
2021 May | 254 | 50 | 304 |
2021 April | 753 | 167 | 920 |
2021 March | 316 | 54 | 370 |
2021 February | 250 | 39 | 289 |
2021 January | 257 | 33 | 290 |
2020 December | 214 | 31 | 245 |
2020 November | 217 | 47 | 264 |
2020 October | 189 | 40 | 229 |
2020 September | 170 | 37 | 207 |
2020 August | 134 | 20 | 154 |
2020 July | 120 | 27 | 147 |
2020 June | 146 | 21 | 167 |
2020 May | 154 | 30 | 184 |
2020 April | 218 | 24 | 242 |
2020 March | 154 | 29 | 183 |
2020 February | 357 | 58 | 415 |
2020 January | 150 | 49 | 199 |
2019 December | 297 | 66 | 363 |
2019 November | 252 | 60 | 312 |
2019 October | 448 | 43 | 491 |
2019 September | 378 | 47 | 425 |
2019 August | 242 | 28 | 270 |
2019 July | 172 | 26 | 198 |
2019 June | 106 | 28 | 134 |
2019 May | 134 | 39 | 173 |
2019 April | 107 | 18 | 125 |
2019 March | 93 | 30 | 123 |
2019 February | 69 | 30 | 99 |
2019 January | 59 | 31 | 90 |
2018 December | 108 | 43 | 151 |
2018 November | 97 | 96 | 193 |
2018 October | 91 | 21 | 112 |
2018 September | 41 | 13 | 54 |
2018 August | 31 | 9 | 40 |
2018 July | 41 | 20 | 61 |
2018 June | 41 | 7 | 48 |
2018 May | 16 | 8 | 24 |
2018 April | 70 | 9 | 79 |
2018 March | 36 | 5 | 41 |
2018 February | 25 | 14 | 39 |
2018 January | 67 | 18 | 85 |
2017 December | 31 | 6 | 37 |
2017 November | 44 | 13 | 57 |
2017 October | 39 | 17 | 56 |
2017 September | 55 | 21 | 76 |
2017 August | 31 | 11 | 42 |
2017 July | 13 | 7 | 20 |
2017 May | 2 | 0 | 2 |
2017 April | 1 | 3 | 4 |