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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">After reading the comment published in your journal<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> on the decisions to be made after suffering an irreversible cardiopulmonary arrest &#40;CPA&#41; when it comes to the optimal duration of the resuscitation attempts&#44;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> and where the possibility of donor asystole is discussed after conducting unsuccessful attempts of cardiopulmonary resuscitation &#40;CPR&#41; maneuvers&#44; I would like to make a few comments in this regard&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">We need to emphasize how important it is to extend the donor asystole programs as much as possible&#44; even though I understand that this is not an easy task to do&#44; and that it needs to be based not only on the characteristics of every cardiac arrest and victim&#44; but also on the location and area where it occurs&#46; The maintenance of resuscitation maneuvers by the emergency teams without an exact knowledge of the existence of an established donation program may lead to the unsuccessful continuation of such maneuvers&#44; with the corresponding fatigue from the healthcare team&#44; or wear and tear of the family&#39;s expectations on potential donors and receivers&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">On the other hand&#44; and as it has been published recently&#44; if the aforementioned conditions are present&#44; the prospective victim without survival possibilities should be identified as soon as possible&#44; and then considered a potential donor&#46; In this regard&#44; Jabre et al&#46;&#8217;s trial<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> establishes three criteria in order to conduct early identifications&#46; These criteria would require it to be a CPA unwitnessed by the emergency teams&#59; initial non-shockable rhythm&#59; and inability to recover spontaneous circulation before the administration of a third dose of adrenaline&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Yet despite all this&#44; both in Europe and Spain there is an important variability in the ethical approach to both CPR and the decisions to be made to achieve resuscitation&#44;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a> and based on the ethical recommendations from the 2015 European Resuscitation Council&#44; it may be necessary to identify very clearly the cases of refractory CPA that may benefit from prolonged interventions&#46; The publications that discuss the recovery of victims of prolonged CPAs are not an exception&#44; especially in cases such as hypothermia&#44; or patients included in donor asystole programs&#44; where the prolonged maintenance of CPR maneuvers led to an initially unexpected recovery&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a> The advances made in CPR techniques may change previously established paradigms&#44; which is why we should remain cautious and not establish any strict recommendations for all cases and situations&#44; since it seems evident that in many situations&#44; the healthcare providers make decisions not based on validated criteria&#44; but on intuitions and perceptions of the victim&#39;s possibilities of recovery or potential donation&#46;</p></span>"
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Letter to the Editor
Reply to “Decisions after irreversible cardiopulmonary arrest: Ends and opportunities”
Respuesta a «Decisiones tras parada cardiaca irreversible: finales y oportunidades»
J.B. López Messa
Servicio de Medicina Intensiva, Complejo Asistencial Universitario de Palencia, Palencia, Spain
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">After reading the comment published in your journal<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> on the decisions to be made after suffering an irreversible cardiopulmonary arrest &#40;CPA&#41; when it comes to the optimal duration of the resuscitation attempts&#44;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> and where the possibility of donor asystole is discussed after conducting unsuccessful attempts of cardiopulmonary resuscitation &#40;CPR&#41; maneuvers&#44; I would like to make a few comments in this regard&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">We need to emphasize how important it is to extend the donor asystole programs as much as possible&#44; even though I understand that this is not an easy task to do&#44; and that it needs to be based not only on the characteristics of every cardiac arrest and victim&#44; but also on the location and area where it occurs&#46; The maintenance of resuscitation maneuvers by the emergency teams without an exact knowledge of the existence of an established donation program may lead to the unsuccessful continuation of such maneuvers&#44; with the corresponding fatigue from the healthcare team&#44; or wear and tear of the family&#39;s expectations on potential donors and receivers&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">On the other hand&#44; and as it has been published recently&#44; if the aforementioned conditions are present&#44; the prospective victim without survival possibilities should be identified as soon as possible&#44; and then considered a potential donor&#46; In this regard&#44; Jabre et al&#46;&#8217;s trial<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> establishes three criteria in order to conduct early identifications&#46; These criteria would require it to be a CPA unwitnessed by the emergency teams&#59; initial non-shockable rhythm&#59; and inability to recover spontaneous circulation before the administration of a third dose of adrenaline&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Yet despite all this&#44; both in Europe and Spain there is an important variability in the ethical approach to both CPR and the decisions to be made to achieve resuscitation&#44;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a> and based on the ethical recommendations from the 2015 European Resuscitation Council&#44; it may be necessary to identify very clearly the cases of refractory CPA that may benefit from prolonged interventions&#46; The publications that discuss the recovery of victims of prolonged CPAs are not an exception&#44; especially in cases such as hypothermia&#44; or patients included in donor asystole programs&#44; where the prolonged maintenance of CPR maneuvers led to an initially unexpected recovery&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a> The advances made in CPR techniques may change previously established paradigms&#44; which is why we should remain cautious and not establish any strict recommendations for all cases and situations&#44; since it seems evident that in many situations&#44; the healthcare providers make decisions not based on validated criteria&#44; but on intuitions and perceptions of the victim&#39;s possibilities of recovery or potential donation&#46;</p></span>"
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