Letter to the Editor
Decisions after irreversible cardiopulmonary arrest: Ends and opportunities
Decisiones tras parada cardíaca irreversible: finales y oportunidades
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Ruiz de Azúa-López, L. Martín-Villén, J.J. Egea-Guerrero" "autores" => array:3 [ 0 => array:4 [ "nombre" => "Z." "apellidos" => "Ruiz de Azúa-López" "email" => array:1 [ 0 => "zaida@azud.es" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "L." "apellidos" => "Martín-Villén" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "J.J." "apellidos" => "Egea-Guerrero" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Coordinación Intrahospitalaria de Trasplantes, Hospital Universitario Virgen del Rocío, Sevilla, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Coordinación Sectorial de Trasplantes Sevilla-Huelva, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Decisiones tras parada cardíaca irreversible: finales y oportunidades" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">After reading the article recently published in your journal and written by Dr. López-Messa, MD<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> on the optimal duration of cardiopulmonary resuscitation (CPR) after cardiopulmonary arrest (CPA) we agree with the author that somewhere between 20 and 40<span class="elsevierStyleHsp" style=""></span>minutes is an appropriate time based on the presence of reversible causes, rhythm at presentation, and available intra and out-of-hospital resources such as: ultrasound; extracorporeal life support; and coronary intervention with ongoing CPR, among others.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Nevertheless, we would like to emphasize and discuss an aspect we believe to be essential such as the possibility of donor asystole. In this regard, the European Resuscitation Council guidelines from 2015 establish that all European countries should intensify their efforts aimed at increasing the number of dead donors following cardiocirculatory criteria at both intra and out-of-hospital level.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> On this point it is made very clear that it is necessary to start the maintenance maneuvers on prospective donors of organs and tissues and maintain such maneuvers as necessary before confirming with the family what the wishes of the deceased really are, and once the emergency team has considered the CPR maneuvers irreversible and the CPR measures unsuccessful, regardless of how long they have been going on.</p><p id="par0015" class="elsevierStylePara elsevierViewall">In this regard, we consider mandatory for all healthcare providers to check the registry of anticipated wills, not only when it comes to invasive measures and CPR maneuvers, but also when it comes to the donor's wishes on organ and tissue donation. If there is no registry, both the principle of autonomy of the deceased expressed through his/her family, and the principle of well-being of the prospective recipients of the future organs/tissues should be observed.</p><p id="par0020" class="elsevierStylePara elsevierViewall">We would also like to emphasize what we think is something really important, not only for the out-of-hospital donor asystole programs, but also to improve the survival of patients who suffer CPAs, which is the availability of mechanical thoracic compression machines. Although in the comparative studies<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> conducted so far their use does not translate into an improvement of the effectiveness of CPR measures, they do make sure that such measures are performed optimally and for a long period of time, allowing the transfer of patients and liberating the healthcare personnel so they can perform other procedures and maneuvers.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Lastly, we should say that the most recent data published on this type of donation classified as category II donation within the Maastricht classification—and more widely known as uncontrolled donation are becoming more and more favorable in our country.<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">4,5</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">For all these reasons, we would like to emphasize that during the management of irreversible CPAs through CPR maneuvers considered unsuccessful, and regardless of how long they have been going on, both intra and out-of-hospital level, it is essential to systematically remember to always activate the reference hospital transplant coordination team in order to discuss the possibility of organ/tissue donation. Such a team would have to be totally independent from the resuscitation team, in order to avoid any conflicts of interest, which is what all guidelines recommend.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2017-04-28" "fechaAceptado" => "2017-05-04" "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Ruiz de Azúa-López Z, Martín-Villén L, Egea-Guerrero JJ. Decisiones tras parada cardíaca irreversible: finales y oportunidades. Med Intensiva. 2017;41:506.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0030" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:3 [ "comentario" => "[article in English, Spanish]" "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "What should be the appropriate duration for cardiopulmonary resuscitation" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "J.B. 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| 2024 November | 2 | 5 | 7 |
| 2024 October | 95 | 38 | 133 |
| 2024 September | 75 | 29 | 104 |
| 2024 August | 71 | 32 | 103 |
| 2024 July | 51 | 34 | 85 |
| 2024 June | 102 | 42 | 144 |
| 2024 May | 89 | 26 | 115 |
| 2024 April | 129 | 37 | 166 |
| 2024 March | 96 | 33 | 129 |
| 2024 February | 87 | 42 | 129 |
| 2024 January | 113 | 31 | 144 |
| 2023 December | 98 | 41 | 139 |
| 2023 November | 124 | 39 | 163 |
| 2023 October | 112 | 38 | 150 |
| 2023 September | 72 | 40 | 112 |
| 2023 August | 66 | 20 | 86 |
| 2023 July | 65 | 26 | 91 |
| 2023 June | 61 | 22 | 83 |
| 2023 May | 111 | 33 | 144 |
| 2023 April | 70 | 21 | 91 |
| 2023 March | 123 | 32 | 155 |
| 2023 February | 104 | 28 | 132 |
| 2023 January | 105 | 24 | 129 |
| 2022 December | 132 | 48 | 180 |
| 2022 November | 96 | 50 | 146 |
| 2022 October | 111 | 47 | 158 |
| 2022 September | 104 | 34 | 138 |
| 2022 August | 80 | 49 | 129 |
| 2022 July | 54 | 49 | 103 |
| 2022 June | 60 | 36 | 96 |
| 2022 May | 87 | 50 | 137 |
| 2022 April | 64 | 43 | 107 |
| 2022 March | 114 | 59 | 173 |
| 2022 February | 76 | 39 | 115 |
| 2022 January | 85 | 47 | 132 |
| 2021 December | 85 | 49 | 134 |
| 2021 November | 92 | 42 | 134 |
| 2021 October | 137 | 85 | 222 |
| 2021 September | 83 | 57 | 140 |
| 2021 August | 66 | 61 | 127 |
| 2021 July | 65 | 22 | 87 |
| 2021 June | 59 | 33 | 92 |
| 2021 May | 88 | 49 | 137 |
| 2021 April | 154 | 73 | 227 |
| 2021 March | 106 | 35 | 141 |
| 2021 February | 111 | 33 | 144 |
| 2021 January | 98 | 46 | 144 |
| 2020 December | 91 | 46 | 137 |
| 2020 November | 86 | 25 | 111 |
| 2020 October | 87 | 24 | 111 |
| 2020 September | 78 | 24 | 102 |
| 2020 August | 56 | 27 | 83 |
| 2020 July | 57 | 22 | 79 |
| 2020 June | 64 | 8 | 72 |
| 2020 May | 59 | 9 | 68 |
| 2020 April | 74 | 7 | 81 |
| 2020 March | 47 | 16 | 63 |
| 2020 February | 119 | 27 | 146 |
| 2020 January | 68 | 29 | 97 |
| 2019 December | 55 | 17 | 72 |
| 2019 November | 89 | 27 | 116 |
| 2019 October | 33 | 16 | 49 |
| 2019 September | 36 | 25 | 61 |
| 2019 August | 23 | 19 | 42 |
| 2019 July | 25 | 21 | 46 |
| 2019 June | 23 | 19 | 42 |
| 2019 May | 39 | 32 | 71 |
| 2019 April | 13 | 15 | 28 |
| 2019 March | 23 | 21 | 44 |
| 2019 February | 30 | 23 | 53 |
| 2019 January | 21 | 32 | 53 |
| 2018 December | 49 | 21 | 70 |
| 2018 November | 101 | 56 | 157 |
| 2018 October | 100 | 17 | 117 |
| 2018 September | 35 | 13 | 48 |
| 2018 August | 21 | 9 | 30 |
| 2018 July | 41 | 17 | 58 |
| 2018 June | 39 | 10 | 49 |
| 2018 May | 23 | 11 | 34 |
| 2018 April | 40 | 12 | 52 |
| 2018 March | 35 | 8 | 43 |
| 2017 December | 0 | 1 | 1 |
| 2017 November | 1 | 0 | 1 |
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