Letter to the Editor
Increasing time to stop cardiopulmonary resuscitation in out of hospital cardiac arrest
Aumento del tiempo para cesar la reanimación cardiopulmonar en la parada cardiaca extrahospitalaria
N. Báez-Ferrera, C. Gironés-Bredyb,c, A. Domínguez-Rodrigueza,d, G. Burillo-Putzeb,d,
Corresponding author
a Servicio de Cardiología, Hospital Universitario de Canarias, Tenerife, Spain
b Servicio de Urgencias, Hospital Universitario de Canarias, Tenerife, Spain
c Facultad de Ciencias de la Salud, Universidad de La Laguna, Tenerife, Spain
d Facultad de Ciencias de la Salud, Universidad Europea de Canarias, Tenerife, Spain
Read
5666
Timeswas read the article
2314
Total PDF
3352
Total HTML
Share statistics
array:24 [ "pii" => "S2173572718300985" "issn" => "21735727" "doi" => "10.1016/j.medine.2018.05.008" "estado" => "S300" "fechaPublicacion" => "2018-08-01" "aid" => "1083" "copyright" => "Elsevier España, S.L.U. and SEMICYUC" "copyrightAnyo" => "2017" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Med Intensiva. 2018;42:395-6" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 1052 "formatos" => array:3 [ "EPUB" => 162 "HTML" => 503 "PDF" => 387 ] ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S0210569117302012" "issn" => "02105691" "doi" => "10.1016/j.medin.2017.06.004" "estado" => "S300" "fechaPublicacion" => "2018-08-01" "aid" => "1083" "copyright" => "Elsevier España, S.L.U. y SEMICYUC" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Med Intensiva. 2018;42:395-6" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 1692 "formatos" => array:3 [ "EPUB" => 192 "HTML" => 913 "PDF" => 587 ] ] "es" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">CARTA AL EDITOR</span>" "titulo" => "Aumento del tiempo para cesar la reanimación cardiopulmonar en la parada cardiaca extrahospitalaria" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "395" "paginaFinal" => "396" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Increasing time to stop cardiopulmonary resuscitation in out of hospital cardiac arrest" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "N. Báez-Ferrer, C. Gironés-Bredy, A. Domínguez-Rodriguez, G. Burillo-Putze" "autores" => array:4 [ 0 => array:2 [ "nombre" => "N." "apellidos" => "Báez-Ferrer" ] 1 => array:2 [ "nombre" => "C." "apellidos" => "Gironés-Bredy" ] 2 => array:2 [ "nombre" => "A." "apellidos" => "Domínguez-Rodriguez" ] 3 => array:2 [ "nombre" => "G." "apellidos" => "Burillo-Putze" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2173572718300985" "doi" => "10.1016/j.medine.2018.05.008" "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/S2173572718300985?idApp=WMIE" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0210569117302012?idApp=WMIE" "url" => "/02105691/0000004200000006/v1_201807240418/S0210569117302012/v1_201807240418/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S2173572718300973" "issn" => "21735727" "doi" => "10.1016/j.medine.2018.05.007" "estado" => "S300" "fechaPublicacion" => "2018-08-01" "aid" => "1035" "copyright" => "Elsevier España, S.L.U. and SEMICYUC" "documento" => "article" "crossmark" => 1 "subdocumento" => "sco" "cita" => "Med Intensiva. 2018;42:e13-4" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 1411 "formatos" => array:3 [ "EPUB" => 173 "HTML" => 767 "PDF" => 471 ] ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Images in Intensive Medicine</span>" "titulo" => "Propofol-induced non-convulsive epileptic crisis" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "e13" "paginaFinal" => "e14" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Crisis epiléptica no convulsiva inducida por propofol" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:6 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1295 "Ancho" => 2667 "Tamanyo" => 871425 ] ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "A. Zabalegui, M. Arroyo Diez, R.A. Peláez Cruz" "autores" => array:3 [ 0 => array:2 [ "nombre" => "A." "apellidos" => "Zabalegui" ] 1 => array:2 [ "nombre" => "M." "apellidos" => "Arroyo Diez" ] 2 => array:2 [ "nombre" => "R.A." "apellidos" => "Peláez Cruz" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0210569117300578" "doi" => "10.1016/j.medin.2017.01.005" "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/S0210569117300578?idApp=WMIE" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173572718300973?idApp=WMIE" "url" => "/21735727/0000004200000006/v1_201807240414/S2173572718300973/v1_201807240414/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S2173572718300997" "issn" => "21735727" "doi" => "10.1016/j.medine.2018.05.009" "estado" => "S300" "fechaPublicacion" => "2018-08-01" "aid" => "1159" "copyright" => "Elsevier España, S.L.U. and SEMICYUC" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Med Intensiva. 2018;42:394-5" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 1035 "formatos" => array:3 [ "EPUB" => 152 "HTML" => 534 "PDF" => 349 ] ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "SMART: Is saline on the tightrope?" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "394" "paginaFinal" => "395" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "SMART: ¿está el suero salino en la cuerda floja?" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "A. González-Castro, M. Ortiz-Lasa, J. Bada Da Silva" "autores" => array:3 [ 0 => array:2 [ "nombre" => "A." "apellidos" => "González-Castro" ] 1 => array:2 [ "nombre" => "M." "apellidos" => "Ortiz-Lasa" ] 2 => array:2 [ "nombre" => "J." "apellidos" => "Bada Da Silva" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0210569117303674" "doi" => "10.1016/j.medin.2017.12.008" "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/S0210569117303674?idApp=WMIE" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173572718300997?idApp=WMIE" "url" => "/21735727/0000004200000006/v1_201807240414/S2173572718300997/v1_201807240414/en/main.assets" ] "en" => array:15 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Increasing time to stop cardiopulmonary resuscitation in out of hospital cardiac arrest" "tieneTextoCompleto" => true "saludo" => "Dear Editor," "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "395" "paginaFinal" => "396" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "N. Báez-Ferrer, C. Gironés-Bredy, A. Domínguez-Rodriguez, G. Burillo-Putze" "autores" => array:4 [ 0 => array:3 [ "nombre" => "N." "apellidos" => "Báez-Ferrer" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 1 => array:3 [ "nombre" => "C." "apellidos" => "Gironés-Bredy" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 2 => array:3 [ "nombre" => "A." "apellidos" => "Domínguez-Rodriguez" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0020" ] ] ] 3 => array:4 [ "nombre" => "G." "apellidos" => "Burillo-Putze" "email" => array:1 [ 0 => "gburillo@telefonica.net" ] "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0020" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:4 [ 0 => array:3 [ "entidad" => "Servicio de Cardiología, Hospital Universitario de Canarias, Tenerife, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Urgencias, Hospital Universitario de Canarias, Tenerife, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Facultad de Ciencias de la Salud, Universidad de La Laguna, Tenerife, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Facultad de Ciencias de la Salud, Universidad Europea de Canarias, Tenerife, Spain" "etiqueta" => "d" "identificador" => "aff0020" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Aumento del tiempo para cesar la reanimación cardiopulmonar en la parada cardiaca extrahospitalaria" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Back in 2015, the European Resuscitation Council established a maximum of 20<span class="elsevierStyleHsp" style=""></span>min of caldiopulmonary resuscitation (CPR) maneuvers for non-shockable rhythms without specifying the time in the case of cardiac arrests (CA) with shockable rhythms.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The excellent review from López-Messa provides, based on the scarce series available, a wider CPR window, particularly in certain groups of population, and addresses the use of the available diagnostic and therapeutic elements in and out of the hospital (capnography, ultrasound, etc.).<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Based on his proposal on CPR times, we hereby present the following case: thirty-nine-year-old male fire fighter without a significant personal history who back in his home suffers a cardiac arrest witnessed by his wife who immediately calls 112. This emergency service explains to her how to perform CPR maneuvers. Then the wife calls a neighbor who happens to be an ER doctor. Using her phone hands-free functionality, this ER physician explains to her how to perform CPR maneuvers and gives her personal support until her arrival. After 20<span class="elsevierStyleHsp" style=""></span>min performing basic CPR maneuvers, the EMT arrives with a SAED capable of identifying shockable rhythms and extends CPR for another 19<span class="elsevierStyleHsp" style=""></span>min with advanced life support plus 3<span class="elsevierStyleHsp" style=""></span>electric discharges. The victim recovers spontaneous circulation, the trace in the ST segment elevation is detected, and the patient is transferred to a hospital with hemodynamic laboratory capabilities, and then admitted to the Intensive Care Unit.</p><p id="par0020" class="elsevierStylePara elsevierViewall">After the hospital discharge and after patient's follow-up for one full year, no neurological or any other kind of sequelae have been identified; the patient has remained asymptomatic and without any new cardiological events (<a class="elsevierStyleCrossRef" href="#sec0005">Appendix A</a> additional material).</p><p id="par0025" class="elsevierStylePara elsevierViewall">Our case is similar to the 11 patients from Grunau et al.’s series who went over the 30<span class="elsevierStyleHsp" style=""></span>min-threshold performing CPR maneuvers. Eight (8) of these patients kept their neurological capabilities intact after hospital discharge.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> Similarly, Loma-Osorio's study on out-of-hospital sudden death due to cardiac causes with Coronary Intensive Care Unit admission established a series of negative prognostic factors that we also saw in our patient, such as the need for invasive ventilation for over 10 days, CPR maneuver times <30<span class="elsevierStyleHsp" style=""></span>min, and shock and lactic acidosis upon arrival at the hospital.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a> However, our case shares good prognostic factors such as, among others, being a witnessed out-of-hospital sudden death, the implementation of SAED with initial shockable rhythm, the induction of hypothermia, and the ST-segment elevation myocardial infarction (STEMI) as the underlying cause. As the OHSCAR study establishes, we believe that the initial phone support given to the CA witness also contributed to a successful PCR in the aforementioned case.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">As López Mesa,<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> at least in the subgroup of young and healthy patients, with a witnessed CA and initial shockable rhythm, we should think about the possibility of extending the time of CPR maneuvers up to 40<span class="elsevierStyleHsp" style=""></span>min, even more so if a STEMI has been the cause leading to the CA.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Báez-Ferrer N, Gironés-Bredy C, Domínguez-Rodriguez A, Burillo-Putze G. Aumento del tiempo para cesar la reanimación cardiopulmonar en la parada cardiaca extrahospitalaria. Med Intensiva. 2018;42:395–396.</p>" ] ] "apendice" => array:1 [ 0 => array:1 [ "seccion" => array:1 [ 0 => array:4 [ "apendice" => "<p id="par0040" class="elsevierStylePara elsevierViewall">The following are the supplementary data to this article:<elsevierMultimedia ident="upi0005"></elsevierMultimedia></p>" "etiqueta" => "Appendix A" "titulo" => "Supplementary data" "identificador" => "sec0010" ] ] ] ] "multimedia" => array:1 [ 0 => array:5 [ "identificador" => "upi0005" "tipo" => "MULTIMEDIAECOMPONENTE" "mostrarFloat" => false "mostrarDisplay" => true "Ecomponente" => array:2 [ "fichero" => "mmc1.doc" "ficheroTamanyo" => 67584 ] ] ] "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:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "European Resuscitation Council Guidelines for Resuscitation 2015. Section 1. Executive summary" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "K.G. Monsieurs" 1 => "J.P. Nolan" 2 => "L.L. Bossaert" 3 => "R. Greif" 4 => "I.K. Maconochie" 5 => "N.I. Nikolaou" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.resuscitation.2015.07.038" "Revista" => array:6 [ "tituloSerie" => "Resuscitation" "fecha" => "2015" "volumen" => "95" "paginaInicial" => "1" "paginaFinal" => "80" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26477410" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0035" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "What should be the appropriate duration of cardiopulmonary resuscitation?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "J.B. López-Messa" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.medin.2016.08.004" "Revista" => array:6 [ "tituloSerie" => "Med Intensiva" "fecha" => "2017" "volumen" => "41" "paginaInicial" => "188" "paginaFinal" => "190" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27773492" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0040" "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 resucitation" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "B. Grunau" 1 => "J.C. Reynolds" 2 => "F.X. Scheuermeyer" 3 => "R. Stenstrom" 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" => "bib0045" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Características clínicas, pronóstico vital y funcional de los pacientes supervivientes a una muerte súbita extrahospitalaria ingresados en cinco unidades de cuidados intensivos cardiológicos" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "P. Loma-Osorio" 1 => "J. Aboal" 2 => "M. Sanz" 3 => "A. Caballero" 4 => "M. Vila" 5 => "V. Lorente" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.rec.2013.03.011" "Revista" => array:6 [ "tituloSerie" => "Rev Esp Cardiol" "fecha" => "2013" "volumen" => "66" "paginaInicial" => "623" "paginaFinal" => "628" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24776330" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0050" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Recomendaciones para el soporte telefónico a la reanimación por testigos desde los centros de coordinación de urgencias y urgencias" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J. Garcia del Aguila" 1 => "J.B. López-Messa" 2 => "F. Rosell Ortiz" 3 => "R. de Elías Hernández" 4 => "M. Martinez del Valle" 5 => "L. Sanchez-Santos" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.medin.2015.02.005" "Revista" => array:6 [ "tituloSerie" => "Med Intensiva" "fecha" => "2015" "volumen" => "39" "paginaInicial" => "298" "paginaFinal" => "302" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25895627" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21735727/0000004200000006/v1_201807240414/S2173572718300985/v1_201807240414/en/main.assets" "Apartado" => array:4 [ "identificador" => "64604" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letters to the Editor" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21735727/0000004200000006/v1_201807240414/S2173572718300985/v1_201807240414/en/main.pdf?idApp=WMIE&text.app=https://medintensiva.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173572718300985?idApp=WMIE" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 4 | 9 | 13 |
| 2024 October | 51 | 55 | 106 |
| 2024 September | 53 | 32 | 85 |
| 2024 August | 47 | 52 | 99 |
| 2024 July | 47 | 26 | 73 |
| 2024 June | 54 | 52 | 106 |
| 2024 May | 33 | 29 | 62 |
| 2024 April | 52 | 43 | 95 |
| 2024 March | 46 | 23 | 69 |
| 2024 February | 40 | 36 | 76 |
| 2024 January | 31 | 29 | 60 |
| 2023 December | 31 | 43 | 74 |
| 2023 November | 38 | 37 | 75 |
| 2023 October | 21 | 26 | 47 |
| 2023 September | 38 | 42 | 80 |
| 2023 August | 21 | 16 | 37 |
| 2023 July | 31 | 28 | 59 |
| 2023 June | 29 | 17 | 46 |
| 2023 May | 54 | 45 | 99 |
| 2023 April | 25 | 21 | 46 |
| 2023 March | 69 | 33 | 102 |
| 2023 February | 39 | 32 | 71 |
| 2023 January | 20 | 34 | 54 |
| 2022 December | 67 | 39 | 106 |
| 2022 November | 64 | 35 | 99 |
| 2022 October | 61 | 40 | 101 |
| 2022 September | 64 | 30 | 94 |
| 2022 August | 60 | 42 | 102 |
| 2022 July | 60 | 35 | 95 |
| 2022 June | 80 | 27 | 107 |
| 2022 May | 56 | 30 | 86 |
| 2022 April | 46 | 49 | 95 |
| 2022 March | 43 | 55 | 98 |
| 2022 February | 32 | 39 | 71 |
| 2022 January | 34 | 36 | 70 |
| 2021 December | 62 | 40 | 102 |
| 2021 November | 36 | 37 | 73 |
| 2021 October | 292 | 79 | 371 |
| 2021 September | 39 | 43 | 82 |
| 2021 August | 19 | 45 | 64 |
| 2021 July | 22 | 23 | 45 |
| 2021 June | 34 | 34 | 68 |
| 2021 May | 42 | 45 | 87 |
| 2021 April | 111 | 52 | 163 |
| 2021 March | 76 | 47 | 123 |
| 2021 February | 66 | 39 | 105 |
| 2021 January | 73 | 28 | 101 |
| 2020 December | 50 | 21 | 71 |
| 2020 November | 42 | 19 | 61 |
| 2020 October | 52 | 32 | 84 |
| 2020 September | 69 | 24 | 93 |
| 2020 August | 28 | 19 | 47 |
| 2020 July | 42 | 19 | 61 |
| 2020 June | 45 | 19 | 64 |
| 2020 May | 34 | 10 | 44 |
| 2020 April | 32 | 11 | 43 |
| 2020 March | 23 | 12 | 35 |
| 2020 February | 114 | 48 | 162 |
| 2020 January | 38 | 26 | 64 |
| 2019 December | 38 | 21 | 59 |
| 2019 November | 32 | 25 | 57 |
| 2019 October | 29 | 26 | 55 |
| 2019 September | 25 | 22 | 47 |
| 2019 August | 29 | 18 | 47 |
| 2019 July | 28 | 21 | 49 |
| 2019 June | 22 | 18 | 40 |
| 2019 May | 32 | 31 | 63 |
| 2019 April | 15 | 21 | 36 |
| 2019 March | 13 | 24 | 37 |
| 2019 February | 23 | 29 | 52 |
| 2019 January | 23 | 28 | 51 |
| 2018 December | 44 | 23 | 67 |
| 2018 November | 17 | 17 | 34 |
| 2018 July | 0 | 1 | 1 |
Show all
