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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The Spanish multicenter study on cardiac arrest published by Loza et al&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> within the context of the Cardiological Intensive Care and Cardiopulmonary Resuscitation Working Group has been of considerable interest to us&#46; Among other reasons&#44; the study is notorious because it involves an important number of care units throughout Spain&#44; and provides information corresponding to a 12-month follow-up period&#44; which is longer than usually reported in the literature&#46; This aspect of the study deserves to be highlighted&#44; since a prolonged period of time is needed to assess the outcome of the neurological damage of hypoxic&#8211;ischemic encephalopathy&#44; and the reported mortality and functional status results assessed by means of the Barthel score at 12 months are worthy of the best of healthcare systems&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">The main results of the study point to older age&#44; non-cardiac causes of arrest&#44; and a return to spontaneous circulation of over 20<span class="elsevierStyleHsp" style=""></span>min as severity predictors&#44; while the presence of defibrillable rhythms<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> and coronary revascularization are established as protective factors&#46; Other reported protective factors are the presence of a witnessing physician&#44; short cardiopulmonary resuscitation times&#44; and no need for adrenalin<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a>&#46; Hypothermia was irregularly used by the different centers&#44; with criteria corresponding to those applied at the time of conception of the study and recruitment&#46; The analysis of the results suggest that this practice did not influence either mortality or the neurological status of the patients&#46; Particular mention is required of the discussion and analysis made by the authors of the role of hypothermia as part of the objectives of treatment&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">It is known that among the combined parameters affording greatest certainty&#44; mention must be made of the absence of N2O cortical waves in the short-latency somatosensory evoked potentials and ocular reflexes&#46; It is advisable to perform the neurological examination on a daily basis<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a>&#44; with significance being established from 72<span class="elsevierStyleHsp" style=""></span>h after the event or from the recovery of normothermia&#44; once other confounding factors such as residual sedation or the use of muscle relaxants have been discarded&#46; Their presence may make it advisable to prolong the analysis for several days&#59; the required study period cannot be determined on a general basis&#44; since up to 15&#8211;20&#37; of all patients may be late awakeners&#44; requiring periods that can reach 10&#8211;12 days<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">5&#44;9</span></a>&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">The most influential exploratory signs are the bilateral absence of corneal and pupil reflexes<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a>&#44; and a motor score of under 2 on the Glasgow scale&#46; These data prove more specific when combined with others such as continuous and persistent myoclonus lasting over 30<span class="elsevierStyleHsp" style=""></span>min within the first 48<span class="elsevierStyleHsp" style=""></span>h&#59; an isoelectric electroencephalographic tracing of low voltage &#40;&#60;20<span class="elsevierStyleHsp" style=""></span>&#956;V&#41;&#44; or burst suppression with generalized epileptiform activity<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a>&#59; or elevation of serum biomarkers such as neuron specific enolase at 48<span class="elsevierStyleHsp" style=""></span>h&#44; S-100B&#44; microRNA and tau protein &#8211; with no exact defined threshold according to the current recommendations&#46; Lastly&#44; mention must be made of the neuroimaging techniques such as brain computed tomography&#44; which evidences brain edema&#44; though with no consensus on how to apply these findings&#59; and brain magnetic resonance imaging between the second and seventh day<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a>&#44; showing hyperintense areas in diffusion weighted imaging&#46; These techniques are all used in combination with other predictors&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">The fact is that the availability of reliable predictors is very important in order to establish a prognosis as objective as possible and thus facilitate shared decision making&#44; with the generation of information that is so necessary for the healthcare providers and is so demanded by the patient representatives&#46; It is known that most deaths caused by post-cardiac arrest hypoxic-ischemic encephalopathy are secondary to the suspension of life support measures once a negative prognosis has been established<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">8&#44;9</span></a>&#46; We therefore need to optimize the specificity of the prognostic predictors&#44; as this will help to avoid self-fulfilling predictions&#59; in this regard&#44; a multimodal approach is currently recommended&#44; with the combination of different predictors<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a>&#46; This strategy and monitoring of the outcomes over the long term will probably serve to improve our understanding of this serious clinical condition and its prognosis&#46;</p></span>"
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Editorial
Prognostic factors of neurological outcome after cardiac arrest
Factores pronósticos de resultado neurológico tras un paro cardíaco
A. Canabal Berlanga
Hospital Universitario de la Princesa, Madrid, Spain
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The Spanish multicenter study on cardiac arrest published by Loza et al&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> within the context of the Cardiological Intensive Care and Cardiopulmonary Resuscitation Working Group has been of considerable interest to us&#46; Among other reasons&#44; the study is notorious because it involves an important number of care units throughout Spain&#44; and provides information corresponding to a 12-month follow-up period&#44; which is longer than usually reported in the literature&#46; This aspect of the study deserves to be highlighted&#44; since a prolonged period of time is needed to assess the outcome of the neurological damage of hypoxic&#8211;ischemic encephalopathy&#44; and the reported mortality and functional status results assessed by means of the Barthel score at 12 months are worthy of the best of healthcare systems&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">The main results of the study point to older age&#44; non-cardiac causes of arrest&#44; and a return to spontaneous circulation of over 20<span class="elsevierStyleHsp" style=""></span>min as severity predictors&#44; while the presence of defibrillable rhythms<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> and coronary revascularization are established as protective factors&#46; Other reported protective factors are the presence of a witnessing physician&#44; short cardiopulmonary resuscitation times&#44; and no need for adrenalin<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a>&#46; Hypothermia was irregularly used by the different centers&#44; with criteria corresponding to those applied at the time of conception of the study and recruitment&#46; The analysis of the results suggest that this practice did not influence either mortality or the neurological status of the patients&#46; Particular mention is required of the discussion and analysis made by the authors of the role of hypothermia as part of the objectives of treatment&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">It is known that among the combined parameters affording greatest certainty&#44; mention must be made of the absence of N2O cortical waves in the short-latency somatosensory evoked potentials and ocular reflexes&#46; It is advisable to perform the neurological examination on a daily basis<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a>&#44; with significance being established from 72<span class="elsevierStyleHsp" style=""></span>h after the event or from the recovery of normothermia&#44; once other confounding factors such as residual sedation or the use of muscle relaxants have been discarded&#46; Their presence may make it advisable to prolong the analysis for several days&#59; the required study period cannot be determined on a general basis&#44; since up to 15&#8211;20&#37; of all patients may be late awakeners&#44; requiring periods that can reach 10&#8211;12 days<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">5&#44;9</span></a>&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">The most influential exploratory signs are the bilateral absence of corneal and pupil reflexes<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a>&#44; and a motor score of under 2 on the Glasgow scale&#46; These data prove more specific when combined with others such as continuous and persistent myoclonus lasting over 30<span class="elsevierStyleHsp" style=""></span>min within the first 48<span class="elsevierStyleHsp" style=""></span>h&#59; an isoelectric electroencephalographic tracing of low voltage &#40;&#60;20<span class="elsevierStyleHsp" style=""></span>&#956;V&#41;&#44; or burst suppression with generalized epileptiform activity<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a>&#59; or elevation of serum biomarkers such as neuron specific enolase at 48<span class="elsevierStyleHsp" style=""></span>h&#44; S-100B&#44; microRNA and tau protein &#8211; with no exact defined threshold according to the current recommendations&#46; Lastly&#44; mention must be made of the neuroimaging techniques such as brain computed tomography&#44; which evidences brain edema&#44; though with no consensus on how to apply these findings&#59; and brain magnetic resonance imaging between the second and seventh day<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a>&#44; showing hyperintense areas in diffusion weighted imaging&#46; These techniques are all used in combination with other predictors&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">The fact is that the availability of reliable predictors is very important in order to establish a prognosis as objective as possible and thus facilitate shared decision making&#44; with the generation of information that is so necessary for the healthcare providers and is so demanded by the patient representatives&#46; It is known that most deaths caused by post-cardiac arrest hypoxic-ischemic encephalopathy are secondary to the suspension of life support measures once a negative prognosis has been established<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">8&#44;9</span></a>&#46; We therefore need to optimize the specificity of the prognostic predictors&#44; as this will help to avoid self-fulfilling predictions&#59; in this regard&#44; a multimodal approach is currently recommended&#44; with the combination of different predictors<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a>&#46; This strategy and monitoring of the outcomes over the long term will probably serve to improve our understanding of this serious clinical condition and its prognosis&#46;</p></span>"
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ISSN: 21735727
Original language: English
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