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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Introduction</span><p id="par0115" class="elsevierStylePara elsevierViewall">Cardiac arrest &#40;CA&#41; with cerebral ischemia can lead to severe neurological damage and death&#46; The survival rate of out-of-hospital CA is reported to be 2-11&#37;&#44; rising to 20-40&#37; in witnessed ventricular fibrillation &#40;VF&#41; cases&#46;<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">1&#8211;3</span></a></p><p id="par0120" class="elsevierStylePara elsevierViewall">Induced hypothermia has been employed as a therapeutic approach for CA survivors and other critically ill patients for decades&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">4</span></a> Two randomized controlled trials published in 2002 reported a dramatic improvement in survival and neurological outcome for comatose survivors of out-of-hospital VF CA with therapeutic hypothermia &#40;TH&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">5&#44;6</span></a></p><p id="par0125" class="elsevierStylePara elsevierViewall">TH &#40;32<span class="elsevierStyleHsp" style=""></span>&#176;C-34<span class="elsevierStyleHsp" style=""></span>&#176;C for 12-24 hours&#41; has been the standard of care for patients remaining comatose after resuscitation&#46;<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">7&#44;8</span></a> A recent randomized trial found a similar outcome in patients treated with targeted temperature management at either 33<span class="elsevierStyleHsp" style=""></span>&#176;C or 36<span class="elsevierStyleHsp" style=""></span>&#176;C&#44;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">9</span></a> prompting the International Liaison Committee on Resuscitation &#40;ILCOR&#41; Advanced Life Support &#40;ALS&#41; Task Force to perform a systematic review&#46;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">10</span></a> Currently&#44; a constant temperature between 32<span class="elsevierStyleHsp" style=""></span>&#176;C and 36<span class="elsevierStyleHsp" style=""></span>&#176;C for at least 24 hours is the recommended targeted temperature management for adults following out-of-hospital CA with an initial shockable rhythm and&#44; with a lower level of evidence&#44; for out-of-hospital CA with a non-shockable rhythm and in-hospital CA&#46;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">11</span></a></p><p id="par0130" class="elsevierStylePara elsevierViewall">The aim of this retrospective analysis was to describe the initial experience of a non-tertiary care center and to determine predictors of mortality and neurological outcome at discharge for CA patients treated with TH&#44; focusing on a combination of initial rhythm&#44; time to return of spontaneous circulation &#40;ROSC&#41; and laboratory biomarkers&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Design and setting</span><p id="par0135" class="elsevierStylePara elsevierViewall">We performed a retrospective review of consecutive patients who suffered CA admitted between January 1&#44; 2011 and December 31&#44; 2014 to the intensive care unit &#40;ICU&#41; at a non-tertiary care center&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Inclusion and exclusion criteria</span><p id="par0140" class="elsevierStylePara elsevierViewall">We studied comatose adults &#40;unable to follow verbal commands after ROSC&#41; aged &#8805;18 years admitted to the ICU with ROSC after in-hospital or out-of-hospital CA who were treated by TH&#46; Patients without known time of CA&#44; in a comatose state before CA&#44; or with a terminal illness that preceded CA were excluded&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Therapeutic hypothermia technique</span><p id="par0145" class="elsevierStylePara elsevierViewall">Patients treated by TH were cooled to a target temperature of 33<span class="elsevierStyleHsp" style=""></span>&#176;C with a combination of core-cooling and surface-cooling methods&#46; By protocol 30 ml of cold &#40;4<span class="elsevierStyleHsp" style=""></span>&#176;C&#41; lactated Ringer&#39;s solution per kg was administered intravenously over 30 min&#46; An external cooling device&#44; Arctic Sun<span class="elsevierStyleSup">&#174;</span>&#44; was also used&#46; This is a targeted temperature management system that uses chilled water circulating in gel-coated pads to maintain body temperature in the desired range&#46; An esophageal probe was used to monitor core temperature&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">All patients underwent three phases of TH&#58; a fast induction phase to 33<span class="elsevierStyleHsp" style=""></span>&#176;C&#59; a maintenance phase for 24 hours at 33<span class="elsevierStyleHsp" style=""></span>&#176;C&#59; and a rewarming phase of about 0&#46;25<span class="elsevierStyleHsp" style=""></span>&#176;C of warming per hour until 36<span class="elsevierStyleHsp" style=""></span>&#176;C&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Data collection and definitions</span><p id="par0155" class="elsevierStylePara elsevierViewall">The following baseline characteristics were collected from patients&#8217; medical records&#58; demographic data&#59; cardiovascular risk factors&#59; place and initial rhythm of CA&#59; time from collapse to cardiopulmonary resuscitation &#40;CPR&#41;&#44; to ROSC and to TH&#59; admission data including Glasgow Coma Scale &#40;GCS&#41; score and laboratory tests including levels of neuron-specific enolase &#40;NSE&#41;&#44; the gamma isomer of enolase expressed mainly in neurons and neuroectodermal cells&#44; measured within 72 hours of CA&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">Bedside focused transthoracic echocardiography &#40;TTE&#41; and cranial computed tomography &#40;CT&#41; were performed within 24 hours of admission&#46; Coronary angiography was performed before TH&#46; Etiological diagnosis of CA was determined according to the current European Society of Cardiology guidelines&#46;<a class="elsevierStyleCrossRefs" href="#bib0240"><span class="elsevierStyleSup">12&#8211;15</span></a></p><p id="par0165" class="elsevierStylePara elsevierViewall">CA was defined as receipt of chest compressions for pulselessness as determined by a healthcare provider&#46; The first monitored rhythm was recorded as the initial rhythm of CA&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">An initial neurological assessment and GCS score at admission were obtained&#44; in order to identify comatose patients&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Outcome measures</span><p id="par0175" class="elsevierStylePara elsevierViewall">In-hospital mortality and Cerebral Performance Category &#40;CPC&#41; were assessed at ICU discharge&#44; hospital discharge and at six months after discharge&#46; Adverse events and length of ICU and hospital stay were assessed&#46; Statistical analyses were performed in order to determine predictors of outcome&#46;</p><p id="par0180" class="elsevierStylePara elsevierViewall">CPC categories were defined according to Safar<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">16</span></a> as follows&#58; CPC 1 &#8211; good cerebral performance&#59; CPC 2 &#8211; moderate cerebral disability&#59; CPC 3 &#8211; severe cerebral disability&#59; CPC 4 &#8211; coma or vegetative state&#59; CPC 5 &#8211; brain death&#46; CPC was scored based on information from hospital charts and follow-up notes&#46;</p><p id="par0185" class="elsevierStylePara elsevierViewall">Adverse events reported were defined as major bleeding &#40;any intracranial bleeding or clinically overt signs of bleeding associated with a drop in hemoglobin of &#8805;5 g&#47;dl or hematocrit of &#8805;15&#37;&#44; or fatal bleeding &#8211; a bleeding event that directly led to death within seven days&#41;&#44; non-major bleeding &#40;any clinically overt sign of bleeding associated with a fall in hemoglobin of 2 to &#60;5 g&#47;dl or hematocrit of 6 to &#60;15&#37;&#41;&#44; seizures&#44; arrhythmias &#40;any documented abnormal rhythm that did not precipitate a re-arrest&#41; and re-arrest&#46; Isolated microorganisms and electrolyte and metabolic disturbances were also analyzed&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Statistical analysis</span><p id="par0190" class="elsevierStylePara elsevierViewall">The statistical analysis was performed using SPSS<span class="elsevierStyleSup">&#174;</span> software for Windows&#44; 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The mean time from CA to CPR &#40;CA-CPR&#41; was 14&#46;3&#177;12&#46;4 min&#44; minimum 1&#44; maximum 40&#59; mean time to ROSC &#40;CA-ROSC&#41; was 44&#46;7&#177;36&#46;5 min&#44; minimum 10&#44; maximum 120&#59; and mean time to TH &#40;CA-TH&#41; was 342&#177;186 min&#44; minimum 90&#44; maximum 780&#46; Mean GCS at admission was 5&#46;1&#177;2&#46;9&#44; median 3&#44; 25th percentile 3&#44; 75th percentile 8&#46;</p><p id="par0205" class="elsevierStylePara elsevierViewall">Bedside focused TTE was performed within 24 hours of admission in 14 patients &#40;93&#46;3&#37;&#41;&#59; eyeball left ventricular ejection fraction was estimated and was low only in the non-survival group&#46; Cranial CT was not performed systematically &#40;in only seven patients&#44; 46&#46;6&#37;&#41;&#59; all but one already had signs of hypoxic encephalopathy&#46; Emergency coronary angiography was performed in 14 &#40;93&#46;3&#37;&#41; patients&#44; all before TH&#46; During ICU stay&#44; all patients were under inotropic hemodynamic support&#46;</p><p id="par0210" class="elsevierStylePara elsevierViewall">All patients were maintained at a TH target temperature of 33<span class="elsevierStyleHsp" style=""></span>&#176;C for 24 hours&#46; During TH&#44; esophageal temperature&#44; heart rate&#44; and mean arterial blood pressure were continuously monitored and documented hourly for all patients&#46;</p><p id="par0215" class="elsevierStylePara elsevierViewall">The etiological diagnosis of CA&#44; defined according to the current European Society of Cardiology guidelines&#44;<a class="elsevierStyleCrossRefs" href="#bib0240"><span class="elsevierStyleSup">12&#8211;15</span></a> coronary angiography findings&#44; and treatment are shown in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Neurological outcome</span><p id="par0220" class="elsevierStylePara elsevierViewall">CPC was assessed at ICU discharge &#40;CPC 1 or 2 in seven patients&#44; CPC 3 in three patients&#44; CPC 5 in five patients&#41; and hospital discharge &#40;CPC 1 in seven patients&#44; CPC 5 in eight patients&#41;&#46; In-hospital mortality occurred in eight patients &#40;53&#46;3&#37;&#41; and seven patients &#40;46&#46;7&#37;&#41; were discharged with good cerebral performance&#46; At six months after hospital discharge&#44; CPC scores were the same as at discharge&#46;</p><p id="par0225" class="elsevierStylePara elsevierViewall">Cranial CT was not performed systematically after TH or at admission&#46; Of eight patients &#40;53&#46;3&#37;&#41; who underwent CT after TH&#44; five had signs of hypoxic encephalopathy and all died in-hospital&#46; Mean NSE level was 93&#46;7&#177;109&#46;0 &#956;g&#47;l&#46;</p><p id="par0230" class="elsevierStylePara elsevierViewall">Length of ICU stay was 16&#46;5&#177;24&#46;2 days and hospital stay was 22&#46;5&#177;26&#46;4 days&#46;</p><p id="par0235" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a> shows the adverse events reported during the three phases of TH&#46; As respiratory infections were frequent&#44; occurring in 13 patients &#40;86&#46;7&#37;&#41;&#44; cultures of bronchial secretions are performed in all patients&#46; <a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a> shows the microorganisms isolated in bronchial secretions&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Comparison of baseline characteristics</span><p id="par0240" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a> compares the seven patients &#40;47&#37;&#41; who survived &#40;survivor group&#41; and were discharged with CPC 1 with the eight patients &#40;53&#37;&#41; who died in-hospital &#40;non-survivor group&#41;&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><p id="par0245" class="elsevierStylePara elsevierViewall">No differences were found between the groups regarding gender &#40;male&#58; 71&#46;4&#37; vs&#46; 62&#46;5&#37;&#59; p&#61;0&#46;724&#41;&#44; history of hypertension &#40;28&#46;6&#37; vs&#46; 50&#46;0&#37;&#59; p&#61;0&#46;414&#41;&#44; diabetes &#40;0&#46;0&#37; vs&#46; 37&#46;5&#37;&#59; p&#61;0&#46;080&#41;&#59; dyslipidemia &#40;28&#46;6&#37; vs&#46; 37&#46;5&#37;&#59; p&#61;0&#46;724&#41;&#44; active smoking &#40;28&#46;6&#37; vs&#46; 50&#46;0&#37;&#59; p&#61;0&#46;414&#41;&#44; or overweight or obesity &#40;0&#46;0&#37; vs&#46; 25&#46;0&#37;&#59; p&#61;0&#46;170&#41;&#46; The location of CA was similar &#40;out-of-hospital&#58; 71&#46;4&#37; vs&#46; 75&#46;0&#37;&#59; p&#61;0&#46;880&#41;&#46; Although an initial VF rhythm was more frequent in survivors in this small group of patients&#44; there was no statistical difference between the groups &#40;85&#46;7&#37; vs&#46; 50&#46;0&#37;&#59; p&#61;0&#46;157&#41;&#46;</p><p id="par0250" class="elsevierStylePara elsevierViewall">Patients who survived were a mean of 16&#46;7 years younger than those who died &#40;38&#46;4 vs&#46; 55&#46;1 years&#59; p&#61;0&#46;032&#41;&#44; had shorter CA-ROSC &#40;22&#46;9 vs&#46; 63&#46;8 min&#59; p&#61;0&#46;048&#41; and lower NSE values &#40;42&#46;6 vs&#46; 138&#46;4 &#956;g&#47;l&#59; p&#61;0&#46;020&#41;&#46;</p><p id="par0255" class="elsevierStylePara elsevierViewall">To analyze the clinical predictors for survival&#44; the cut-off values were calculated on the basis of the 50th percentile&#46; Age &#62;48 years was a strong predictor of survival &#40;OR&#58; 18&#46;00&#59; 95&#37; CI&#58; 1&#46;27-255&#46;74&#59; p&#61;0&#46;023&#41;&#46; Approaching borderline statistical significance as predictors of mortality were presence of cardiovascular risk factors &#40;OR&#58; 9&#46;33&#59; 95&#37; CI&#58; 0&#46;711-122&#46;57&#59; p&#61;0&#46;077&#41;&#44; CA-ROSC &#62;35 min &#40;OR&#58; 4&#46;17&#59; 95&#37; CI&#58; 0&#46;47-36&#46;74&#59; p&#61;0&#46;082&#41; and NSE &#62;76 &#956;g&#47;l &#40;OR&#58; 7&#46;50&#59; 95&#37; CI&#58; 0&#46;76-74&#46;16&#59; p&#61;0&#46;082&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0025">Table 5</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0025"></elsevierMultimedia></span></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Discussion</span><p id="par0260" class="elsevierStylePara elsevierViewall">Within the last decade outcomes after CA have improved&#44; thanks to a combination of various measures&#46; TH has shown benefit&#44; however specific predictors of outcome in hypothermia-treated CA patients are missing&#46;</p><p id="par0265" class="elsevierStylePara elsevierViewall">In our study we used a target temperature of 33<span class="elsevierStyleHsp" style=""></span>&#176;C in all patients&#44; as further evidence has supported the findings of Holzer et al&#46; and Bernard et al&#46;<a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">5&#44;6</span></a> However&#44; a recent international randomized controlled trial by Nielsen et al&#46;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">9</span></a> completely contradicts the findings of all previous studies&#46; They reported no significant difference in outcome between out-of-hospital CA patients treated with hypothermia at target temperatures of 33<span class="elsevierStyleHsp" style=""></span>&#176;C or 36<span class="elsevierStyleHsp" style=""></span>&#176;C&#46; New guidelines have established targeted temperature management at a constant temperature between 32<span class="elsevierStyleHsp" style=""></span>&#176;C and 36<span class="elsevierStyleHsp" style=""></span>&#176;C for at least 24 hours&#46;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">11</span></a> They state that the terms &#8220;target temperature management&#8221; or &#8220;temperature control&#8221; are now preferred over the previous term &#8220;therapeutic hypothermia&#8221; and that a priority in temperature control should be to avoid hyperthermia&#46; Nevertheless&#44; it is clear that weak recommendations and low-quality evidence in some points suggest that doubts remain and that further large high-quality trials are needed&#46;</p><p id="par0270" class="elsevierStylePara elsevierViewall">Post-cardiac arrest syndrome in patients who remain comatose after CA is a complex set of pathophysiological processes consisting of systemic ischemia-reperfusion injury&#44; brain injury&#44; and myocardial depression&#44; as well as ongoing injury caused by the precipitating etiology of the arrest&#46;<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">17</span></a> In this field TH has been the cornerstone in neurological improvement&#46; In this study we investigated mortality&#44; neurological outcome and possible predictors of poor outcome&#46; Our overall survival to discharge was 47&#37;&#44; with all patients surviving to discharge having a good neurological outcome&#44; defined as a CPC of 1&#46; In the first two major clinical trials that provided direct evidence of a benefit of TH&#44; 49&#37; and 55&#37;&#44; respectively&#44; who were treated with hypothermia survived and had a favorable neurological recovery at hospital discharge&#46;<a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">5&#44;6</span></a></p><p id="par0275" class="elsevierStylePara elsevierViewall">Assessment of neurological function and prognosis is challenging in patients undergoing TH and some authors suggest a multimodal approach based on neurological examination&#44; continuous electroencephalographic monitoring&#44; somatosensory-evoked potential&#44; magnetic resonance and CT imaging and serum markers of neuronal damage&#46;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">18</span></a></p><p id="par0280" class="elsevierStylePara elsevierViewall">An early CT scan is commonly used to rule out an unexpected intracerebral cause of coma in patients who remain comatose after cardiac arrest&#44; and CT after TH gives important information about neurological outcome and longtime survival&#46;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">18</span></a> In the current series CT was not routinely performed at admission&#44; or after TH as a prognostic tool&#46; In those who underwent CT after TH&#44; cerebral edema and hypoxic encephalopathy were associated with a poor outcome&#46; Current resuscitation guidelines recognize echocardiography as a valuable diagnostic tool in the early identification of the precipitating cause of CA&#44;<a class="elsevierStyleCrossRefs" href="#bib0235"><span class="elsevierStyleSup">11&#44;19</span></a> which is why it was performed in all except one of our patients in the after-arrest setting&#46; However the exam was a point-of-care focused study&#44; with non-standard echocardiographic views&#44; in patients under mechanical ventilation and inotropic support&#46; This limited approach could have led to important findings being missed or misinterpreted&#44; particularly with left ventricular ejection fraction being overestimated due to inotropic support leading to myocardial hypercontractility&#46;</p><p id="par0285" class="elsevierStylePara elsevierViewall">Various interesting biomarkers for prognosis after CA have been studied&#44; including S100B protein&#44;<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">20</span></a> glial fibrillary acidic protein&#44; neurofilaments&#44; and organ-specific micro-RNA&#46;<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">21</span></a> The most extensively studied biomarker is NSE&#46; A large Dutch study&#44; prior to the era of TH&#44; identified an NSE value &#62;33 &#956;g&#47;l within 72 hours of CA as a reliable marker for poor outcome&#46;<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">22</span></a> While some recent studies have questioned the value of NSE for prognostication in hypothermia-treated patients and consider it insufficiently predictive&#44;<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">23</span></a> other studies support its use&#46;<a class="elsevierStyleCrossRefs" href="#bib0300"><span class="elsevierStyleSup">24&#44;25</span></a> Cut-off points for predicting a poor outcome with no false positives vary greatly &#40;from 9 to 97 &#956;g&#47;l&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">26</span></a> Studies testing NSE as a predictor of poor outcome in comatose patients after CA treated with TH have reported cut-off values at 48 hours of 28 ng&#47;ml and 33 ng&#47;ml&#46;<a class="elsevierStyleCrossRefs" href="#bib0300"><span class="elsevierStyleSup">24&#44;25</span></a> In our population&#44; NSE levels were 95&#46;8 &#956;g&#47;l higher in those who died &#40;42&#46;6&#177;35&#46;1 vs&#46; 138&#46;4&#177;133&#46;4 &#956;g&#47;l&#44; p&#61;0&#46;020&#41;&#46; An NSE cut-off of 76 &#956;g&#47;l appears to separate the two groups at close to statistical significance&#46; This cut-off&#44; higher than in previous studies&#44; could be explained by differences in assay procedures and time of blood sampling &#40;in our study within 72 hours&#41;&#46; If only NSE values within the first 48 hours are considered&#44; the mean is 44&#46;2 &#956;g&#47;l&#44; approaching those in previous studies&#46; When and how to prognosticate&#44; in particular which biomarkers should be used&#44; is a question that requires more data&#46; Furthermore&#44; any specific absolute cut-off value proposed to provide neuroprognostication should only be used in conjunction with other prognostic variables&#46;</p><p id="par0290" class="elsevierStylePara elsevierViewall">N-terminal pro-B-type natriuretic peptide &#40;NT-proBNP&#41; and troponin I have been shown to be important biomarker predictors for death in CA patients&#46;<a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">27</span></a> In our study higher B-type natriuretic peptide &#40;BNP&#41; &#40;339&#46;6&#177;401&#46;2 vs&#46; 479&#46;7&#177;365&#46;4 pg&#47;ml&#44; p&#61;NS&#41; and peak troponin I &#40;16&#46;5&#177;24&#46;8 vs&#46; 56&#46;8&#177;47&#46;1 ng&#47;ml&#44; p&#61;NS&#41; were found in the non-survivor group&#44; but without statistical significance&#44; due to the small number of patients enrolled&#46;</p><p id="par0295" class="elsevierStylePara elsevierViewall">In our results gender&#44; GCS&#44; and location and initial rhythm of CA were not predictors of mortality&#46; While some studies show female gender as an independent predictor for both less use of TH and poor outcome in patients with a shockable rhythm&#44;<a class="elsevierStyleCrossRef" href="#bib0320"><span class="elsevierStyleSup">28</span></a> others identify female gender as a positive predictor for survival to hospital arrival after an out-of-hospital CA&#44; despite worse survival to hospital discharge&#46;<a class="elsevierStyleCrossRef" href="#bib0325"><span class="elsevierStyleSup">29</span></a> The abnormal distribution of GCS scores in our study&#44; with a median of 3&#44; meant it had no influence on mortality&#44; in contrast to other studies in which one of the best predictors was low GCS at admission&#46;<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">30</span></a> Although in-hospital CA has a weaker recommendation to use TH&#44;<a class="elsevierStyleCrossRefs" href="#bib0230"><span class="elsevierStyleSup">10&#44;11</span></a> in our study&#44; as well as in another Portuguese study&#44;<a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">31</span></a> there was no difference in survival between in-hospital and out-of-hospital CA&#46; One of the reasons for this could be less effective prehospital care affecting in-hospital mortality&#46;</p><p id="par0300" class="elsevierStylePara elsevierViewall">A Scandinavian registry enrolling 986 patients reported 61&#37; survival in the witnessed ventricular tachycardia&#47;VF arrest group and 56&#37; good neurological outcome&#46;<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">30</span></a> Consistent with these findings&#44; we report 66&#46;7&#37; &#40;n&#61;10&#41; of patients with shockable initial rhythm and overall survival with a good neurological outcome in 60&#37; &#40;n&#61;4&#41; of these&#46; These data highlight the expected survival rate and hence the superior impact of TH for these patients compared with those with a non-shockable CA rhythm&#46; There are multiple causes of CA due to asystole and pulseless electrical activity&#44; and the underlying medical problems are more difficult to treat&#46; In this context&#44; some authors have found that hypothermia was not of benefit in terms of survival or good neurological outcome if the CA was related to a non-shockable rhythm&#46;<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">32</span></a> Others have concluded that a positive impact on survival is likely&#46;<a class="elsevierStyleCrossRef" href="#bib0345"><span class="elsevierStyleSup">33</span></a> It is still unclear whether TH benefits non-shockable victims if the pathophysiology of cerebral metabolism and dysfunction is different or if a different target temperature is needed in such patients&#46;</p><p id="par0305" class="elsevierStylePara elsevierViewall">Patients who survived in our study were a mean of 16&#46;7 years younger than those who died and patients aged over 48 years had a markedly poorer outcome&#46; Older age remains a negative predictor for TH use<a class="elsevierStyleCrossRef" href="#bib0320"><span class="elsevierStyleSup">28</span></a> as well as predicting worse survival&#46;<a class="elsevierStyleCrossRefs" href="#bib0320"><span class="elsevierStyleSup">28&#44;30</span></a> Advanced age is a common reason for withholding TH in unconscious out-of-hospital CA patients&#46;<a class="elsevierStyleCrossRef" href="#bib0350"><span class="elsevierStyleSup">34</span></a></p><p id="par0310" class="elsevierStylePara elsevierViewall">Emergency coronary angiography giving an opportunity for emergency percutaneous coronary intervention &#40;PCI&#41; is an established and widely implemented first-line treatment in patients with ST-segment elevation myocardial infarction &#40;STEMI&#41; complicated with CA&#46;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">12</span></a> However&#44; it remains unclear whether an early invasive strategy is beneficial in all comatose survivors of CA&#46; Selection of patients with a high likelihood of coronary artery disease may be challenging&#46; In our study&#44; all but one patients &#40;n&#61;14&#59; 93&#46;3&#37;&#41; received emergency coronary angiography and 60&#37; &#40;n&#61;9&#41; subsequently received PCI&#46; Despite this&#44; we consider that the benefits &#40;marginal in many cases&#41; and potential procedure-related complications of emergency coronary angiography and emergency PCI in comatose patients should be balanced against those of a less invasive strategy&#46;</p><p id="par0315" class="elsevierStylePara elsevierViewall">Although in our population coronary angiography and PCI were performed before TH&#44; most centers combine early PCI with simultaneous initiation of TH&#44; which has also been shown to be feasible without increasing door-to-balloon time&#46; It seems reasonable that hypothermia should be initiated as early as possible&#44; however there is a study showing that later initiation of cooling is still effective in mitigating neuronal damage&#46;<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">30</span></a> The mean CA-TH in this study &#40;90 min&#41; was considerably shorter than in ours &#40;342 min&#41;&#44; showing how much our performance could be improved&#46; In fact&#44; the technique of TH requires a learning period and specific skills&#46; Although time is crucial at every step of the process&#44; in our study there was no difference in CA-TH between survivor and non-survivor groups &#40;348&#177;138 vs&#46; 336&#177;234 min&#44; p&#61;NS&#41;&#46; Our findings are similar to those of the Hypothermia After Cardiac Arrest &#40;HACA&#41; study&#44; in which the median interval between ROSC and target temperature was eight hours &#40;480 min&#41;&#44;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">5</span></a> due to rapid induction of TH&#46;</p><p id="par0320" class="elsevierStylePara elsevierViewall">Comatose CA patients are admitted to the ICU with a broad range of baseline probability of survival&#44; mainly due to differences in resuscitation times&#46; The time from collapse to ROSC is an important predictor of survival&#44; as confirmed by our results&#44; in which this was a mean of 40&#46;9 min longer in those who died and a cut-off of 35 min approached statistical significance to differentiate the two groups&#46; The cut-offs are not very different in other studies&#44; in which the outcome for patients with time to ROSC of over 30 min &#40;after calling for an ambulance&#41; is dismal<a class="elsevierStyleCrossRef" href="#bib0355"><span class="elsevierStyleSup">35</span></a> and time from collapse to ROSC of over 25 min is strongly associated with poor outcome&#46;<a class="elsevierStyleCrossRef" href="#bib0360"><span class="elsevierStyleSup">36</span></a> Although longer time to ROSC was a predictor of poor outcome&#44; on the basis of absolute numbers it could not be used as a sole predictor of outcome&#44; and other factors such as the quality of CPR may be equally important&#46;</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Limitations</span><p id="par0325" class="elsevierStylePara elsevierViewall">Certain limitations to our retrospective&#44; registry-based study should be recognized&#46;</p><p id="par0330" class="elsevierStylePara elsevierViewall">First of all&#44; the small sample size may limit the analysis&#44; which is clearly underpowered to assess major differences&#46; However this is the largest series so far published in the Portuguese population after the implementation of TH and the patient characteristics are similar to previous reports&#46;</p><p id="par0335" class="elsevierStylePara elsevierViewall">The overall low use of objective prognostic tools in our patient group was in agreement with common practice in the ICU at the time of the study&#46;</p><p id="par0340" class="elsevierStylePara elsevierViewall">Finally&#44; we studied patients from a single center&#44; and therefore the generalizability of our results to other centers may be questioned&#46;</p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Conclusions</span><p id="par0345" class="elsevierStylePara elsevierViewall">The high morbidity and mortality associated with CA means the recommendations in this article should be viewed in light of the very poor prognosis in CA patients&#46; Due to the complexity and heterogeneity of these patients&#44; performing well-controlled randomized trials is a challenge&#44; and thus there are very few proven interventions&#46; Our study results support the findings of prior studies conducted on TH-treated CA patients&#58; 53&#37; of all patients died and 47&#37; of all patients were discharged with a favorable outcome&#46; Predictors for death were higher age&#44; previous cardiovascular risk factors&#44; longer CA-ROSC and higher NSE levels at admission&#59; a relation between shockable rhythm or out-of-hospital CA and mortality was not fully documented&#46;</p><p id="par0350" class="elsevierStylePara elsevierViewall">Several questions remain unanswered&#58; the optimal time to begin TH&#59; the target temperature and duration of TH&#59; the best local cooling practices&#59; the effect of rewarming rate&#59; and the possibility that some subgroups of patients may benefit from a specific target temperature&#46;</p><p id="par0355" class="elsevierStylePara elsevierViewall">No single test can predict a poor prognosis with absolute certainty and it will be difficult to establish cut-off values supporting the decision whether to induce hypothermia&#46; Furthermore&#44; the use of TH may complicate assessment of the neurological outcome&#46; The optimal approach to prognosticate CA patients treated with TH has not been fully resolved&#46; This is an issue of central importance&#44; since it can be ethically justifiable to limit care or withdraw support only when a poor prognosis is reasonably certain&#46;</p></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0145">Ethical disclosures</span><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0150">Protection of human and animal subjects</span><p id="par0360" class="elsevierStylePara elsevierViewall">The authors declare that the procedures followed were in accordance with the regulations of the relevant clinical research ethics committee and with those of the Code of Ethics of the World Medical Association &#40;Declaration of Helsinki&#41;&#46;</p></span><span id="sec0090" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0155">Confidentiality of data</span><p id="par0365" class="elsevierStylePara elsevierViewall">The authors declare that they have followed the protocols of their work center on the publication of patient data&#46;</p></span><span id="sec0095" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0160">Right of privacy and informed consent</span><p id="par0370" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this article&#46;</p></span></span><span id="sec0100" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0165">Conflicts of interest</span><p id="par0375" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
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              "identificador" => "sec0050"
              "titulo" => "Patient population"
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              "identificador" => "sec0055"
              "titulo" => "Neurological outcome"
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              "identificador" => "sec0060"
              "titulo" => "Comparison of baseline characteristics"
            ]
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          "identificador" => "sec0065"
          "titulo" => "Discussion"
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        8 => array:2 [
          "identificador" => "sec0070"
          "titulo" => "Limitations"
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          "titulo" => "Conclusions"
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          "titulo" => "Ethical disclosures"
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            0 => array:2 [
              "identificador" => "sec0085"
              "titulo" => "Protection of human and animal subjects"
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            1 => array:2 [
              "identificador" => "sec0090"
              "titulo" => "Confidentiality of data"
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              "identificador" => "sec0095"
              "titulo" => "Right of privacy and informed consent"
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          "identificador" => "sec0100"
          "titulo" => "Conflicts of interest"
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        12 => array:1 [
          "titulo" => "References"
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    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2015-11-17"
    "fechaAceptado" => "2016-03-08"
    "PalabrasClave" => array:2 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec821795"
          "palabras" => array:3 [
            0 => "Therapeutic hypothermia"
            1 => "Cardiac arrest"
            2 => "Neuron-specific enolase"
          ]
        ]
      ]
      "pt" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palavras-chave"
          "identificador" => "xpalclavsec821796"
          "palabras" => array:3 [
            0 => "Hipotermia terap&#234;utica"
            1 => "Paragem card&#237;aca"
            2 => "Enolase espec&#237;fica dos neur&#243;nios"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction and Objectives</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Therapeutic hypothermia &#40;TH&#41; is recommended for patients with return of spontaneous circulation &#40;ROSC&#41; after cardiac arrest &#40;CA&#41;&#46; There is still uncertainty about management&#44; target temperature and duration of TH&#46; In the present study we aim to describe the initial experience of a non-tertiary care center with TH after CA and to determine predictors of mortality&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">During the period 2011-2014&#44; out of 2279 patients hospitalized in the intensive care unit&#44; 82 had a diagnosis of CA with ROSC&#46; We determined predictors of mortality and neurological outcome in comatose patients with ROSC after CA treated by TH&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">A total of 15 patients were included&#44; mean age 47&#46;3&#177;14 years&#44; 10 &#40;67&#46;0&#37;&#41; male&#46; CA occurred out-of-hospital &#40;n&#61;11&#59; 73&#46;3&#37;&#41; or in-hospital &#40;n&#61;4&#59; 26&#46;7&#37;&#41;&#44; in initial shockable &#40;n&#61;10&#59; 66&#46;7&#37;&#41; or non-shockable &#40;n&#61;5&#44; 33&#46;3&#37;&#41; rhythm&#46; The mean time from CA to ROSC &#40;CA-ROSC&#41; was 44&#46;7&#177;36&#46;5 min&#46; All patients met the 24-hour TH target temperature of 33<span class="elsevierStyleHsp" style=""></span>&#176;C&#46; The mean neuron-specific enolase &#40;NSE&#41; level was 93&#46;7&#177;109&#46;0 &#956;g&#47;l&#46; Seven patients &#40;46&#46;7&#37;&#41; were discharged with good cerebral performance and eight &#40;53&#46;3&#37;&#41; died&#46; Patients who survived had lower median age &#40;p&#61;0&#46;032&#41;&#44; shorter CA-ROSC &#40;p&#61;0&#46;048&#41;&#44; lower NSE levels &#40;p&#61;0&#46;020&#41; and initial ventricular fibrillation rhythm &#40;p&#61;NS&#41;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">The effectiveness of TH appears to be related to younger age&#44; shockable initial rhythm and shorter CA-ROSC time&#46; This results indicates some lines of inquiry that should be developed in appropriate prospective studies&#46; The role of biomarkers as predictors of prognosis is an open question&#44; with NSE potentially playing an important role&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Introduction and Objectives"
          ]
          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Methods"
          ]
          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Results"
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          3 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Conclusions"
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      ]
      "pt" => array:3 [
        "titulo" => "Resumo"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introdu&#231;&#227;o e objetivos</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">A Hipotermia Terap&#234;utica &#40;HT&#41; &#233; recomendada em doentes com recupera&#231;&#227;o da circula&#231;&#227;o espont&#226;nea &#40;ROSC&#41; ap&#243;s paragem card&#237;aca &#40;PC&#41;&#46; D&#250;vidas persistem sobre a melhor abordagem&#44; a temperatura alvo e a dura&#231;&#227;o da t&#233;cnica&#46; Neste estudo descrevemos a experi&#234;ncia inicial de um centro n&#227;o-terci&#225;rio com HT ap&#243;s PC e procuramos preditores de mortalidade&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Durante os anos de 2011-2014&#44; dos 2279 doentes hospitalizados na unidade de cuidados intensivos&#44; 68 tinham diagn&#243;stico de PC com ROSC&#46; Determin&#225;mos preditores de mortalidade e progn&#243;stico neurol&#243;gico nos doentes comatosos com ROSC ap&#243;s PC&#44; submetidos a HT&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Quinze doentes&#44; 47&#44;3&#177;14 anos&#44; dez &#40;67&#44;0&#37;&#41; do sexo masculino&#46; A PC ocorreu extra &#40;n&#61;11&#59; 73&#44;3&#37;&#41; ou intra-hospitalar &#40;n&#61;4&#59; 26&#44;7&#37;&#41;&#44; em ritmo card&#237;aco inicial desfibrilh&#225;vel &#40;n&#61;10&#59; 66&#44;7&#37;&#41; ou n&#227;o-desfibrilh&#225;vel &#40;n&#61;5&#44; 33&#44;3&#37;&#41;&#46; O tempo m&#233;dio decorrido desde a PC at&#233; &#224; ROSC &#40;PC-ROSC&#41; foi de 44&#44;7&#177;36&#44;5 min&#46; O valor m&#233;dio da enolase espec&#237;fica dos neur&#243;nios &#40;NSE&#41; foi de 93&#44;7&#177;109&#44;0 &#956;g&#47;L&#46; Sete doentes &#40;46&#44;7&#37;&#41; tiveram alta hospitalar com bom desempenho cerebral e oito doentes &#40;53&#44;3&#37;&#41; faleceram&#46; Os doentes que sobreviveram apresentavam idade m&#233;dia inferior &#40;p&#61;0&#44;032&#41;&#44; menor tempo PC-ROSC &#40;p&#61;0&#44;048&#41;&#44; doseamentos mais baixos de NSE &#40;p&#61;0&#44;020&#41; e ritmo inicial predominante de fibrilha&#231;&#227;o ventricular &#40;p&#61;NS&#41;&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclus&#245;es</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">A efic&#225;cia da HT parece relacionada com idades mais jovens&#44; ritmo inicial desfibrilh&#225;vel e tempo PC-ROSC reduzido&#46; Estes resultados apontam algumas linhas de investiga&#231;&#227;o que estudos prospetivos adequados dever&#227;o desenvolver&#46; O papel de biomarcadores preditores de progn&#243;stico &#233; um tema em aberto&#44; devendo a NSE ocupar um lugar particular neste dom&#237;nio&#46;</p></span>"
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            "titulo" => "Introdu&#231;&#227;o e objetivos"
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            "titulo" => "Resultados"
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            "titulo" => "Conclus&#245;es"
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    ]
    "nomenclatura" => array:1 [
      0 => array:3 [
        "identificador" => "nom0005"
        "titulo" => "<span class="elsevierStyleSectionTitle" id="sect0065">List of abbreviations</span>"
        "listaDefinicion" => array:1 [
          0 => array:1 [
            "definicion" => array:22 [
              0 => array:2 [
                "termino" => "ALS"
                "descripcion" => "<p id="par0005" class="elsevierStylePara elsevierViewall">advanced life support</p>"
              ]
              1 => array:2 [
                "termino" => "BNP"
                "descripcion" => "<p id="par0010" class="elsevierStylePara elsevierViewall">B-type natriuretic peptide</p>"
              ]
              2 => array:2 [
                "termino" => "CA"
                "descripcion" => "<p id="par0015" class="elsevierStylePara elsevierViewall">cardiac arrest</p>"
              ]
              3 => array:2 [
                "termino" => "CPC"
                "descripcion" => "<p id="par0020" class="elsevierStylePara elsevierViewall">Cerebral Performance Category</p>"
              ]
              4 => array:2 [
                "termino" => "CPR"
                "descripcion" => "<p id="par0025" class="elsevierStylePara elsevierViewall">cardiopulmonary resuscitation</p>"
              ]
              5 => array:2 [
                "termino" => "CT"
                "descripcion" => "<p id="par0030" class="elsevierStylePara elsevierViewall">computed tomography</p>"
              ]
              6 => array:2 [
                "termino" => "CV"
                "descripcion" => "<p id="par0035" class="elsevierStylePara elsevierViewall">cardiovascular</p>"
              ]
              7 => array:2 [
                "termino" => "EEG"
                "descripcion" => "<p id="par0040" class="elsevierStylePara elsevierViewall">electroencephalography</p>"
              ]
              8 => array:2 [
                "termino" => "GCS"
                "descripcion" => "<p id="par0045" class="elsevierStylePara elsevierViewall">Glasgow Coma Scale</p>"
              ]
              9 => array:2 [
                "termino" => "ICU"
                "descripcion" => "<p id="par0050" class="elsevierStylePara elsevierViewall">intensive care unit</p>"
              ]
              10 => array:2 [
                "termino" => "ILCOR"
                "descripcion" => "<p id="par0055" class="elsevierStylePara elsevierViewall">International Liaison Committee on Resuscitation</p>"
              ]
              11 => array:2 [
                "termino" => "NSE"
                "descripcion" => "<p id="par0060" class="elsevierStylePara elsevierViewall">neuron-specific enolase</p>"
              ]
              12 => array:2 [
                "termino" => "NT-proBNP"
                "descripcion" => "<p id="par0065" class="elsevierStylePara elsevierViewall">N-terminal pro-B-type natriuretic peptide</p>"
              ]
              13 => array:2 [
                "termino" => "PCI"
                "descripcion" => "<p id="par0070" class="elsevierStylePara elsevierViewall">percutaneous coronary intervention</p>"
              ]
              14 => array:2 [
                "termino" => "ROSC"
                "descripcion" => "<p id="par0075" class="elsevierStylePara elsevierViewall">return of spontaneous circulation</p>"
              ]
              15 => array:2 [
                "termino" => "STEMI"
                "descripcion" => "<p id="par0080" class="elsevierStylePara elsevierViewall">ST-segment elevation myocardial infarction</p>"
              ]
              16 => array:2 [
                "termino" => "TH"
                "descripcion" => "<p id="par0085" class="elsevierStylePara elsevierViewall">therapeutic hypothermia</p>"
              ]
              17 => array:2 [
                "termino" => "CA-CPR"
                "descripcion" => "<p id="par0090" class="elsevierStylePara elsevierViewall">time from collapse to cardiopulmonary resuscitation</p>"
              ]
              18 => array:2 [
                "termino" => "CA-ROSC"
                "descripcion" => "<p id="par0095" class="elsevierStylePara elsevierViewall">time from collapse to return of spontaneous circulation</p>"
              ]
              19 => array:2 [
                "termino" => "CA-TH"
                "descripcion" => "<p id="par0100" class="elsevierStylePara elsevierViewall">time from collapse to beginning of therapeutic hypothermia</p>"
              ]
              20 => array:2 [
                "termino" => "TTE"
                "descripcion" => "<p id="par0105" class="elsevierStylePara elsevierViewall">transthoracic echocardiography</p>"
              ]
              21 => array:2 [
                "termino" => "VF"
                "descripcion" => "<p id="par0110" class="elsevierStylePara elsevierViewall">ventricular fibrillation</p>"
              ]
            ]
          ]
        ]
      ]
    ]
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        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
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          "leyenda" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">ALT&#58; alanine transaminase&#59; AST&#58; aspartate transaminase&#59; BMI&#58; body mass index&#59; BNP&#58; B-type natriuretic peptide&#59; BUN&#58; blood urea nitrogen&#59; CV&#58; cardiovascular&#59; eGFR&#58; estimated glomerular filtration rate &#40;Modification of Diet in Renal Disease formula&#41;&#59; GCS&#58; Glasgow Coma Scale&#59; LV&#58; left ventricular&#59; NSE&#58; neuron-specific enolase&#59; CA-CPR&#58; time from collapse to cardiopulmonary resuscitation&#59; CA-ROSC&#58; time from collapse to return of spontaneous circulation&#59; CA-TH&#58; time from collapse to beginning of therapeutic hypothermia&#59; VF&#58; ventricular fibrillation&#46;</p>"
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                  <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" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Characteristics&#44; n &#40;&#37;&#41; or mean &#177; SD&nbsp;\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">Study population &#40;n&#61;15&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Gender</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Male&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10 &#40;66&#46;6&#37;&#41;&nbsp;\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"><span class="elsevierStyleHsp" style=""></span>Female&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5 &#40;33&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">47&#46;3&#177;14&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">CV risk factors</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Hypertension&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6 &#40;40&#46;0&#37;&#41;&nbsp;\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"><span class="elsevierStyleHsp" style=""></span>Diabetes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3 &#40;20&#46;0&#37;&#41;&nbsp;\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"><span class="elsevierStyleHsp" style=""></span>Dyslipidemia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5 &#40;33&#46;3&#37;&#41;&nbsp;\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"><span class="elsevierStyleHsp" style=""></span>Active smoking&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6 &#40;40&#46;0&#37;&#41;&nbsp;\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"><span class="elsevierStyleHsp" style=""></span>BMI &#8805;25 kg&#47;m<span class="elsevierStyleSup">2</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2 &#40;13&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Location of cardiac arrest</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Out-of-hospital&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">11 &#40;73&#46;3&#37;&#41;&nbsp;\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"><span class="elsevierStyleHsp" style=""></span>In-hospital&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4 &#40;26&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">VF rhythm at presentation</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10 &#40;66&#46;7&#37;&#41;&nbsp;\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"><span class="elsevierStyleItalic">Asystole rhythm at presentation</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5 &#40;33&#46;3&#37;&#41;&nbsp;\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"><span class="elsevierStyleItalic">CA-CPR&#44; min</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">14&#46;3&#177;12&#46;4&nbsp;\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"><span class="elsevierStyleItalic">CA-ROSC&#44; min</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">44&#46;7&#177;36&#46;5&nbsp;\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"><span class="elsevierStyleItalic">CA-TH&#44; min</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">342&#177;186&nbsp;\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"><span class="elsevierStyleItalic">GCS</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5&#46;1&#177;2&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Laboratory values</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Hemoglobin&#44; g&#47;dl<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">13&#46;5&#177;2&#46;3&nbsp;\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"><span class="elsevierStyleHsp" style=""></span>Sodium&#44; mmol&#47;l<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">139&#46;9&#177;5&#46;5&nbsp;\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"><span class="elsevierStyleHsp" style=""></span>Potassium&#44; mmol&#47;l<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&#46;8&#177;1&#46;0&nbsp;\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"><span class="elsevierStyleHsp" style=""></span>Total bilirubin&#44; &#956;mol&#47;l<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10&#46;9&#177;6&#46;9&nbsp;\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"><span class="elsevierStyleHsp" style=""></span>AST&#44; U&#47;l<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">281&#46;7&#177;335&#46;5&nbsp;\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"><span class="elsevierStyleHsp" style=""></span>ALT&#44; U&#47;l<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">171&#46;4&#177;160&#46;4&nbsp;\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"><span class="elsevierStyleHsp" style=""></span>NSE&#44; &#956;g&#47;l<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">93&#46;7&#177;109&#46;0&nbsp;\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"><span class="elsevierStyleHsp" style=""></span>Troponin I&#44; ng&#47;ml<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">38&#46;0&#177;42&#46;5&nbsp;\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"><span class="elsevierStyleHsp" style=""></span>BNP&#44; pg&#47;ml<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">415&#46;0&#177;373&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Renal function</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Creatinine&#44; mg&#47;dl<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#46;19&#177;6&#46;9&nbsp;\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"><span class="elsevierStyleHsp" style=""></span>BUN&#44; mmol&#47;l<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7&#46;0&#177;3&#46;7&nbsp;\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"><span class="elsevierStyleHsp" style=""></span>eGFR&#44; ml&#47;min&#47;1&#46;73 m<span class="elsevierStyleSup">2</span><a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">65&#46;3&#177;19&#46;2&nbsp;\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"><span class="elsevierStyleHsp" style=""></span>eGFR &#60;60 ml&#47;min&#47;1&#46;73 m<span class="elsevierStyleSup">2</span><a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6 &#40;40&#46;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">LV function</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">14 &#40;93&#46;3&#37;&#41;&nbsp;\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"><span class="elsevierStyleItalic">LV diastolic dimension&#44; mm</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">52&#177;6&#46;4&nbsp;\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"><span class="elsevierStyleItalic">LV systolic dimension&#44; mm</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">35&#177;8&#46;2&nbsp;\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"><span class="elsevierStyleItalic">LV fractional shortening&#44; &#37;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">36&#46;8&#177;3&#46;3&nbsp;\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"><span class="elsevierStyleItalic">&#8220;Eyeball&#8221; LV ejection fraction &#60;50&#37;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6 &#40;42&#46;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "leyenda" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">ARVC&#58; arrhythmogenic right ventricular cardiomyopathy&#59; HCM&#58; hypertrophic cardiomyopathy&#59; LAD&#58; left anterior descending artery&#59; LCX&#58; circumflex artery&#59; LVNC&#58; left ventricular non-compaction&#59; MI&#58; myocardial infarction&#59; PCI&#58; percutaneous coronary intervention&#46;</p>"
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                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" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Diagnosis&#44; n &#40;&#37;&#41;&nbsp;\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">Study population &#40;n&#61;15&#41;&nbsp;\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"><span class="elsevierStyleItalic">MI</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10 &#40;66&#46;6&#37;&#41;&nbsp;\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"><span class="elsevierStyleHsp" style=""></span>ST-elevation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6 &#40;40&#46;0&#37;&#41;&nbsp;\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"><span class="elsevierStyleHsp" style=""></span>Non-ST-elevation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4 &#40;26&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Cardiomyopathies</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3 &#40;20&#46;0&#37;&#41;&nbsp;\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"><span class="elsevierStyleHsp" style=""></span>ARVC&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;6&#46;7&#37;&#41;&nbsp;\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"><span class="elsevierStyleHsp" style=""></span>HCM&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;6&#46;7&#37;&#41;&nbsp;\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"><span class="elsevierStyleHsp" style=""></span>LVNC&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;6&#46;7&#37;&#41;&nbsp;\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"><span class="elsevierStyleHsp" style=""></span>Type 1 Brugada syndrome&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;6&#46;7&#37;&#41;&nbsp;\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"><span class="elsevierStyleHsp" style=""></span>Unknown diagnosis<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;6&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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            1 => array:2 [
              "tabla" => array:1 [
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                  <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" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Treatment&#44; n &#40;&#37;&#41;&nbsp;\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">Study population &#40;n&#61;15&#41;&nbsp;\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"><span class="elsevierStyleItalic">Coronary angiography</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">14 &#40;93&#46;3&#37;&#41;&nbsp;\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"><span class="elsevierStyleItalic">Normal epicardial coronary arteries</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4 &#40;28&#46;6&#37;&#41;&nbsp;\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"><span class="elsevierStyleItalic">Significant coronary angiographic lesions</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10 &#40;71&#46;4&#37;&#41;&nbsp;\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"><span class="elsevierStyleItalic">PCI</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9 &#40;60&#46;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Primary angioplasty</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6 &#40;66&#46;7&#37;&#41;&nbsp;\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"><span class="elsevierStyleHsp" style=""></span>LAD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5 &#40;83&#46;3&#37;&#41;&nbsp;\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"><span class="elsevierStyleHsp" style=""></span>LCX&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;16&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Non-primary angioplasty</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3 &#40;33&#46;3&#37;&#41;&nbsp;\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"><span class="elsevierStyleHsp" style=""></span>LAD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;66&#46;7&#37;&#41;&nbsp;\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"><span class="elsevierStyleHsp" style=""></span>LCX&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;33&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Implanted cardioverter-defibrillator</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4 &#40;26&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Etiological diagnosis&#44; coronary angiography findings and treatment&#46;</p>"
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                  <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" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Event&#44; n &#40;&#37;&#41;&nbsp;\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">Study population &#40;n&#61;15&#41;&nbsp;\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"><span class="elsevierStyleItalic">Shivering</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15 &#40;100&#46;0&#37;&#41;&nbsp;\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"><span class="elsevierStyleItalic">Electrolyte disturbances</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15 &#40;100&#46;0&#37;&#41;&nbsp;\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"><span class="elsevierStyleItalic">Metabolic disturbances</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15 &#40;100&#46;0&#37;&#41;&nbsp;\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"><span class="elsevierStyleItalic">Hematologic disturbances</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15 &#40;100&#46;0&#37;&#41;&nbsp;\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"><span class="elsevierStyleItalic">Respiratory infection</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">13 &#40;86&#46;7&#37;&#41;&nbsp;\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"><span class="elsevierStyleItalic">Arrhythmias</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7 &#40;46&#46;7&#37;&#41;&nbsp;\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"><span class="elsevierStyleItalic">Sinus bradycardia</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5 &#40;71&#46;4&#37;&#41;&nbsp;\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"><span class="elsevierStyleItalic">AFL&#47;AF</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3 &#40;42&#46;9&#37;&#41;&nbsp;\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"><span class="elsevierStyleItalic">VF&#47;VT</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;14&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Bleeding</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3 &#40;20&#46;0&#37;&#41;&nbsp;\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"><span class="elsevierStyleHsp" style=""></span>Major&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;33&#46;3&#37;&#41;&nbsp;\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"><span class="elsevierStyleHsp" style=""></span>Non-major&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;66&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Tonic-clonic status epilepticus</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;13&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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                  <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" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Characteristics&#44; n &#40;&#37;&#41; or mean &#177; SD&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Non-survivor group &#40;n&#61;8&#41;&nbsp;\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">p&nbsp;\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"><span class="elsevierStyleItalic">Gender&#44; male</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5 &#40;71&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5 &#40;62&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;724&nbsp;\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"><span class="elsevierStyleItalic">Age&#44; years</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">38&#46;4&#177;10&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">55&#46;1&#177;13&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;032&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">CV risk factors</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3 &#40;42&#46;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7 &#40;87&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;077&nbsp;\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"><span class="elsevierStyleHsp" style=""></span>Hypertension&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2 &#40;28&#46;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4 &#40;50&#46;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;414&nbsp;\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"><span class="elsevierStyleHsp" style=""></span>Diabetes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0 &#40;0&#46;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3 &#40;37&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;080&nbsp;\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"><span class="elsevierStyleHsp" style=""></span>Dyslipidemia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2 &#40;28&#46;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3 &#40;37&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;724&nbsp;\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"><span class="elsevierStyleHsp" style=""></span>Active smoking&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2 &#40;28&#46;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4 &#40;50&#46;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;414&nbsp;\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"><span class="elsevierStyleHsp" style=""></span>BMI &#8805;25 kg&#47;m<span class="elsevierStyleSup">2</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0 &#40;0&#46;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2 &#40;25&#46;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;170&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Out-of-hospital cardiac arrest</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5 &#40;71&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6 &#40;75&#46;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;880&nbsp;\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"><span class="elsevierStyleItalic">VF rhythm at presentation</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6 &#40;85&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4 &#40;50&#46;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;157&nbsp;\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"><span class="elsevierStyleItalic">CA-CPR&#44; min</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">9&#46;4&#177;4&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">18&#46;5&#177;15&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;473&nbsp;\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"><span class="elsevierStyleItalic">CA-ROSC&#44; min</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">22&#46;9&#177;12&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">63&#46;8&#177;40&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;048&nbsp;\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"><span class="elsevierStyleItalic">CA-TH&#44; min</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">348&#177;138&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">336&#177;234&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;601&nbsp;\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"><span class="elsevierStyleItalic">GCS</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5&#46;9&#177;3&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&#46;5&#177;2&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;413&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleItalic">Laboratory values</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Hemoglobin&#44; g&#47;dl<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">13&#46;8&#177;3&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">13&#46;3&#177;1&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;417&nbsp;\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"><span class="elsevierStyleHsp" style=""></span>Sodium&#44; mmol&#47;l<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">140&#46;7&#177;7&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">139&#46;1&#177;3&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;685&nbsp;\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"><span class="elsevierStyleHsp" style=""></span>Potassium&#44; mmol&#47;l<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&#46;5&#177;0&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&#46;1&#177;1&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;450&nbsp;\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"><span class="elsevierStyleHsp" style=""></span>Total bilirubin&#44; &#956;mol&#47;l<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">13&#46;3&#177;7&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8&#46;9&#177;5&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;247&nbsp;\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"><span class="elsevierStyleHsp" style=""></span>AST&#44; U&#47;l<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">145&#46;6&#177;112&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">400&#46;8&#177;423&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;418&nbsp;\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"><span class="elsevierStyleHsp" style=""></span>ALT&#44; U&#47;l<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">83&#46;6&#177;43&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">248&#46;3&#177;188&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;203&nbsp;\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"><span class="elsevierStyleHsp" style=""></span>NSE&#44; &#956;g&#47;l<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">42&#46;6&#177;35&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">138&#46;4&#177;133&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;020&nbsp;\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"><span class="elsevierStyleHsp" style=""></span>Troponin I&#44; ng&#47;ml<a class="elsevierStyleCrossRef" href="#tblfn0025"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">16&#46;5&#177;24&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">56&#46;8&#177;47&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;165&nbsp;\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"><span class="elsevierStyleHsp" style=""></span>BNP&#44; pg&#47;ml<a class="elsevierStyleCrossRef" href="#tblfn0025"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">339&#46;6&#177;401&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">479&#46;7&#177;365&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;475&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleItalic">Renal function</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Creatinine&#44; mg&#47;dl<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#46;1&#177;0&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#46;3&#177;0&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;354&nbsp;\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"><span class="elsevierStyleHsp" style=""></span>BUN&#44; mmol&#47;l<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6&#46;1&#177;1&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7&#46;7&#177;4&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;954&nbsp;\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"><span class="elsevierStyleHsp" style=""></span>eGFR&#44; ml&#47;min&#47;1&#46;73 m<span class="elsevierStyleSup">2</span><a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">72&#46;7&#177;12&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">58&#46;9&#177;22&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;183&nbsp;\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"><span class="elsevierStyleHsp" style=""></span>eGFR &#60;60 ml&#47;min&#47;1&#46;73 m<span class="elsevierStyleSup">2</span><a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2 &#40;28&#46;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4 &#40;50&#46;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;414&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleItalic">LV function</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Eyeball LV ejection fraction &#60;50&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0 &#40;0&#46;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6 &#40;75&#46;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;002&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleItalic">Treatment</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>PCI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3 &#40;42&#46;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6 &#40;75&#46;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;221&nbsp;\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"><span class="elsevierStyleHsp" style=""></span>Implanted cardioverter-defibrillator&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4 &#40;57&#46;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0 &#40;0&#46;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;016&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Length of ICU stay&#44; days</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">9&#46;0&#177;3&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">23&#46;1&#177;32&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;480&nbsp;\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"><span class="elsevierStyleItalic">Length of hospital stay&#44; days</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">16&#46;1&#177;7&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">28&#46;1&#177;35&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;908&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">95&#37; CI&nbsp;\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">p&nbsp;\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">Age &#62;48 years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">18&#46;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;27-255&#46;74&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;023&nbsp;\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">&#8805;1 CV risk factors&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9&#46;33&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;711-122&#46;57&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;077&nbsp;\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">CA-ROSC &#62;35 min&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;17&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;47-36&#46;74&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;082&nbsp;\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">NSE &#62;76 &#956;g&#47;l&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&#46;50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;76-74&#46;16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;082&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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          "en" => "<p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">Cut-off values of clinical predictors of mortality&#46;</p>"
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    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:36 [
            0 => array:3 [
              "identificador" => "bib0185"
              "etiqueta" => "1"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Global incidences of out-of-hospital cardiac arrest and survival rates&#58; systematic review of 67 prospective studies"
                      "autores" => array:1 [
                        0 => array:2 [
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Original Article
Predictors of death among cardiac arrest patients after therapeutic hypothermia: A non-tertiary care center's initial experience
Preditores de morte em doentes pós-paragem cardíaca submetidos a hipotermia terapêutica: experiência inicial de um centro não-terciário
Catarina Ruivoa,
Corresponding author
catarinaruivo10@gmail.com

Corresponding author.
, Célia Jesusb, João Moraisa, Paula Vianab
a Serviço de Cardiologia, Centro Hospitalar de Leiria, Leiria, Portugal
b Serviço de Medicina Intensiva, Centro Hospitalar de Leiria, Leiria, Portugal
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Introduction</span><p id="par0115" class="elsevierStylePara elsevierViewall">Cardiac arrest &#40;CA&#41; with cerebral ischemia can lead to severe neurological damage and death&#46; The survival rate of out-of-hospital CA is reported to be 2-11&#37;&#44; rising to 20-40&#37; in witnessed ventricular fibrillation &#40;VF&#41; cases&#46;<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">1&#8211;3</span></a></p><p id="par0120" class="elsevierStylePara elsevierViewall">Induced hypothermia has been employed as a therapeutic approach for CA survivors and other critically ill patients for decades&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">4</span></a> Two randomized controlled trials published in 2002 reported a dramatic improvement in survival and neurological outcome for comatose survivors of out-of-hospital VF CA with therapeutic hypothermia &#40;TH&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">5&#44;6</span></a></p><p id="par0125" class="elsevierStylePara elsevierViewall">TH &#40;32<span class="elsevierStyleHsp" style=""></span>&#176;C-34<span class="elsevierStyleHsp" style=""></span>&#176;C for 12-24 hours&#41; has been the standard of care for patients remaining comatose after resuscitation&#46;<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">7&#44;8</span></a> A recent randomized trial found a similar outcome in patients treated with targeted temperature management at either 33<span class="elsevierStyleHsp" style=""></span>&#176;C or 36<span class="elsevierStyleHsp" style=""></span>&#176;C&#44;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">9</span></a> prompting the International Liaison Committee on Resuscitation &#40;ILCOR&#41; Advanced Life Support &#40;ALS&#41; Task Force to perform a systematic review&#46;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">10</span></a> Currently&#44; a constant temperature between 32<span class="elsevierStyleHsp" style=""></span>&#176;C and 36<span class="elsevierStyleHsp" style=""></span>&#176;C for at least 24 hours is the recommended targeted temperature management for adults following out-of-hospital CA with an initial shockable rhythm and&#44; with a lower level of evidence&#44; for out-of-hospital CA with a non-shockable rhythm and in-hospital CA&#46;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">11</span></a></p><p id="par0130" class="elsevierStylePara elsevierViewall">The aim of this retrospective analysis was to describe the initial experience of a non-tertiary care center and to determine predictors of mortality and neurological outcome at discharge for CA patients treated with TH&#44; focusing on a combination of initial rhythm&#44; time to return of spontaneous circulation &#40;ROSC&#41; and laboratory biomarkers&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Design and setting</span><p id="par0135" class="elsevierStylePara elsevierViewall">We performed a retrospective review of consecutive patients who suffered CA admitted between January 1&#44; 2011 and December 31&#44; 2014 to the intensive care unit &#40;ICU&#41; at a non-tertiary care center&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Inclusion and exclusion criteria</span><p id="par0140" class="elsevierStylePara elsevierViewall">We studied comatose adults &#40;unable to follow verbal commands after ROSC&#41; aged &#8805;18 years admitted to the ICU with ROSC after in-hospital or out-of-hospital CA who were treated by TH&#46; Patients without known time of CA&#44; in a comatose state before CA&#44; or with a terminal illness that preceded CA were excluded&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Therapeutic hypothermia technique</span><p id="par0145" class="elsevierStylePara elsevierViewall">Patients treated by TH were cooled to a target temperature of 33<span class="elsevierStyleHsp" style=""></span>&#176;C with a combination of core-cooling and surface-cooling methods&#46; By protocol 30 ml of cold &#40;4<span class="elsevierStyleHsp" style=""></span>&#176;C&#41; lactated Ringer&#39;s solution per kg was administered intravenously over 30 min&#46; An external cooling device&#44; Arctic Sun<span class="elsevierStyleSup">&#174;</span>&#44; was also used&#46; This is a targeted temperature management system that uses chilled water circulating in gel-coated pads to maintain body temperature in the desired range&#46; An esophageal probe was used to monitor core temperature&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">All patients underwent three phases of TH&#58; a fast induction phase to 33<span class="elsevierStyleHsp" style=""></span>&#176;C&#59; a maintenance phase for 24 hours at 33<span class="elsevierStyleHsp" style=""></span>&#176;C&#59; and a rewarming phase of about 0&#46;25<span class="elsevierStyleHsp" style=""></span>&#176;C of warming per hour until 36<span class="elsevierStyleHsp" style=""></span>&#176;C&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Data collection and definitions</span><p id="par0155" class="elsevierStylePara elsevierViewall">The following baseline characteristics were collected from patients&#8217; medical records&#58; demographic data&#59; cardiovascular risk factors&#59; place and initial rhythm of CA&#59; time from collapse to cardiopulmonary resuscitation &#40;CPR&#41;&#44; to ROSC and to TH&#59; admission data including Glasgow Coma Scale &#40;GCS&#41; score and laboratory tests including levels of neuron-specific enolase &#40;NSE&#41;&#44; the gamma isomer of enolase expressed mainly in neurons and neuroectodermal cells&#44; measured within 72 hours of CA&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">Bedside focused transthoracic echocardiography &#40;TTE&#41; and cranial computed tomography &#40;CT&#41; were performed within 24 hours of admission&#46; Coronary angiography was performed before TH&#46; Etiological diagnosis of CA was determined according to the current European Society of Cardiology guidelines&#46;<a class="elsevierStyleCrossRefs" href="#bib0240"><span class="elsevierStyleSup">12&#8211;15</span></a></p><p id="par0165" class="elsevierStylePara elsevierViewall">CA was defined as receipt of chest compressions for pulselessness as determined by a healthcare provider&#46; The first monitored rhythm was recorded as the initial rhythm of CA&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">An initial neurological assessment and GCS score at admission were obtained&#44; in order to identify comatose patients&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Outcome measures</span><p id="par0175" class="elsevierStylePara elsevierViewall">In-hospital mortality and Cerebral Performance Category &#40;CPC&#41; were assessed at ICU discharge&#44; hospital discharge and at six months after discharge&#46; Adverse events and length of ICU and hospital stay were assessed&#46; Statistical analyses were performed in order to determine predictors of outcome&#46;</p><p id="par0180" class="elsevierStylePara elsevierViewall">CPC categories were defined according to Safar<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">16</span></a> as follows&#58; 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The mean time from CA to CPR &#40;CA-CPR&#41; was 14&#46;3&#177;12&#46;4 min&#44; minimum 1&#44; maximum 40&#59; mean time to ROSC &#40;CA-ROSC&#41; was 44&#46;7&#177;36&#46;5 min&#44; minimum 10&#44; maximum 120&#59; and mean time to TH &#40;CA-TH&#41; was 342&#177;186 min&#44; minimum 90&#44; maximum 780&#46; Mean GCS at admission was 5&#46;1&#177;2&#46;9&#44; median 3&#44; 25th percentile 3&#44; 75th percentile 8&#46;</p><p id="par0205" class="elsevierStylePara elsevierViewall">Bedside focused TTE was performed within 24 hours of admission in 14 patients &#40;93&#46;3&#37;&#41;&#59; eyeball left ventricular ejection fraction was estimated and was low only in the non-survival group&#46; Cranial CT was not performed systematically &#40;in only seven patients&#44; 46&#46;6&#37;&#41;&#59; all but one already had signs of hypoxic encephalopathy&#46; Emergency coronary angiography was performed in 14 &#40;93&#46;3&#37;&#41; patients&#44; all before TH&#46; During ICU stay&#44; all patients were under inotropic hemodynamic support&#46;</p><p id="par0210" class="elsevierStylePara elsevierViewall">All patients were maintained at a TH target temperature of 33<span class="elsevierStyleHsp" style=""></span>&#176;C for 24 hours&#46; 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CPC 5 in eight patients&#41;&#46; In-hospital mortality occurred in eight patients &#40;53&#46;3&#37;&#41; and seven patients &#40;46&#46;7&#37;&#41; were discharged with good cerebral performance&#46; At six months after hospital discharge&#44; CPC scores were the same as at discharge&#46;</p><p id="par0225" class="elsevierStylePara elsevierViewall">Cranial CT was not performed systematically after TH or at admission&#46; Of eight patients &#40;53&#46;3&#37;&#41; who underwent CT after TH&#44; five had signs of hypoxic encephalopathy and all died in-hospital&#46; Mean NSE level was 93&#46;7&#177;109&#46;0 &#956;g&#47;l&#46;</p><p id="par0230" class="elsevierStylePara elsevierViewall">Length of ICU stay was 16&#46;5&#177;24&#46;2 days and hospital stay was 22&#46;5&#177;26&#46;4 days&#46;</p><p id="par0235" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a> shows the adverse events reported during the three phases of TH&#46; As respiratory infections were frequent&#44; occurring in 13 patients &#40;86&#46;7&#37;&#41;&#44; cultures of bronchial secretions are performed in all patients&#46; <a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a> shows the microorganisms isolated in bronchial secretions&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Comparison of baseline characteristics</span><p id="par0240" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a> compares the seven patients &#40;47&#37;&#41; who survived &#40;survivor group&#41; and were discharged with CPC 1 with the eight patients &#40;53&#37;&#41; who died in-hospital &#40;non-survivor group&#41;&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><p id="par0245" class="elsevierStylePara elsevierViewall">No differences were found between the groups regarding gender &#40;male&#58; 71&#46;4&#37; vs&#46; 62&#46;5&#37;&#59; p&#61;0&#46;724&#41;&#44; history of hypertension &#40;28&#46;6&#37; vs&#46; 50&#46;0&#37;&#59; p&#61;0&#46;414&#41;&#44; diabetes &#40;0&#46;0&#37; vs&#46; 37&#46;5&#37;&#59; p&#61;0&#46;080&#41;&#59; dyslipidemia &#40;28&#46;6&#37; vs&#46; 37&#46;5&#37;&#59; p&#61;0&#46;724&#41;&#44; active smoking &#40;28&#46;6&#37; vs&#46; 50&#46;0&#37;&#59; p&#61;0&#46;414&#41;&#44; or overweight or obesity &#40;0&#46;0&#37; vs&#46; 25&#46;0&#37;&#59; p&#61;0&#46;170&#41;&#46; The location of CA was similar &#40;out-of-hospital&#58; 71&#46;4&#37; vs&#46; 75&#46;0&#37;&#59; p&#61;0&#46;880&#41;&#46; Although an initial VF rhythm was more frequent in survivors in this small group of patients&#44; there was no statistical difference between the groups &#40;85&#46;7&#37; vs&#46; 50&#46;0&#37;&#59; p&#61;0&#46;157&#41;&#46;</p><p id="par0250" class="elsevierStylePara elsevierViewall">Patients who survived were a mean of 16&#46;7 years younger than those who died &#40;38&#46;4 vs&#46; 55&#46;1 years&#59; p&#61;0&#46;032&#41;&#44; had shorter CA-ROSC &#40;22&#46;9 vs&#46; 63&#46;8 min&#59; p&#61;0&#46;048&#41; and lower NSE values &#40;42&#46;6 vs&#46; 138&#46;4 &#956;g&#47;l&#59; p&#61;0&#46;020&#41;&#46;</p><p id="par0255" class="elsevierStylePara elsevierViewall">To analyze the clinical predictors for survival&#44; the cut-off values were calculated on the basis of the 50th percentile&#46; Age &#62;48 years was a strong predictor of survival &#40;OR&#58; 18&#46;00&#59; 95&#37; CI&#58; 1&#46;27-255&#46;74&#59; p&#61;0&#46;023&#41;&#46; Approaching borderline statistical significance as predictors of mortality were presence of cardiovascular risk factors &#40;OR&#58; 9&#46;33&#59; 95&#37; CI&#58; 0&#46;711-122&#46;57&#59; p&#61;0&#46;077&#41;&#44; CA-ROSC &#62;35 min &#40;OR&#58; 4&#46;17&#59; 95&#37; CI&#58; 0&#46;47-36&#46;74&#59; p&#61;0&#46;082&#41; and NSE &#62;76 &#956;g&#47;l &#40;OR&#58; 7&#46;50&#59; 95&#37; CI&#58; 0&#46;76-74&#46;16&#59; p&#61;0&#46;082&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0025">Table 5</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0025"></elsevierMultimedia></span></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Discussion</span><p id="par0260" class="elsevierStylePara elsevierViewall">Within the last decade outcomes after CA have improved&#44; thanks to a combination of various measures&#46; TH has shown benefit&#44; however specific predictors of outcome in hypothermia-treated CA patients are missing&#46;</p><p id="par0265" class="elsevierStylePara elsevierViewall">In our study we used a target temperature of 33<span class="elsevierStyleHsp" style=""></span>&#176;C in all patients&#44; as further evidence has supported the findings of Holzer et al&#46; and Bernard et al&#46;<a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">5&#44;6</span></a> However&#44; a recent international randomized controlled trial by Nielsen et al&#46;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">9</span></a> completely contradicts the findings of all previous studies&#46; They reported no significant difference in outcome between out-of-hospital CA patients treated with hypothermia at target temperatures of 33<span class="elsevierStyleHsp" style=""></span>&#176;C or 36<span class="elsevierStyleHsp" style=""></span>&#176;C&#46; New guidelines have established targeted temperature management at a constant temperature between 32<span class="elsevierStyleHsp" style=""></span>&#176;C and 36<span class="elsevierStyleHsp" style=""></span>&#176;C for at least 24 hours&#46;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">11</span></a> They state that the terms &#8220;target temperature management&#8221; or &#8220;temperature control&#8221; are now preferred over the previous term &#8220;therapeutic hypothermia&#8221; and that a priority in temperature control should be to avoid hyperthermia&#46; Nevertheless&#44; it is clear that weak recommendations and low-quality evidence in some points suggest that doubts remain and that further large high-quality trials are needed&#46;</p><p id="par0270" class="elsevierStylePara elsevierViewall">Post-cardiac arrest syndrome in patients who remain comatose after CA is a complex set of pathophysiological processes consisting of systemic ischemia-reperfusion injury&#44; brain injury&#44; and myocardial depression&#44; as well as ongoing injury caused by the precipitating etiology of the arrest&#46;<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">17</span></a> In this field TH has been the cornerstone in neurological improvement&#46; In this study we investigated mortality&#44; neurological outcome and possible predictors of poor outcome&#46; Our overall survival to discharge was 47&#37;&#44; with all patients surviving to discharge having a good neurological outcome&#44; defined as a CPC of 1&#46; In the first two major clinical trials that provided direct evidence of a benefit of TH&#44; 49&#37; and 55&#37;&#44; respectively&#44; who were treated with hypothermia survived and had a favorable neurological recovery at hospital discharge&#46;<a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">5&#44;6</span></a></p><p id="par0275" class="elsevierStylePara elsevierViewall">Assessment of neurological function and prognosis is challenging in patients undergoing TH and some authors suggest a multimodal approach based on neurological examination&#44; continuous electroencephalographic monitoring&#44; somatosensory-evoked potential&#44; magnetic resonance and CT imaging and serum markers of neuronal damage&#46;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">18</span></a></p><p id="par0280" class="elsevierStylePara elsevierViewall">An early CT scan is commonly used to rule out an unexpected intracerebral cause of coma in patients who remain comatose after cardiac arrest&#44; and CT after TH gives important information about neurological outcome and longtime survival&#46;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">18</span></a> In the current series CT was not routinely performed at admission&#44; or after TH as a prognostic tool&#46; In those who underwent CT after TH&#44; cerebral edema and hypoxic encephalopathy were associated with a poor outcome&#46; Current resuscitation guidelines recognize echocardiography as a valuable diagnostic tool in the early identification of the precipitating cause of CA&#44;<a class="elsevierStyleCrossRefs" href="#bib0235"><span class="elsevierStyleSup">11&#44;19</span></a> which is why it was performed in all except one of our patients in the after-arrest setting&#46; However the exam was a point-of-care focused study&#44; with non-standard echocardiographic views&#44; in patients under mechanical ventilation and inotropic support&#46; This limited approach could have led to important findings being missed or misinterpreted&#44; particularly with left ventricular ejection fraction being overestimated due to inotropic support leading to myocardial hypercontractility&#46;</p><p id="par0285" class="elsevierStylePara elsevierViewall">Various interesting biomarkers for prognosis after CA have been studied&#44; including S100B protein&#44;<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">20</span></a> glial fibrillary acidic protein&#44; neurofilaments&#44; and organ-specific micro-RNA&#46;<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">21</span></a> The most extensively studied biomarker is NSE&#46; A large Dutch study&#44; prior to the era of TH&#44; identified an NSE value &#62;33 &#956;g&#47;l within 72 hours of CA as a reliable marker for poor outcome&#46;<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">22</span></a> While some recent studies have questioned the value of NSE for prognostication in hypothermia-treated patients and consider it insufficiently predictive&#44;<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">23</span></a> other studies support its use&#46;<a class="elsevierStyleCrossRefs" href="#bib0300"><span class="elsevierStyleSup">24&#44;25</span></a> Cut-off points for predicting a poor outcome with no false positives vary greatly &#40;from 9 to 97 &#956;g&#47;l&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">26</span></a> Studies testing NSE as a predictor of poor outcome in comatose patients after CA treated with TH have reported cut-off values at 48 hours of 28 ng&#47;ml and 33 ng&#47;ml&#46;<a class="elsevierStyleCrossRefs" href="#bib0300"><span class="elsevierStyleSup">24&#44;25</span></a> In our population&#44; NSE levels were 95&#46;8 &#956;g&#47;l higher in those who died &#40;42&#46;6&#177;35&#46;1 vs&#46; 138&#46;4&#177;133&#46;4 &#956;g&#47;l&#44; p&#61;0&#46;020&#41;&#46; An NSE cut-off of 76 &#956;g&#47;l appears to separate the two groups at close to statistical significance&#46; This cut-off&#44; higher than in previous studies&#44; could be explained by differences in assay procedures and time of blood sampling &#40;in our study within 72 hours&#41;&#46; If only NSE values within the first 48 hours are considered&#44; the mean is 44&#46;2 &#956;g&#47;l&#44; approaching those in previous studies&#46; When and how to prognosticate&#44; in particular which biomarkers should be used&#44; is a question that requires more data&#46; Furthermore&#44; any specific absolute cut-off value proposed to provide neuroprognostication should only be used in conjunction with other prognostic variables&#46;</p><p id="par0290" class="elsevierStylePara elsevierViewall">N-terminal pro-B-type natriuretic peptide &#40;NT-proBNP&#41; and troponin I have been shown to be important biomarker predictors for death in CA patients&#46;<a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">27</span></a> In our study higher B-type natriuretic peptide &#40;BNP&#41; &#40;339&#46;6&#177;401&#46;2 vs&#46; 479&#46;7&#177;365&#46;4 pg&#47;ml&#44; p&#61;NS&#41; and peak troponin I &#40;16&#46;5&#177;24&#46;8 vs&#46; 56&#46;8&#177;47&#46;1 ng&#47;ml&#44; p&#61;NS&#41; were found in the non-survivor group&#44; but without statistical significance&#44; due to the small number of patients enrolled&#46;</p><p id="par0295" class="elsevierStylePara elsevierViewall">In our results gender&#44; GCS&#44; and location and initial rhythm of CA were not predictors of mortality&#46; While some studies show female gender as an independent predictor for both less use of TH and poor outcome in patients with a shockable rhythm&#44;<a class="elsevierStyleCrossRef" href="#bib0320"><span class="elsevierStyleSup">28</span></a> others identify female gender as a positive predictor for survival to hospital arrival after an out-of-hospital CA&#44; despite worse survival to hospital discharge&#46;<a class="elsevierStyleCrossRef" href="#bib0325"><span class="elsevierStyleSup">29</span></a> The abnormal distribution of GCS scores in our study&#44; with a median of 3&#44; meant it had no influence on mortality&#44; in contrast to other studies in which one of the best predictors was low GCS at admission&#46;<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">30</span></a> Although in-hospital CA has a weaker recommendation to use TH&#44;<a class="elsevierStyleCrossRefs" href="#bib0230"><span class="elsevierStyleSup">10&#44;11</span></a> in our study&#44; as well as in another Portuguese study&#44;<a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">31</span></a> there was no difference in survival between in-hospital and out-of-hospital CA&#46; One of the reasons for this could be less effective prehospital care affecting in-hospital mortality&#46;</p><p id="par0300" class="elsevierStylePara elsevierViewall">A Scandinavian registry enrolling 986 patients reported 61&#37; survival in the witnessed ventricular tachycardia&#47;VF arrest group and 56&#37; good neurological outcome&#46;<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">30</span></a> Consistent with these findings&#44; we report 66&#46;7&#37; &#40;n&#61;10&#41; of patients with shockable initial rhythm and overall survival with a good neurological outcome in 60&#37; &#40;n&#61;4&#41; of these&#46; These data highlight the expected survival rate and hence the superior impact of TH for these patients compared with those with a non-shockable CA rhythm&#46; There are multiple causes of CA due to asystole and pulseless electrical activity&#44; and the underlying medical problems are more difficult to treat&#46; In this context&#44; some authors have found that hypothermia was not of benefit in terms of survival or good neurological outcome if the CA was related to a non-shockable rhythm&#46;<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">32</span></a> Others have concluded that a positive impact on survival is likely&#46;<a class="elsevierStyleCrossRef" href="#bib0345"><span class="elsevierStyleSup">33</span></a> It is still unclear whether TH benefits non-shockable victims if the pathophysiology of cerebral metabolism and dysfunction is different or if a different target temperature is needed in such patients&#46;</p><p id="par0305" class="elsevierStylePara elsevierViewall">Patients who survived in our study were a mean of 16&#46;7 years younger than those who died and patients aged over 48 years had a markedly poorer outcome&#46; Older age remains a negative predictor for TH use<a class="elsevierStyleCrossRef" href="#bib0320"><span class="elsevierStyleSup">28</span></a> as well as predicting worse survival&#46;<a class="elsevierStyleCrossRefs" href="#bib0320"><span class="elsevierStyleSup">28&#44;30</span></a> Advanced age is a common reason for withholding TH in unconscious out-of-hospital CA patients&#46;<a class="elsevierStyleCrossRef" href="#bib0350"><span class="elsevierStyleSup">34</span></a></p><p id="par0310" class="elsevierStylePara elsevierViewall">Emergency coronary angiography giving an opportunity for emergency percutaneous coronary intervention &#40;PCI&#41; is an established and widely implemented first-line treatment in patients with ST-segment elevation myocardial infarction &#40;STEMI&#41; complicated with CA&#46;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">12</span></a> However&#44; it remains unclear whether an early invasive strategy is beneficial in all comatose survivors of CA&#46; Selection of patients with a high likelihood of coronary artery disease may be challenging&#46; In our study&#44; all but one patients &#40;n&#61;14&#59; 93&#46;3&#37;&#41; received emergency coronary angiography and 60&#37; &#40;n&#61;9&#41; subsequently received PCI&#46; Despite this&#44; we consider that the benefits &#40;marginal in many cases&#41; and potential procedure-related complications of emergency coronary angiography and emergency PCI in comatose patients should be balanced against those of a less invasive strategy&#46;</p><p id="par0315" class="elsevierStylePara elsevierViewall">Although in our population coronary angiography and PCI were performed before TH&#44; most centers combine early PCI with simultaneous initiation of TH&#44; which has also been shown to be feasible without increasing door-to-balloon time&#46; It seems reasonable that hypothermia should be initiated as early as possible&#44; however there is a study showing that later initiation of cooling is still effective in mitigating neuronal damage&#46;<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">30</span></a> The mean CA-TH in this study &#40;90 min&#41; was considerably shorter than in ours &#40;342 min&#41;&#44; showing how much our performance could be improved&#46; In fact&#44; the technique of TH requires a learning period and specific skills&#46; Although time is crucial at every step of the process&#44; in our study there was no difference in CA-TH between survivor and non-survivor groups &#40;348&#177;138 vs&#46; 336&#177;234 min&#44; p&#61;NS&#41;&#46; Our findings are similar to those of the Hypothermia After Cardiac Arrest &#40;HACA&#41; study&#44; in which the median interval between ROSC and target temperature was eight hours &#40;480 min&#41;&#44;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">5</span></a> due to rapid induction of TH&#46;</p><p id="par0320" class="elsevierStylePara elsevierViewall">Comatose CA patients are admitted to the ICU with a broad range of baseline probability of survival&#44; mainly due to differences in resuscitation times&#46; The time from collapse to ROSC is an important predictor of survival&#44; as confirmed by our results&#44; in which this was a mean of 40&#46;9 min longer in those who died and a cut-off of 35 min approached statistical significance to differentiate the two groups&#46; The cut-offs are not very different in other studies&#44; in which the outcome for patients with time to ROSC of over 30 min &#40;after calling for an ambulance&#41; is dismal<a class="elsevierStyleCrossRef" href="#bib0355"><span class="elsevierStyleSup">35</span></a> and time from collapse to ROSC of over 25 min is strongly associated with poor outcome&#46;<a class="elsevierStyleCrossRef" href="#bib0360"><span class="elsevierStyleSup">36</span></a> Although longer time to ROSC was a predictor of poor outcome&#44; on the basis of absolute numbers it could not be used as a sole predictor of outcome&#44; and other factors such as the quality of CPR may be equally important&#46;</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Limitations</span><p id="par0325" class="elsevierStylePara elsevierViewall">Certain limitations to our retrospective&#44; registry-based study should be recognized&#46;</p><p id="par0330" class="elsevierStylePara elsevierViewall">First of all&#44; the small sample size may limit the analysis&#44; which is clearly underpowered to assess major differences&#46; However this is the largest series so far published in the Portuguese population after the implementation of TH and the patient characteristics are similar to previous reports&#46;</p><p id="par0335" class="elsevierStylePara elsevierViewall">The overall low use of objective prognostic tools in our patient group was in agreement with common practice in the ICU at the time of the study&#46;</p><p id="par0340" class="elsevierStylePara elsevierViewall">Finally&#44; we studied patients from a single center&#44; and therefore the generalizability of our results to other centers may be questioned&#46;</p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Conclusions</span><p id="par0345" class="elsevierStylePara elsevierViewall">The high morbidity and mortality associated with CA means the recommendations in this article should be viewed in light of the very poor prognosis in CA patients&#46; Due to the complexity and heterogeneity of these patients&#44; performing well-controlled randomized trials is a challenge&#44; and thus there are very few proven interventions&#46; Our study results support the findings of prior studies conducted on TH-treated CA patients&#58; 53&#37; of all patients died and 47&#37; of all patients were discharged with a favorable outcome&#46; Predictors for death were higher age&#44; previous cardiovascular risk factors&#44; longer CA-ROSC and higher NSE levels at admission&#59; a relation between shockable rhythm or out-of-hospital CA and mortality was not fully documented&#46;</p><p id="par0350" class="elsevierStylePara elsevierViewall">Several questions remain unanswered&#58; the optimal time to begin TH&#59; the target temperature and duration of TH&#59; the best local cooling practices&#59; the effect of rewarming rate&#59; and the possibility that some subgroups of patients may benefit from a specific target temperature&#46;</p><p id="par0355" class="elsevierStylePara elsevierViewall">No single test can predict a poor prognosis with absolute certainty and it will be difficult to establish cut-off values supporting the decision whether to induce hypothermia&#46; Furthermore&#44; the use of TH may complicate assessment of the neurological outcome&#46; The optimal approach to prognosticate CA patients treated with TH has not been fully resolved&#46; This is an issue of central importance&#44; since it can be ethically justifiable to limit care or withdraw support only when a poor prognosis is reasonably certain&#46;</p></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0145">Ethical disclosures</span><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0150">Protection of human and animal subjects</span><p id="par0360" class="elsevierStylePara elsevierViewall">The authors declare that the procedures followed were in accordance with the regulations of the relevant clinical research ethics committee and with those of the Code of Ethics of the World Medical Association &#40;Declaration of Helsinki&#41;&#46;</p></span><span id="sec0090" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0155">Confidentiality of data</span><p id="par0365" class="elsevierStylePara elsevierViewall">The authors declare that they have followed the protocols of their work center on the publication of patient data&#46;</p></span><span id="sec0095" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0160">Right of privacy and informed consent</span><p id="par0370" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this article&#46;</p></span></span><span id="sec0100" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0165">Conflicts of interest</span><p id="par0375" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
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            1 => "Cardiac arrest"
            2 => "Neuron-specific enolase"
          ]
        ]
      ]
      "pt" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palavras-chave"
          "identificador" => "xpalclavsec821796"
          "palabras" => array:3 [
            0 => "Hipotermia terap&#234;utica"
            1 => "Paragem card&#237;aca"
            2 => "Enolase espec&#237;fica dos neur&#243;nios"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction and Objectives</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Therapeutic hypothermia &#40;TH&#41; is recommended for patients with return of spontaneous circulation &#40;ROSC&#41; after cardiac arrest &#40;CA&#41;&#46; There is still uncertainty about management&#44; target temperature and duration of TH&#46; In the present study we aim to describe the initial experience of a non-tertiary care center with TH after CA and to determine predictors of mortality&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">During the period 2011-2014&#44; out of 2279 patients hospitalized in the intensive care unit&#44; 82 had a diagnosis of CA with ROSC&#46; We determined predictors of mortality and neurological outcome in comatose patients with ROSC after CA treated by TH&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">A total of 15 patients were included&#44; mean age 47&#46;3&#177;14 years&#44; 10 &#40;67&#46;0&#37;&#41; male&#46; CA occurred out-of-hospital &#40;n&#61;11&#59; 73&#46;3&#37;&#41; or in-hospital &#40;n&#61;4&#59; 26&#46;7&#37;&#41;&#44; in initial shockable &#40;n&#61;10&#59; 66&#46;7&#37;&#41; or non-shockable &#40;n&#61;5&#44; 33&#46;3&#37;&#41; rhythm&#46; The mean time from CA to ROSC &#40;CA-ROSC&#41; was 44&#46;7&#177;36&#46;5 min&#46; All patients met the 24-hour TH target temperature of 33<span class="elsevierStyleHsp" style=""></span>&#176;C&#46; The mean neuron-specific enolase &#40;NSE&#41; level was 93&#46;7&#177;109&#46;0 &#956;g&#47;l&#46; Seven patients &#40;46&#46;7&#37;&#41; were discharged with good cerebral performance and eight &#40;53&#46;3&#37;&#41; died&#46; Patients who survived had lower median age &#40;p&#61;0&#46;032&#41;&#44; shorter CA-ROSC &#40;p&#61;0&#46;048&#41;&#44; lower NSE levels &#40;p&#61;0&#46;020&#41; and initial ventricular fibrillation rhythm &#40;p&#61;NS&#41;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">The effectiveness of TH appears to be related to younger age&#44; shockable initial rhythm and shorter CA-ROSC time&#46; This results indicates some lines of inquiry that should be developed in appropriate prospective studies&#46; The role of biomarkers as predictors of prognosis is an open question&#44; with NSE potentially playing an important role&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Introduction and Objectives"
          ]
          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Methods"
          ]
          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Results"
          ]
          3 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Conclusions"
          ]
        ]
      ]
      "pt" => array:3 [
        "titulo" => "Resumo"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introdu&#231;&#227;o e objetivos</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">A Hipotermia Terap&#234;utica &#40;HT&#41; &#233; recomendada em doentes com recupera&#231;&#227;o da circula&#231;&#227;o espont&#226;nea &#40;ROSC&#41; ap&#243;s paragem card&#237;aca &#40;PC&#41;&#46; D&#250;vidas persistem sobre a melhor abordagem&#44; a temperatura alvo e a dura&#231;&#227;o da t&#233;cnica&#46; Neste estudo descrevemos a experi&#234;ncia inicial de um centro n&#227;o-terci&#225;rio com HT ap&#243;s PC e procuramos preditores de mortalidade&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Durante os anos de 2011-2014&#44; dos 2279 doentes hospitalizados na unidade de cuidados intensivos&#44; 68 tinham diagn&#243;stico de PC com ROSC&#46; Determin&#225;mos preditores de mortalidade e progn&#243;stico neurol&#243;gico nos doentes comatosos com ROSC ap&#243;s PC&#44; submetidos a HT&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Quinze doentes&#44; 47&#44;3&#177;14 anos&#44; dez &#40;67&#44;0&#37;&#41; do sexo masculino&#46; A PC ocorreu extra &#40;n&#61;11&#59; 73&#44;3&#37;&#41; ou intra-hospitalar &#40;n&#61;4&#59; 26&#44;7&#37;&#41;&#44; em ritmo card&#237;aco inicial desfibrilh&#225;vel &#40;n&#61;10&#59; 66&#44;7&#37;&#41; ou n&#227;o-desfibrilh&#225;vel &#40;n&#61;5&#44; 33&#44;3&#37;&#41;&#46; O tempo m&#233;dio decorrido desde a PC at&#233; &#224; ROSC &#40;PC-ROSC&#41; foi de 44&#44;7&#177;36&#44;5 min&#46; O valor m&#233;dio da enolase espec&#237;fica dos neur&#243;nios &#40;NSE&#41; foi de 93&#44;7&#177;109&#44;0 &#956;g&#47;L&#46; Sete doentes &#40;46&#44;7&#37;&#41; tiveram alta hospitalar com bom desempenho cerebral e oito doentes &#40;53&#44;3&#37;&#41; faleceram&#46; Os doentes que sobreviveram apresentavam idade m&#233;dia inferior &#40;p&#61;0&#44;032&#41;&#44; menor tempo PC-ROSC &#40;p&#61;0&#44;048&#41;&#44; doseamentos mais baixos de NSE &#40;p&#61;0&#44;020&#41; e ritmo inicial predominante de fibrilha&#231;&#227;o ventricular &#40;p&#61;NS&#41;&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclus&#245;es</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">A efic&#225;cia da HT parece relacionada com idades mais jovens&#44; ritmo inicial desfibrilh&#225;vel e tempo PC-ROSC reduzido&#46; Estes resultados apontam algumas linhas de investiga&#231;&#227;o que estudos prospetivos adequados dever&#227;o desenvolver&#46; O papel de biomarcadores preditores de progn&#243;stico &#233; um tema em aberto&#44; devendo a NSE ocupar um lugar particular neste dom&#237;nio&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0025"
            "titulo" => "Introdu&#231;&#227;o e objetivos"
          ]
          1 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "M&#233;todos"
          ]
          2 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Resultados"
          ]
          3 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Conclus&#245;es"
          ]
        ]
      ]
    ]
    "nomenclatura" => array:1 [
      0 => array:3 [
        "identificador" => "nom0005"
        "titulo" => "<span class="elsevierStyleSectionTitle" id="sect0065">List of abbreviations</span>"
        "listaDefinicion" => array:1 [
          0 => array:1 [
            "definicion" => array:22 [
              0 => array:2 [
                "termino" => "ALS"
                "descripcion" => "<p id="par0005" class="elsevierStylePara elsevierViewall">advanced life support</p>"
              ]
              1 => array:2 [
                "termino" => "BNP"
                "descripcion" => "<p id="par0010" class="elsevierStylePara elsevierViewall">B-type natriuretic peptide</p>"
              ]
              2 => array:2 [
                "termino" => "CA"
                "descripcion" => "<p id="par0015" class="elsevierStylePara elsevierViewall">cardiac arrest</p>"
              ]
              3 => array:2 [
                "termino" => "CPC"
                "descripcion" => "<p id="par0020" class="elsevierStylePara elsevierViewall">Cerebral Performance Category</p>"
              ]
              4 => array:2 [
                "termino" => "CPR"
                "descripcion" => "<p id="par0025" class="elsevierStylePara elsevierViewall">cardiopulmonary resuscitation</p>"
              ]
              5 => array:2 [
                "termino" => "CT"
                "descripcion" => "<p id="par0030" class="elsevierStylePara elsevierViewall">computed tomography</p>"
              ]
              6 => array:2 [
                "termino" => "CV"
                "descripcion" => "<p id="par0035" class="elsevierStylePara elsevierViewall">cardiovascular</p>"
              ]
              7 => array:2 [
                "termino" => "EEG"
                "descripcion" => "<p id="par0040" class="elsevierStylePara elsevierViewall">electroencephalography</p>"
              ]
              8 => array:2 [
                "termino" => "GCS"
                "descripcion" => "<p id="par0045" class="elsevierStylePara elsevierViewall">Glasgow Coma Scale</p>"
              ]
              9 => array:2 [
                "termino" => "ICU"
                "descripcion" => "<p id="par0050" class="elsevierStylePara elsevierViewall">intensive care unit</p>"
              ]
              10 => array:2 [
                "termino" => "ILCOR"
                "descripcion" => "<p id="par0055" class="elsevierStylePara elsevierViewall">International Liaison Committee on Resuscitation</p>"
              ]
              11 => array:2 [
                "termino" => "NSE"
                "descripcion" => "<p id="par0060" class="elsevierStylePara elsevierViewall">neuron-specific enolase</p>"
              ]
              12 => array:2 [
                "termino" => "NT-proBNP"
                "descripcion" => "<p id="par0065" class="elsevierStylePara elsevierViewall">N-terminal pro-B-type natriuretic peptide</p>"
              ]
              13 => array:2 [
                "termino" => "PCI"
                "descripcion" => "<p id="par0070" class="elsevierStylePara elsevierViewall">percutaneous coronary intervention</p>"
              ]
              14 => array:2 [
                "termino" => "ROSC"
                "descripcion" => "<p id="par0075" class="elsevierStylePara elsevierViewall">return of spontaneous circulation</p>"
              ]
              15 => array:2 [
                "termino" => "STEMI"
                "descripcion" => "<p id="par0080" class="elsevierStylePara elsevierViewall">ST-segment elevation myocardial infarction</p>"
              ]
              16 => array:2 [
                "termino" => "TH"
                "descripcion" => "<p id="par0085" class="elsevierStylePara elsevierViewall">therapeutic hypothermia</p>"
              ]
              17 => array:2 [
                "termino" => "CA-CPR"
                "descripcion" => "<p id="par0090" class="elsevierStylePara elsevierViewall">time from collapse to cardiopulmonary resuscitation</p>"
              ]
              18 => array:2 [
                "termino" => "CA-ROSC"
                "descripcion" => "<p id="par0095" class="elsevierStylePara elsevierViewall">time from collapse to return of spontaneous circulation</p>"
              ]
              19 => array:2 [
                "termino" => "CA-TH"
                "descripcion" => "<p id="par0100" class="elsevierStylePara elsevierViewall">time from collapse to beginning of therapeutic hypothermia</p>"
              ]
              20 => array:2 [
                "termino" => "TTE"
                "descripcion" => "<p id="par0105" class="elsevierStylePara elsevierViewall">transthoracic echocardiography</p>"
              ]
              21 => array:2 [
                "termino" => "VF"
                "descripcion" => "<p id="par0110" class="elsevierStylePara elsevierViewall">ventricular fibrillation</p>"
              ]
            ]
          ]
        ]
      ]
    ]
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      0 => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 759
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        "descripcion" => array:1 [
          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Microorganisms isolated in bronchial secretions&#46;</p>"
        ]
      ]
      1 => array:8 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at1"
            "detalle" => "Table "
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        "tabla" => array:3 [
          "leyenda" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">ALT&#58; alanine transaminase&#59; AST&#58; aspartate transaminase&#59; BMI&#58; body mass index&#59; BNP&#58; B-type natriuretic peptide&#59; BUN&#58; blood urea nitrogen&#59; CV&#58; cardiovascular&#59; eGFR&#58; estimated glomerular filtration rate &#40;Modification of Diet in Renal Disease formula&#41;&#59; GCS&#58; Glasgow Coma Scale&#59; LV&#58; left ventricular&#59; NSE&#58; neuron-specific enolase&#59; CA-CPR&#58; time from collapse to cardiopulmonary resuscitation&#59; CA-ROSC&#58; time from collapse to return of spontaneous circulation&#59; CA-TH&#58; time from collapse to beginning of therapeutic hypothermia&#59; VF&#58; ventricular fibrillation&#46;</p>"
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              "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" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Characteristics&#44; n &#40;&#37;&#41; or mean &#177; SD&nbsp;\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">Study population &#40;n&#61;15&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Gender</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Male&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10 &#40;66&#46;6&#37;&#41;&nbsp;\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"><span class="elsevierStyleHsp" style=""></span>Female&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5 &#40;33&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Age&#44; years</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">47&#46;3&#177;14&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">CV risk factors</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Hypertension&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6 &#40;40&#46;0&#37;&#41;&nbsp;\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"><span class="elsevierStyleHsp" style=""></span>Diabetes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3 &#40;20&#46;0&#37;&#41;&nbsp;\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"><span class="elsevierStyleHsp" style=""></span>Dyslipidemia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5 &#40;33&#46;3&#37;&#41;&nbsp;\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"><span class="elsevierStyleHsp" style=""></span>Active smoking&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6 &#40;40&#46;0&#37;&#41;&nbsp;\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"><span class="elsevierStyleHsp" style=""></span>BMI &#8805;25 kg&#47;m<span class="elsevierStyleSup">2</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2 &#40;13&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Location of cardiac arrest</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Out-of-hospital&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">11 &#40;73&#46;3&#37;&#41;&nbsp;\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"><span class="elsevierStyleHsp" style=""></span>In-hospital&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4 &#40;26&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">VF rhythm at presentation</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10 &#40;66&#46;7&#37;&#41;&nbsp;\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"><span class="elsevierStyleItalic">Asystole rhythm at presentation</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5 &#40;33&#46;3&#37;&#41;&nbsp;\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"><span class="elsevierStyleItalic">CA-CPR&#44; min</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">14&#46;3&#177;12&#46;4&nbsp;\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"><span class="elsevierStyleItalic">CA-ROSC&#44; min</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">44&#46;7&#177;36&#46;5&nbsp;\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"><span class="elsevierStyleItalic">CA-TH&#44; min</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">342&#177;186&nbsp;\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"><span class="elsevierStyleItalic">GCS</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5&#46;1&#177;2&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Laboratory values</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Hemoglobin&#44; g&#47;dl<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">13&#46;5&#177;2&#46;3&nbsp;\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"><span class="elsevierStyleHsp" style=""></span>Sodium&#44; mmol&#47;l<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">139&#46;9&#177;5&#46;5&nbsp;\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"><span class="elsevierStyleHsp" style=""></span>Potassium&#44; mmol&#47;l<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&#46;8&#177;1&#46;0&nbsp;\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"><span class="elsevierStyleHsp" style=""></span>Total bilirubin&#44; &#956;mol&#47;l<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10&#46;9&#177;6&#46;9&nbsp;\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"><span class="elsevierStyleHsp" style=""></span>AST&#44; U&#47;l<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">281&#46;7&#177;335&#46;5&nbsp;\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"><span class="elsevierStyleHsp" style=""></span>ALT&#44; U&#47;l<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">171&#46;4&#177;160&#46;4&nbsp;\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"><span class="elsevierStyleHsp" style=""></span>NSE&#44; &#956;g&#47;l<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">93&#46;7&#177;109&#46;0&nbsp;\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"><span class="elsevierStyleHsp" style=""></span>Troponin I&#44; ng&#47;ml<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">38&#46;0&#177;42&#46;5&nbsp;\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"><span class="elsevierStyleHsp" style=""></span>BNP&#44; pg&#47;ml<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">415&#46;0&#177;373&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Renal function</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Creatinine&#44; mg&#47;dl<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#46;19&#177;6&#46;9&nbsp;\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"><span class="elsevierStyleHsp" style=""></span>BUN&#44; mmol&#47;l<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7&#46;0&#177;3&#46;7&nbsp;\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"><span class="elsevierStyleHsp" style=""></span>eGFR&#44; ml&#47;min&#47;1&#46;73 m<span class="elsevierStyleSup">2</span><a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">65&#46;3&#177;19&#46;2&nbsp;\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"><span class="elsevierStyleHsp" style=""></span>eGFR &#60;60 ml&#47;min&#47;1&#46;73 m<span class="elsevierStyleSup">2</span><a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6 &#40;40&#46;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">LV function</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">14 &#40;93&#46;3&#37;&#41;&nbsp;\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"><span class="elsevierStyleItalic">LV diastolic dimension&#44; mm</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">52&#177;6&#46;4&nbsp;\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"><span class="elsevierStyleItalic">LV systolic dimension&#44; mm</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">35&#177;8&#46;2&nbsp;\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"><span class="elsevierStyleItalic">LV fractional shortening&#44; &#37;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">36&#46;8&#177;3&#46;3&nbsp;\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"><span class="elsevierStyleItalic">&#8220;Eyeball&#8221; LV ejection fraction &#60;50&#37;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6 &#40;42&#46;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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          "leyenda" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">ARVC&#58; arrhythmogenic right ventricular cardiomyopathy&#59; HCM&#58; hypertrophic cardiomyopathy&#59; LAD&#58; left anterior descending artery&#59; LCX&#58; circumflex artery&#59; LVNC&#58; left ventricular non-compaction&#59; MI&#58; myocardial infarction&#59; PCI&#58; percutaneous coronary intervention&#46;</p>"
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                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" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Diagnosis&#44; n &#40;&#37;&#41;&nbsp;\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">Study population &#40;n&#61;15&#41;&nbsp;\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"><span class="elsevierStyleItalic">MI</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10 &#40;66&#46;6&#37;&#41;&nbsp;\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"><span class="elsevierStyleHsp" style=""></span>ST-elevation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6 &#40;40&#46;0&#37;&#41;&nbsp;\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"><span class="elsevierStyleHsp" style=""></span>Non-ST-elevation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4 &#40;26&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Cardiomyopathies</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3 &#40;20&#46;0&#37;&#41;&nbsp;\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"><span class="elsevierStyleHsp" style=""></span>ARVC&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;6&#46;7&#37;&#41;&nbsp;\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"><span class="elsevierStyleHsp" style=""></span>HCM&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;6&#46;7&#37;&#41;&nbsp;\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"><span class="elsevierStyleHsp" style=""></span>LVNC&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;6&#46;7&#37;&#41;&nbsp;\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"><span class="elsevierStyleHsp" style=""></span>Type 1 Brugada syndrome&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;6&#46;7&#37;&#41;&nbsp;\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"><span class="elsevierStyleHsp" style=""></span>Unknown diagnosis<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;6&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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            1 => array:2 [
              "tabla" => array:1 [
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                  <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" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Treatment&#44; n &#40;&#37;&#41;&nbsp;\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">Study population &#40;n&#61;15&#41;&nbsp;\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"><span class="elsevierStyleItalic">Coronary angiography</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">14 &#40;93&#46;3&#37;&#41;&nbsp;\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"><span class="elsevierStyleItalic">Normal epicardial coronary arteries</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4 &#40;28&#46;6&#37;&#41;&nbsp;\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"><span class="elsevierStyleItalic">Significant coronary angiographic lesions</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10 &#40;71&#46;4&#37;&#41;&nbsp;\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"><span class="elsevierStyleItalic">PCI</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9 &#40;60&#46;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Primary angioplasty</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6 &#40;66&#46;7&#37;&#41;&nbsp;\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"><span class="elsevierStyleHsp" style=""></span>LAD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5 &#40;83&#46;3&#37;&#41;&nbsp;\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"><span class="elsevierStyleHsp" style=""></span>LCX&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;16&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Non-primary angioplasty</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3 &#40;33&#46;3&#37;&#41;&nbsp;\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"><span class="elsevierStyleHsp" style=""></span>LAD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;66&#46;7&#37;&#41;&nbsp;\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"><span class="elsevierStyleHsp" style=""></span>LCX&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;33&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Implanted cardioverter-defibrillator</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4 &#40;26&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "leyenda" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">AF&#58; atrial fibrillation&#59; AFL&#58; atrial flutter&#59; VF&#58; ventricular fibrillation&#59; VT&#58; ventricular tachycardia&#46;</p>"
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                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Event&#44; n &#40;&#37;&#41;&nbsp;\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">Study population &#40;n&#61;15&#41;&nbsp;\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"><span class="elsevierStyleItalic">Shivering</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15 &#40;100&#46;0&#37;&#41;&nbsp;\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"><span class="elsevierStyleItalic">Electrolyte disturbances</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15 &#40;100&#46;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15 &#40;100&#46;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">13 &#40;86&#46;7&#37;&#41;&nbsp;\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"><span class="elsevierStyleItalic">Arrhythmias</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7 &#40;46&#46;7&#37;&#41;&nbsp;\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"><span class="elsevierStyleItalic">Sinus bradycardia</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5 &#40;71&#46;4&#37;&#41;&nbsp;\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"><span class="elsevierStyleItalic">AFL&#47;AF</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3 &#40;42&#46;9&#37;&#41;&nbsp;\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"><span class="elsevierStyleItalic">VF&#47;VT</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;14&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Bleeding</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3 &#40;20&#46;0&#37;&#41;&nbsp;\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"><span class="elsevierStyleHsp" style=""></span>Major&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;33&#46;3&#37;&#41;&nbsp;\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"><span class="elsevierStyleHsp" style=""></span>Non-major&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;66&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Tonic-clonic status epilepticus</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;13&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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          "en" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Adverse events during therapeutic hypothermia&#46;</p>"
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          "leyenda" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">BMI&#58; body mass index&#59; BNP&#58; B-type natriuretic peptide&#59; BUN&#58; blood urea nitrogen&#59; CA-CPR&#58; time from collapse to cardiopulmonary resuscitation&#59; CA-ROSC&#58; time from collapse to return of spontaneous circulation&#59; CA-TH&#58; time from collapse to beginning of therapeutic hypothermia&#59; CV&#58; cardiovascular&#59; eGFR&#58; estimated glomerular filtration rate &#40;Modification of Diet in Renal Disease formula&#41;&#59; GCS&#58; Glasgow Coma Scale&#59; LV&#58; left ventricular&#59; NSE&#58; neuron-specific enolase&#59; PCI&#58; percutaneous coronary intervention&#59; VF&#58; ventricular fibrillation&#46;</p>"
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                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Characteristics&#44; n &#40;&#37;&#41; or mean &#177; SD&nbsp;\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">Survivor group &#40;n&#61;7&#41;&nbsp;\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">Non-survivor group &#40;n&#61;8&#41;&nbsp;\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">p&nbsp;\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"><span class="elsevierStyleItalic">Gender&#44; male</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5 &#40;71&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5 &#40;62&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;724&nbsp;\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"><span class="elsevierStyleItalic">Age&#44; years</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">38&#46;4&#177;10&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">55&#46;1&#177;13&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;032&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">CV risk factors</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3 &#40;42&#46;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7 &#40;87&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;077&nbsp;\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"><span class="elsevierStyleHsp" style=""></span>Hypertension&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2 &#40;28&#46;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4 &#40;50&#46;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;414&nbsp;\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"><span class="elsevierStyleHsp" style=""></span>Diabetes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0 &#40;0&#46;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3 &#40;37&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;080&nbsp;\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"><span class="elsevierStyleHsp" style=""></span>Dyslipidemia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2 &#40;28&#46;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3 &#40;37&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;724&nbsp;\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"><span class="elsevierStyleHsp" style=""></span>Active smoking&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2 &#40;28&#46;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4 &#40;50&#46;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;414&nbsp;\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"><span class="elsevierStyleHsp" style=""></span>BMI &#8805;25 kg&#47;m<span class="elsevierStyleSup">2</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0 &#40;0&#46;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2 &#40;25&#46;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;170&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Out-of-hospital cardiac arrest</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5 &#40;71&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6 &#40;75&#46;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;880&nbsp;\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"><span class="elsevierStyleItalic">VF rhythm at presentation</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6 &#40;85&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4 &#40;50&#46;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;157&nbsp;\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"><span class="elsevierStyleItalic">CA-CPR&#44; min</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">9&#46;4&#177;4&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">18&#46;5&#177;15&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;473&nbsp;\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"><span class="elsevierStyleItalic">CA-ROSC&#44; min</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">22&#46;9&#177;12&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">63&#46;8&#177;40&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;048&nbsp;\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"><span class="elsevierStyleItalic">CA-TH&#44; min</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">348&#177;138&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">336&#177;234&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;601&nbsp;\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"><span class="elsevierStyleItalic">GCS</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5&#46;9&#177;3&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&#46;5&#177;2&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;413&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleItalic">Laboratory values</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Hemoglobin&#44; g&#47;dl<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">13&#46;8&#177;3&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">13&#46;3&#177;1&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;417&nbsp;\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"><span class="elsevierStyleHsp" style=""></span>Sodium&#44; mmol&#47;l<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">140&#46;7&#177;7&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">139&#46;1&#177;3&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;685&nbsp;\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"><span class="elsevierStyleHsp" style=""></span>Potassium&#44; mmol&#47;l<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&#46;5&#177;0&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&#46;1&#177;1&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;450&nbsp;\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"><span class="elsevierStyleHsp" style=""></span>Total bilirubin&#44; &#956;mol&#47;l<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">13&#46;3&#177;7&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8&#46;9&#177;5&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;247&nbsp;\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"><span class="elsevierStyleHsp" style=""></span>AST&#44; U&#47;l<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">145&#46;6&#177;112&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">400&#46;8&#177;423&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;418&nbsp;\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"><span class="elsevierStyleHsp" style=""></span>ALT&#44; U&#47;l<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">83&#46;6&#177;43&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">248&#46;3&#177;188&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;203&nbsp;\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"><span class="elsevierStyleHsp" style=""></span>NSE&#44; &#956;g&#47;l<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">42&#46;6&#177;35&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">138&#46;4&#177;133&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;020&nbsp;\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"><span class="elsevierStyleHsp" style=""></span>Troponin I&#44; ng&#47;ml<a class="elsevierStyleCrossRef" href="#tblfn0025"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">16&#46;5&#177;24&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">56&#46;8&#177;47&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;165&nbsp;\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"><span class="elsevierStyleHsp" style=""></span>BNP&#44; pg&#47;ml<a class="elsevierStyleCrossRef" href="#tblfn0025"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">339&#46;6&#177;401&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">479&#46;7&#177;365&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;475&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleItalic">Renal function</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Creatinine&#44; mg&#47;dl<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#46;1&#177;0&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#46;3&#177;0&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;354&nbsp;\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"><span class="elsevierStyleHsp" style=""></span>BUN&#44; mmol&#47;l<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6&#46;1&#177;1&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7&#46;7&#177;4&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;954&nbsp;\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"><span class="elsevierStyleHsp" style=""></span>eGFR&#44; ml&#47;min&#47;1&#46;73 m<span class="elsevierStyleSup">2</span><a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">72&#46;7&#177;12&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">58&#46;9&#177;22&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;183&nbsp;\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"><span class="elsevierStyleHsp" style=""></span>eGFR &#60;60 ml&#47;min&#47;1&#46;73 m<span class="elsevierStyleSup">2</span><a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2 &#40;28&#46;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4 &#40;50&#46;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;414&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleItalic">LV function</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Eyeball LV ejection fraction &#60;50&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0 &#40;0&#46;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6 &#40;75&#46;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;002&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleItalic">Treatment</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>PCI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3 &#40;42&#46;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6 &#40;75&#46;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;221&nbsp;\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"><span class="elsevierStyleHsp" style=""></span>Implanted cardioverter-defibrillator&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4 &#40;57&#46;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0 &#40;0&#46;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;016&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Length of ICU stay&#44; days</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">9&#46;0&#177;3&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">23&#46;1&#177;32&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;480&nbsp;\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"><span class="elsevierStyleItalic">Length of hospital stay&#44; days</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">16&#46;1&#177;7&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">28&#46;1&#177;35&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;908&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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              "nota" => "<p class="elsevierStyleNotepara" id="npar0025">Maximum values&#46;</p>"
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          "en" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Comparison of the survivor and non-survivor groups&#46;</p>"
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        "etiqueta" => "Table 5"
        "tipo" => "MULTIMEDIATABLA"
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          "leyenda" => "<p id="spar0095" class="elsevierStyleSimplePara elsevierViewall">CA-ROSC&#58; time from collapse to return of spontaneous circulation&#59; CI&#58; confidence interval&#59; CV&#58; cardiovascular&#59; NSE&#58; neuron-specific enolase&#59; OR&#58; odds ratio&#46;</p>"
          "tablatextoimagen" => array:1 [
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                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" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\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">OR&nbsp;\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">95&#37; CI&nbsp;\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">p&nbsp;\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">Age &#62;48 years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">18&#46;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;27-255&#46;74&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;023&nbsp;\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">&#8805;1 CV risk factors&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9&#46;33&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;711-122&#46;57&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;077&nbsp;\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">CA-ROSC &#62;35 min&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;17&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;47-36&#46;74&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;082&nbsp;\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">NSE &#62;76 &#956;g&#47;l&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&#46;50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;76-74&#46;16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;082&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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                0 => "xTab1387713.png"
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          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">Cut-off values of clinical predictors of mortality&#46;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:36 [
            0 => array:3 [
              "identificador" => "bib0185"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Global incidences of out-of-hospital cardiac arrest and survival rates&#58; systematic review of 67 prospective studies"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "J&#46; Berdowski"
                            1 => "R&#46;A&#46; Berg"
                            2 => "J&#46;G&#46;P&#46; Tijssen"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.resuscitation.2010.08.006"
                      "Revista" => array:6 [
                        "tituloSerie" => "Resuscitation"
                        "fecha" => "2010"
                        "volumen" => "81"
                        "paginaInicial" => "1479"
                        "paginaFinal" => "1487"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20828914"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0190"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Incidence of EMS-treated out-of-hospital cardiac arrest in Europe"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "C&#46; Atwood"
                            1 => "M&#46;S&#46; Eisenberg"
                            2 => "J&#46; Herlitz"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.resuscitation.2005.03.021"
                      "Revista" => array:6 [
                        "tituloSerie" => "Resuscitation"
                        "fecha" => "2005"
                        "volumen" => "67"
                        "paginaInicial" => "75"
                        "paginaFinal" => "80"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16199289"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0195"
              "etiqueta" => "3"
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