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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Mortality and morbidity after cardiac arrest &#40;CA&#41; remain very high&#46; Survival rates at hospital discharge vary considerably between studies and regions&#44; but major European studies report survival of 15&#8211;34&#37; for in-hospital CA &#40;IHCA&#41;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> and 8&#37; for out-of-hospital CA &#40;OHCA&#41;&#44; with 26&#46;4&#37; survival for those admitted to hospital&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Survival rates after OHCA are highly dependent on the quality of the local chain of survival&#44; which includes rates of bystander basic life support&#44; quality of emergency medical services&#44; time to first defibrillation&#44; quality of advanced life support&#44; and post-resuscitation care&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a> On the other hand&#44; most patients who suffer IHCA will show signs of clinical deterioration in the hours preceding the event&#46; While the quality of the chain of survival in IHCA is also important&#44; recognizing those at risk of CA and timely initiation of appropriate therapeutic interventions is of the utmost importance for preventing it&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">But the endpoint cannot be just to survive&#46; It is important to survive with at least an acceptable quality of life&#46; There are many studies on survival&#44; but very few explore functional outcomes after CA&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Functional sequelae from CA are in part determined by the patient&#39;s underlying health status and arrest-specific factors&#44; but many aspects of medical care can influence outcomes&#46; The overall prevalence of good outcome &#40;defined primarily by the Cerebral Performance Category &#91;CPC&#93; score<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a>&#41; can range between 11&#37; and 63&#37; in different centers&#46; This variability is partially explained by in-hospital treatment decisions&#44; particularly regarding post-resuscitation care&#44; in which many measures are associated with outcome&#44; such as targeted temperature management&#44; glucose control&#44; oxygenation and ventilation techniques&#44; blood pressure management&#44; use of mechanical circulatory support&#44; sedation regimes&#44; and the application of multiple neuroprognostication methods&#46; The latter include modalities such as neuroimaging&#44; continuous electroencephalography&#44; biomarkers&#44; and monitoring of somatosensory evoked potential&#44; along with the routine practice of withdrawal of life-sustaining treatment&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">In Portugal&#44; data on post-resuscitation outcomes are scarce&#44; but it is essential to understand the situation in the country and the main reasons for it&#44; in order to take action to improve patients&#8217; prognosis&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">In this context&#44; Pratas et al&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a> designed a retrospective single-center study&#44; published in this issue of the <span class="elsevierStyleItalic">Journal</span>&#44; that included 97 patients admitted to the intensive care unit of Cova da Beira University Hospital Center after CA &#40;67&#37; IHCA&#41; between 2015 and 2019&#44; to analyze the survival curve&#44; independence&#44; quality of life&#44; and performance status after CA&#46; A survey assessing quality of life&#44; based on the validated EuroQoL EQ-5D-3L questionnaire and the Eastern Cooperative Oncology Group &#40;ECOG&#41; performance status scale&#44; was administered&#46; Unlike the CPC score&#44; these tools assess not just neurologic performance&#44; but also the ability to perform activities of daily living &#40;ADL&#41;&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Very interesting results were obtained&#46; The overall survival to hospital discharge rate was 32&#46;0&#37;&#44; which is similar to other Portuguese studies&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a> The quantitative variables with a significant role in survival to discharge were age and admission severity scores&#46; One year after CA&#44; only 20&#46;6&#37; were alive and only 13&#46;4&#37; &#40;65&#37; of the one-year survivors&#41; were independent&#44; a lower percentage than previously published&#44;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a> but this is difficult to interpret due to the heterogeneity between samples&#46; Variables that had a significant impact on one-year survival after discharge were depression&#44; length of hospital stay &#40;LOHS&#41;&#44; dependence for ADL and being in long-term health care facilities after CA&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Fifty percent of previously independent patients became dependent&#44; and 47&#46;4&#37; of those previously at home were admitted to long-term care facilities&#46; Diabetes&#44; age and LOHS were major factors in loss of independence&#46; Only 12 patients were eligible for application of the questionnaire&#44; of whom nine actually responded &#40;three contact attempts failed&#41;&#46; Surprisingly&#44; mean EQ-5D quality of life index &#40;0&#46;528&#177;0&#46;297&#41; and the most affected domains &#40;&#8216;Pain&#47;discomfort&#8217; and &#8216;Anxiety&#47;depression&#8217;&#41; were similar to the overall Portuguese population aged &#62;30 years&#44; based on data published 10 years ago&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a> Seven patients &#40;78&#37;&#41; had a good performance status &#40;ECOG score 0&#8211;1&#41;&#44; but most &#40;66&#46;7&#37;&#41; reported lower quality of life after CA and only two &#40;22&#46;2&#37;&#41; were fully active without restriction&#46; Due to the retrospective nature of the study &#40;with missing data&#41; and the small sample&#44; the authors were unable to correlate data from the CA event and the post-CA period&#44; including data derived from multimodal neuroprognostication&#44; with subsequent quality of life and performance status&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">In conclusion&#44; overall survival from CA&#44; although improving&#44; remains low&#46; Among survivors&#44; there was a significant level of dependence after CA and a decline in quality of life&#46; These data are in line with previous publications&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a> Although some studies report good outcomes after CA when using standard scores such as CPC&#44;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a> survivors do report a deterioration in quality of life&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">There is much to do&#44; right now&#46; Unfortunately&#44; at present there is no risk-adjustment standard for benchmarking hospital performance&#46; Prospective controlled studies in resuscitation are needed&#46; This requires collaboration across multiple sites&#44; thorough organization and careful ethical consideration&#46; In the meantime&#44; it is essential to make a common effort to improve all links of the chain of survival&#44; from identification of CA to the post-resuscitation care period and recovery&#44; with well-designed multidisciplinary rehabilitation plans and facilities&#44; so that survival with at least an acceptable quality of life can improve&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0055" class="elsevierStylePara elsevierViewall">The author has no conflicts of interest to declare&#46;</p></span></span>"
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Cardiac arrest: It is important not just to survive, but to survive with at least an acceptable quality of life
Paragem cardíaca: é importante não apenas sobreviver, mas sobreviver com o mínimo de qualidade de vida considerada aceitável
Doroteia Silvaa,b
a Serviço de Medicina Intensiva e Equipa de Insuficiência Cardíaca – Unidade Local de Saúde de Santa Maria, Lisboa, Portugal
b CCUL, Faculdade de Medicina de Lisboa, Centro Académico de Medicina de Lisboa, Lisboa, Portugal
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    "titulo" => "Cardiac arrest&#58; It is important not just to survive&#44; but to survive with at least an acceptable quality of life"
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        "titulo" => "Paragem card&#237;aca&#58; &#233; importante n&#227;o apenas sobreviver&#44; mas sobreviver com o m&#237;nimo de qualidade de vida considerada aceit&#225;vel"
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Mortality and morbidity after cardiac arrest &#40;CA&#41; remain very high&#46; Survival rates at hospital discharge vary considerably between studies and regions&#44; but major European studies report survival of 15&#8211;34&#37; for in-hospital CA &#40;IHCA&#41;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> and 8&#37; for out-of-hospital CA &#40;OHCA&#41;&#44; with 26&#46;4&#37; survival for those admitted to hospital&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Survival rates after OHCA are highly dependent on the quality of the local chain of survival&#44; which includes rates of bystander basic life support&#44; quality of emergency medical services&#44; time to first defibrillation&#44; quality of advanced life support&#44; and post-resuscitation care&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a> On the other hand&#44; most patients who suffer IHCA will show signs of clinical deterioration in the hours preceding the event&#46; While the quality of the chain of survival in IHCA is also important&#44; recognizing those at risk of CA and timely initiation of appropriate therapeutic interventions is of the utmost importance for preventing it&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">But the endpoint cannot be just to survive&#46; It is important to survive with at least an acceptable quality of life&#46; There are many studies on survival&#44; but very few explore functional outcomes after CA&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Functional sequelae from CA are in part determined by the patient&#39;s underlying health status and arrest-specific factors&#44; but many aspects of medical care can influence outcomes&#46; The overall prevalence of good outcome &#40;defined primarily by the Cerebral Performance Category &#91;CPC&#93; score<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a>&#41; can range between 11&#37; and 63&#37; in different centers&#46; This variability is partially explained by in-hospital treatment decisions&#44; particularly regarding post-resuscitation care&#44; in which many measures are associated with outcome&#44; such as targeted temperature management&#44; glucose control&#44; oxygenation and ventilation techniques&#44; blood pressure management&#44; use of mechanical circulatory support&#44; sedation regimes&#44; and the application of multiple neuroprognostication methods&#46; The latter include modalities such as neuroimaging&#44; continuous electroencephalography&#44; biomarkers&#44; and monitoring of somatosensory evoked potential&#44; along with the routine practice of withdrawal of life-sustaining treatment&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">In Portugal&#44; data on post-resuscitation outcomes are scarce&#44; but it is essential to understand the situation in the country and the main reasons for it&#44; in order to take action to improve patients&#8217; prognosis&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">In this context&#44; Pratas et al&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a> designed a retrospective single-center study&#44; published in this issue of the <span class="elsevierStyleItalic">Journal</span>&#44; that included 97 patients admitted to the intensive care unit of Cova da Beira University Hospital Center after CA &#40;67&#37; IHCA&#41; between 2015 and 2019&#44; to analyze the survival curve&#44; independence&#44; quality of life&#44; and performance status after CA&#46; A survey assessing quality of life&#44; based on the validated EuroQoL EQ-5D-3L questionnaire and the Eastern Cooperative Oncology Group &#40;ECOG&#41; performance status scale&#44; was administered&#46; Unlike the CPC score&#44; these tools assess not just neurologic performance&#44; but also the ability to perform activities of daily living &#40;ADL&#41;&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Very interesting results were obtained&#46; The overall survival to hospital discharge rate was 32&#46;0&#37;&#44; which is similar to other Portuguese studies&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a> The quantitative variables with a significant role in survival to discharge were age and admission severity scores&#46; One year after CA&#44; only 20&#46;6&#37; were alive and only 13&#46;4&#37; &#40;65&#37; of the one-year survivors&#41; were independent&#44; a lower percentage than previously published&#44;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a> but this is difficult to interpret due to the heterogeneity between samples&#46; Variables that had a significant impact on one-year survival after discharge were depression&#44; length of hospital stay &#40;LOHS&#41;&#44; dependence for ADL and being in long-term health care facilities after CA&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Fifty percent of previously independent patients became dependent&#44; and 47&#46;4&#37; of those previously at home were admitted to long-term care facilities&#46; Diabetes&#44; age and LOHS were major factors in loss of independence&#46; Only 12 patients were eligible for application of the questionnaire&#44; of whom nine actually responded &#40;three contact attempts failed&#41;&#46; Surprisingly&#44; mean EQ-5D quality of life index &#40;0&#46;528&#177;0&#46;297&#41; and the most affected domains &#40;&#8216;Pain&#47;discomfort&#8217; and &#8216;Anxiety&#47;depression&#8217;&#41; were similar to the overall Portuguese population aged &#62;30 years&#44; based on data published 10 years ago&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a> Seven patients &#40;78&#37;&#41; had a good performance status &#40;ECOG score 0&#8211;1&#41;&#44; but most &#40;66&#46;7&#37;&#41; reported lower quality of life after CA and only two &#40;22&#46;2&#37;&#41; were fully active without restriction&#46; Due to the retrospective nature of the study &#40;with missing data&#41; and the small sample&#44; the authors were unable to correlate data from the CA event and the post-CA period&#44; including data derived from multimodal neuroprognostication&#44; with subsequent quality of life and performance status&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">In conclusion&#44; overall survival from CA&#44; although improving&#44; remains low&#46; Among survivors&#44; there was a significant level of dependence after CA and a decline in quality of life&#46; These data are in line with previous publications&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a> Although some studies report good outcomes after CA when using standard scores such as CPC&#44;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a> survivors do report a deterioration in quality of life&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">There is much to do&#44; right now&#46; Unfortunately&#44; at present there is no risk-adjustment standard for benchmarking hospital performance&#46; Prospective controlled studies in resuscitation are needed&#46; This requires collaboration across multiple sites&#44; thorough organization and careful ethical consideration&#46; In the meantime&#44; it is essential to make a common effort to improve all links of the chain of survival&#44; from identification of CA to the post-resuscitation care period and recovery&#44; with well-designed multidisciplinary rehabilitation plans and facilities&#44; so that survival with at least an acceptable quality of life can improve&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0055" class="elsevierStylePara elsevierViewall">The author has no conflicts of interest to declare&#46;</p></span></span>"
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ISSN: 08702551
Idioma original: Inglês
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Revista Portuguesa de Cardiologia
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Are you a health professional able to prescribe or dispense drugs?

Você é um profissional de saúde habilitado a prescrever ou dispensar medicamentos

Ao assinalar que é «Profissional de Saúde», declara conhecer e aceitar que a responsável pelo tratamento dos dados pessoais dos utilizadores da página de internet da Revista Portuguesa de Cardiologia (RPC), é esta entidade, com sede no Campo Grande, n.º 28, 13.º, 1700-093 Lisboa, com os telefones 217 970 685 e 217 817 630, fax 217 931 095 e com o endereço de correio eletrónico revista@spc.pt. Declaro para todos os fins, que assumo inteira responsabilidade pela veracidade e exatidão da afirmação aqui fornecida.