A comprehensive approach to refractory cardiac arrest: saving more lives one way or another

According with the last updated guidelines on resuscitation, the underlying cause of cardiac arrest (CA) should be identified, treated and, if possible, reversed with different strategies but a common target: to increase long-term survival with good neurologic recovery. At the same time, some countries have implemented protocols for donation after considering the irreversibility of cardiac arrest and the failure of resuscitation attempts. Both strategies are complementary and should coexist. Thus, we would be able to go beyond the refractory CA firstly and, if not indicated or unsuccessful, we could increase the organ donation pool after confirming irreversibility. International recommendations on resuscitation (1) highlight the importance of high-quality cardiopulmonary resuscitation (CPR) based on minimal interruptions, focused on determining the cause of the cardiac arrest and offering, as early as possible, etiological treatment of potential reversible causes. Several pioneering protocols have been developed throughout the world in order to provide a multidisciplinary approach to the out-of-hospital (OHCA) and in-hospital cardiac arrest (IHCA). Moreover, international programs including non-conventional resuscitation procedures (NCRPs) have been set up (2-7).