Abstract
BackgroundTo elucidate the incidence of acute kidney injury (AKI) after out-of-hospital cardiac arrest (OHCA) and to examine the impact of target temperature management (TTM) and early coronary angiography on renal function.MethodsPost hoc analysis of the TTM trial, a multinational randomised controlled trial comparing target temperature of 33 °C versus 36 °C in patients with return of spontaneous circulation after OHCA. The impact of TTM and early angiography (within 6 h of OHCA) versus late or no angiography on the development of AKI during the 7-day period after OHCA was analysed. AKI was defined according to modified KDIGO criteria in patients surviving beyond day 2 after OHCA.ResultsFollowing exclusions, 853 of 939 patients enrolled in the main trial were analysed. Unadjusted analysis showed that significantly more patients in the 33 °C group had AKI compared to the 36 °C group [211/431 (49%) versus 170/422 (40%) p = 0.01], with a worse severity (p = 0.018). After multivariable adjustment, the difference was not significant (odds ratio 0.75, 95% confidence interval 0.54–1.06, p = 0.10].Five hundred seventeen patients underwent early coronary angiography. Although the unadjusted analysis showed less AKI and less severe AKI in patients who underwent early angiography compared to patients with late or no angiography, in adjusted analyses, early angiography was not an independent risk factor for AKI (odds ratio 0.73, 95% confidence interval 0.50–1.05, p = 0.09).ConclusionsIn OHCA survivors, TTM at 33 °C compared to management at 36 °C did not show different rates of AKI and early angiography was not associated with an increased risk of AKI.Trial registrationNCT01020916. Registered on www.ClinicalTrials.gov 26 November 2009 (main trial).
Highlights
To elucidate the incidence of acute kidney injury (AKI) after out-of-hospital cardiac arrest (OHCA) and to examine the impact of target temperature management (TTM) and early coronary angiography on renal function
Cardiac arrest-related factors, treatment and renal outcome data split into AKI or no AKI during days 2–7 of Intensive care unit (ICU) stay Abbreviations: CHF chronic heart failure, Ischaemic heart disease (IHD) ischaemic heart disease, PCI percutaneous coronary intervention, AMI acute myocardial infarction, Coronary artery bypass grafting (CABG) coronary artery bypass grafting, CPR cardiopulmonary resuscitation, CA-ROSC time from cardiac arrest to return of spontaneous circulation, intra-aortic balloon pump counterpulsation (IABP) intra-aortic balloon pump, TTM target temperature management, RRT renal replacement therapy, NA not applicable versus 40%, p = 0.01)
The p values were calculated using Fisher’s exact test and Mann-Whitney test respectively Abbreviations: CHF chronic heart failure, IHD ischaemic heart disease, PCI percutaneous coronary intervention, AMI acute myocardial infarction, CABG coronary artery bypass grafting, CPR cardiopulmonary resuscitation, CA-ROSC time from cardiac arrest to return of spontaneous circulation, IABP intra-aortic balloon pump, TTM target temperature management, RRT renal replacement therapy
Summary
To elucidate the incidence of acute kidney injury (AKI) after out-of-hospital cardiac arrest (OHCA) and to examine the impact of target temperature management (TTM) and early coronary angiography on renal function. Neurological injury accounts for the majority of deaths, refractory cardiovascular failure is common. The post cardiac arrest syndrome is characterised by multi-organ dysfunction as a result of an acute inflammatory response and persistent haemodynamic instability. Acute kidney injury (AKI) is common in these circumstances, affecting 12–81% of patients depending on definition and patient selection [1, 2, 4, 5]. It is possible that routine therapeutic interventions and diagnostic procedures, such as target temperature management (TTM) and scans with contrast, impact the development of organ dysfunction, including the development of AKI
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