Renal Dysfunction is Common Following Resuscitation from Out-of-Hospital Cardiac Arrest.
Resuscitation. 2013 Apr 22;
Authors: Yanta J, Guyette FX, Doshi AA, Callaway CW, Rittenberger JC, Post Cardiac Arrest Service
BACKGROUND: Cardiac arrest patients often suffer from dysfunction of multiple organ systems after return of spontaneous circulation (ROSC). The incidence of renal dysfunction in patients with out-of-hospital cardiac arrest (OHCA) is not well described. Renal dysfunction has been associated with worse outcomes in critical illness. HYPOTHESIS: Renal dysfunction is common after OHCA, and renal dysfunction is independently associated with survival. METHODS: We performed a retrospective review of consecutive adult patients admitted to an intensive care unit after successful resuscitation from OHCA between 01/01/2005 and 12/31/2010. Patients were excluded for death or withdrawal of care within 24hours, preexisting end-stage renal disease, or OHCA due to hyperkalemia. The RIFLE criteria were used to classify subjects with renal dysfunction into one of three categories-Risk, Injury, or Failure-based on trending of serum creatinine concentration or glomerular filtration rate. Data were analyzed using descriptive statistics. RESULTS: Of 364 patients, 38 were excluded due to death or withdrawal of care within 24hours, 11 due to end-stage renal disease, and 4 due to OHCA from hyperkalemia, leaving 311 patients in the final analysis. The mean age was 58 (SD 16) years; 174 (59%) were male, VF/VT was the primary rhythm in 156 (50%), and 236 (80%) were comatose at hospital arrival. Among 311 patients, 32 (10.3%) developed acute renal failure (ARF), 27 (8.7%) developed acute kidney injury (AKI), and 56 (18.0%) developed risk of renal dysfunction. Of the 32 subjects that developed ARF, renal replacement therapy (RRT) was initiated on 13 (40.6%). Development of ARF was not associated with survival (OR 0.73; 95% CI 0.26, 2.05) after adjusting for initial rhythm or illness severity. CONCLUSIONS: More than one-third of patients resuscitated from OHCA developed evidence of renal dysfunction, and 19% of patients meeting criteria for AKI or ARF. In this study, development of renal failure was not independently associated with survival.
PMID: 23619738 [PubMed - as supplied by publisher]