scholarly journals Recovery from acute kidney injury is a potent predictor of survival and good neurological outcome at discharge after out-of-hospital cardiac arrest: Fact or fiction

2021 ◽  
Vol 9 (1) ◽  
pp. 57-58
Author(s):  
Patrick M. Honore ◽  
Luc Kugener ◽  
Sebastien Redant ◽  
Rachid Attou ◽  
Andrea Gallerani ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Cardiac Arrest ◽  
Neurological Outcome ◽  
Kidney Injury ◽  
Good Neurological Outcome ◽  
Potent Predictor ◽  
Hospital Cardiac Arrest

scholarly journals Recovery from acute kidney injury is an independent predictor of survival at 30 days only after out-of-hospital cardiac arrest who were treated by targeted temperature management

2021 ◽  
Keyword(s):  
Acute Kidney Injury ◽  
Cardiac Arrest ◽  
Multivariate Analysis ◽  
Neurological Outcome ◽  
Independent Predictor ◽  
Kidney Injury ◽  
Targeted Temperature Management ◽  
Temperature Management ◽  
Recovery Group ◽  
Hospital Cardiac Arrest

Background: Development of acute kidney injury (AKI) after out-of-hospital cardiac arrest (OHCA) is associated with mortality and poor neurological outcome. However, the effect of recovery from AKI after OHCA is uncertain. This study investigates whether recovery from AKI was associated with the rate of survival and neurological outcome at 30 days after OHCA. Methods: This is a prospective multicentre observational cohort study of adult OHCA patients treated with targeted temperature management (TTM) across five hospitals in South Korea between February 2019 and July 2020. AKI was diagnosed using the Kidney Disease: Improving Global Outcomes criteria. The primary outcome was the rate of survival at 30 days, and the secondary outcome was the rate of survival with a favourable neurological outcome at 30 days, defined by a score of 3 or less on the modified Rankin scale. Results: Among the 2,018 patients with OHCA, 79 were treated with TTM. After excluding two patients with incomplete data on outcomes, 77 were analysed. AKI developed in 43 (56%) patients. Among them, 22 (51%) recovered from AKI. Although the rate of survival at 30 days for the recovery group was superior to the non-recovery group (82% vs. 24%, P < 0.001), the rate of survival with a favourable neurological outcome at 30 days for the recovery group was not different than that for the non-recovery group (32% vs. 10%, P = 0.132). Recovery from AKI was an independent predictor of survival at 30 days after OHCA in the multivariate analysis (adjusted odds ratio, 22.737; 95% confidence interval, 3.814-135.533; P = 0.001); however, it was not associated with a favourable neurological outcome at 30 days after OHCA in the multivariate analysis. Conclusion: Recovery from AKI was an independent predictor of survival at 30 days only after OHCA who were treated by TTM.

scholarly journals Acute kidney injury after in-hospital cardiac arrest

Resuscitation ◽  
2021 ◽  
Vol 160 ◽  
pp. 49-58
Author(s):  
Kenneth E. Mah ◽  
Jeffrey A. Alten ◽  
Timothy T. Cornell ◽  
David T. Selewski ◽  
David Askenazi ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Cardiac Arrest ◽  
Kidney Injury ◽  
Hospital Cardiac Arrest

scholarly journals Mechanical circulatory support for refractory out-of-hospital cardiac arrest: a Danish nationwide multicenter study

Critical Care ◽  
2021 ◽  
Vol 25 (1) ◽  
Author(s):  
Sivagowry Rasalingam Mørk ◽  
Carsten Stengaard ◽  
Louise Linde ◽  
Jacob Eifer Møller ◽  
Lisette Okkels Jensen ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Cardiac Arrest ◽  
Survival Rate ◽  
Neurological Outcome ◽  
Mechanical Circulatory Support ◽  
Circulatory Support ◽  
Good Neurological Outcome ◽  
Factors Associated ◽  
National Consensus ◽  
Hospital Cardiac Arrest

Abstract Background Mechanical circulatory support (MCS) with either extracorporeal membrane oxygenation or Impella has shown potential as a salvage therapy for patients with refractory out-of-hospital cardiac arrest (OHCA). The objective of this study was to describe the gradual implementation, survival and adherence to the national consensus with respect to use of MCS for OHCA in Denmark, and to identify factors associated with outcome. Methods This retrospective, observational cohort study included patients receiving MCS for OHCA at all tertiary cardiac arrest centers (n = 4) in Denmark between July 2011 and December 2020. Logistic regression and Kaplan–Meier survival analysis were used to determine association with outcome. Outcome was presented as survival to hospital discharge with good neurological outcome, 30-day survival and predictors of 30-day mortality. Results A total of 259 patients were included in the study. Thirty-day survival was 26%. Sixty-five (25%) survived to hospital discharge and a good neurological outcome (Glasgow–Pittsburgh Cerebral Performance Categories 1–2) was observed in 94% of these patients. Strict adherence to the national consensus showed a 30-day survival rate of 30% compared with 22% in patients violating one or more criteria. Adding criteria to the national consensus such as signs of life during cardiopulmonary resuscitation (CPR), pre-hospital low-flow < 100 min, pH > 6.8 and lactate < 15 mmol/L increased the survival rate to 48%, but would exclude 58% of the survivors from the current cohort. Logistic regression identified asystole (RR 1.36, 95% CI 1.18–1.57), pulseless electrical activity (RR 1.20, 95% CI 1.03–1.41), initial pH < 6.8 (RR 1.28, 95% CI 1.12–1.46) and lactate levels > 15 mmol/L (RR 1.16, 95% CI 1.16–1.53) as factors associated with increased risk of 30-day mortality. Patients presenting signs of life during CPR had reduced risk of 30-day mortality (RR 0.63, 95% CI 0.52–0.76). Conclusions A high survival rate with a good neurological outcome was observed in this Danish population of patients treated with MCS for OHCA. Stringent patient selection for MCS may produce higher survival rates but potentially withholds life-saving treatment in a significant proportion of survivors.

scholarly journals Markers of cardiogenic shock predict persistent acute kidney injury after out of hospital cardiac arrest

Heart & Lung ◽  
2019 ◽  
Vol 48 (2) ◽  
pp. 126-130 ◽  
Author(s):  
Erik Roman-Pognuz ◽  
Jonathan Elmer ◽  
Jon C Rittenberger ◽  
Francis X Guyette ◽  
Giorgio Berlot ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Cardiac Arrest ◽  
Cardiogenic Shock ◽  
Kidney Injury ◽  
Hospital Cardiac Arrest

P1706Neurological outcome in patients with out-of-hospital cardiac arrest undergoing a standardised protocol including therapeutic hypothermia and routine coronary angiography

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M Akin ◽  
V Garcheva ◽  
J T Sieweke ◽  
J Tongers ◽  
L C Napp ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Coronary Angiography ◽  
Therapeutic Hypothermia ◽  
Neurological Outcome ◽  
Life Support ◽  
Neuron Specific Enolase ◽  
Good Neurological Outcome ◽  
Male Predominance ◽  
S 100 ◽  
Hospital Cardiac Arrest

Abstract Purpose To establish cut-offs for neuromarkers such as neuron-specific enolase (NSE) and S-100 predicting good neurological outcome for patients treated with therapeutic hypothermia with out-of-hospital cardiac arrest (OHCA) and return of spontaneous circulation (ROSC) as current cut-offs had been derived from normothermic cohorts. Methods Consecutive data of all patients with OHCA admitted to our institution between 01/2011 and 12/2016 were collected in a database. Patient received standard intensive care according to the Hannover Cardiac Resuscitation Algorithm (HaCRA) including mandatory hypothermia. Neurological markers such as neuron-specific enolase (NSE) and S-100 have been used to assess neurological damage following OHCA. Results Mean age of overall patient population (n=302) was 63±14 [54–74] years with a male predominance (77%). Cardiac arrest was witnessed in 81% and bystander cardiopulmonal resuscitation (CPR) was performed in 67%. Initial rhythm was ventricular fibrillation in 69%. ROSC had been achieved after 24±17 minutes. Hypothermia was applied in all patients. In 95% percutaneous coronary angiography and in 57% of them coronary intervention was performed. After ROSC, STEMI was present in 44%. Mechanical support was required in 19%. 30 day mortality was 44% in the total cohort. Mean NSE was 27±69 μg/l, mean NSE with good neurological outcome was 20±8.7 μg/l, highest NSE with good neurological outcome was 46 μg/l. Mean S-100 was 0.114±2.037μg/l, mean S-100 with good neurological outcome was 0.068±0.067 μg/l, highest S-100 with good neurological outcome was 0.360 μg/l. Conclusion Even when using a strict protocol for OHCA patients and routinely applying therapeutic hypothermia, the cut-offs for NSE and S-100 regarding good neurological outcome are similar to those reported before without therapeutic hypothermia, but they must not be used solitary to withdraw life support as even very high markers can be associated with goof neurological outcome in individual patients.

Sign in / Sign up

Export Citation Format

Share Document