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. 2013 Oct;84(10):1371-4.
doi: 10.1016/j.resuscitation.2013.03.037. Epub 2013 Apr 22.

Renal dysfunction is common following resuscitation from out-of-hospital cardiac arrest

Joseph Yanta  1 , Francis X Guyette, Ankur A Doshi, Clifton W Callaway, Jon C Rittenberger; Post Cardiac Arrest Service
Affiliations

Renal dysfunction is common following resuscitation from out-of-hospital cardiac arrest

Joseph Yanta et al. Resuscitation. 2013 Oct.

Abstract

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 24h, 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 24h, 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.

Keywords: Cardiac arrest; Critical care; Hypothermia; Outcomes; Prognostication; Renal injury.

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