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Cardiac output during targeted temperature management and renal function after out-of-hospital cardiac arrest

Grand, Johannes ; Bro-Jeppesen, John ; Hassager, Christian ; Rundgren, Malin LU ; Winther-Jensen, Matilde ; Thomsen, Jakob Hartvig ; Nielsen, Niklas LU ; Wanscher, Michael and Kjærgaard, Jesper (2019) In Journal of Critical Care 54. p.65-73
Abstract

Purpose: After resuscitation from out-of-hospital cardiac arrest (OHCA), renal injury and hemodynamic instability are common. We aimed to assess the association between low cardiac output during targeted temperature management (TTM) and acute kidney injury (AKI) after OHCA. Materials and methods: Single-center substudy of 171 patients included in the prospective, randomized TTM-trial. Hemodynamic evaluation was performed with serial measurements by pulmonary artery catheter. AKI was the primary endpoint and was defined according to the KDIGO-criteria. Results: Of 152 patients with available hemodynamic data, 49 (32%) had AKI and 21 (14%) had AKI with need for renal replacement therapy (RRT) in the first three days. During targeted... (More)

Purpose: After resuscitation from out-of-hospital cardiac arrest (OHCA), renal injury and hemodynamic instability are common. We aimed to assess the association between low cardiac output during targeted temperature management (TTM) and acute kidney injury (AKI) after OHCA. Materials and methods: Single-center substudy of 171 patients included in the prospective, randomized TTM-trial. Hemodynamic evaluation was performed with serial measurements by pulmonary artery catheter. AKI was the primary endpoint and was defined according to the KDIGO-criteria. Results: Of 152 patients with available hemodynamic data, 49 (32%) had AKI and 21 (14%) had AKI with need for renal replacement therapy (RRT) in the first three days. During targeted temperature management, patients with AKI had higher heart rate (11 beats/min, pgroup < 0.0001), higher mean arterial pressure (MAP) (4 mmHg, pgroup = 0.001) and higher lactate (1 mmol/L, pgroup < 0.0001) compared to patients without AKI. However, there was no difference in cardiac index (pgroup = 0.25). In a multivariate logistic regression model, adjusting for potential confounders, MAP (p = .03), heart rate (p = .01) and lactate (p = .006), but not cardiac output, were independently associated with AKI. Conclusions: Blood pressure, heart rate and lactate, but not cardiac output, during 24 h of TTM were associated with AKI in comatose OHCA-patients.

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author
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organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Acute kidney injury, Cardiac arrest, Cardiac output, Dialysis, Hemodynamic, Post cardiac arrest syndrome
in
Journal of Critical Care
volume
54
pages
9 pages
publisher
Elsevier
external identifiers
  • scopus:85069645527
  • pmid:31362189
ISSN
0883-9441
DOI
10.1016/j.jcrc.2019.07.013
language
English
LU publication?
yes
id
0e8b2f31-3146-44b6-895c-4f31e0d43177
date added to LUP
2019-08-02 09:27:13
date last changed
2023-12-03 21:48:16
@article{0e8b2f31-3146-44b6-895c-4f31e0d43177,
  abstract     = {{<p>Purpose: After resuscitation from out-of-hospital cardiac arrest (OHCA), renal injury and hemodynamic instability are common. We aimed to assess the association between low cardiac output during targeted temperature management (TTM) and acute kidney injury (AKI) after OHCA. Materials and methods: Single-center substudy of 171 patients included in the prospective, randomized TTM-trial. Hemodynamic evaluation was performed with serial measurements by pulmonary artery catheter. AKI was the primary endpoint and was defined according to the KDIGO-criteria. Results: Of 152 patients with available hemodynamic data, 49 (32%) had AKI and 21 (14%) had AKI with need for renal replacement therapy (RRT) in the first three days. During targeted temperature management, patients with AKI had higher heart rate (11 beats/min, p<sub>group</sub> &lt; 0.0001), higher mean arterial pressure (MAP) (4 mmHg, p<sub>group</sub> = 0.001) and higher lactate (1 mmol/L, p<sub>group</sub> &lt; 0.0001) compared to patients without AKI. However, there was no difference in cardiac index (p<sub>group</sub> = 0.25). In a multivariate logistic regression model, adjusting for potential confounders, MAP (p = .03), heart rate (p = .01) and lactate (p = .006), but not cardiac output, were independently associated with AKI. Conclusions: Blood pressure, heart rate and lactate, but not cardiac output, during 24 h of TTM were associated with AKI in comatose OHCA-patients.</p>}},
  author       = {{Grand, Johannes and Bro-Jeppesen, John and Hassager, Christian and Rundgren, Malin and Winther-Jensen, Matilde and Thomsen, Jakob Hartvig and Nielsen, Niklas and Wanscher, Michael and Kjærgaard, Jesper}},
  issn         = {{0883-9441}},
  keywords     = {{Acute kidney injury; Cardiac arrest; Cardiac output; Dialysis; Hemodynamic; Post cardiac arrest syndrome}},
  language     = {{eng}},
  pages        = {{65--73}},
  publisher    = {{Elsevier}},
  series       = {{Journal of Critical Care}},
  title        = {{Cardiac output during targeted temperature management and renal function after out-of-hospital cardiac arrest}},
  url          = {{http://dx.doi.org/10.1016/j.jcrc.2019.07.013}},
  doi          = {{10.1016/j.jcrc.2019.07.013}},
  volume       = {{54}},
  year         = {{2019}},
}