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

• Published in: Journal of critical care Vol. 54; pp. 65 - 73
• Main Authors: Grand, Johannes, Bro-Jeppesen, John, Hassager, Christian, Rundgren, Malin, Winther-Jensen, Matilde, Thomsen, Jakob Hartvig, Nielsen, Niklas, Wanscher, Michael, Kjærgaard, Jesper
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.12.2019; Elsevier Limited
• Subjects: Acute kidney injury; Ambulance services; Anesthesia; Blood pressure; Cardiac arrest; Cardiac output; Cardiology and Cardiovascular Disease; Catheters; Clinical Medicine; Critical care; Dialysis; Dopamine; Heart attacks; Heart rate; Hemodynamic; Hemodynamics; Kardiologi och kardiovaskulära sjukdomar; Kidneys; Klinisk medicin; Medical and Health Sciences; Medicin och hälsovetenskap; Post cardiac arrest syndrome; Pulmonary arteries; Urine; Post cardiac arrest syndrome; Dialysis; Cardiac output; Hemodynamic; Acute kidney injury; Cardiac arrest
• ISSN: 0883-9441; 1557-8615; 1557-8615
• DOI: 10.1016/j.jcrc.2019.07.013

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. 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. 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. Blood pressure, heart rate and lactate, but not cardiac output, during 24 h of TTM were associated with AKI in comatose OHCA-patients. •Acute kidney injury in addition to hemodynamic instability are common after out-of-hospital cardiac arrest.•Evidence regarding hemodynamic treatment after cardiac arrest is sparse.•This study finds no association between low cardiac index during targeted temperature management and renal function.•Treating low cardiac index in unselected OHCA-patients remains to be evaluated.