Renal function after out-of-hospital cardiac arrest; the influence of temperature management and coronary angiography, a post hoc study of the target temperature management trial

Malin Rundgren, Susann Ullén, Matt P G Morgan, Guy Glover, Julius Cranshaw, Nawaf Al-Subaie, Andrew Walden, Michael Joannidis, Marlies Ostermann, Josef Dankiewicz, Niklas Nielsen, Matthew P Wise, Malin Rundgren, Susann Ullén, Matt P G Morgan, Guy Glover, Julius Cranshaw, Nawaf Al-Subaie, Andrew Walden, Michael Joannidis, Marlies Ostermann, Josef Dankiewicz, Niklas Nielsen, Matthew P Wise

Abstract

Background: To elucidate the incidence of acute kidney injury (AKI) after out-of-hospital cardiac arrest (OHCA) and to examine the impact of target temperature management (TTM) and early coronary angiography on renal function.

Methods: Post hoc analysis of the TTM trial, a multinational randomised controlled trial comparing target temperature of 33 °C versus 36 °C in patients with return of spontaneous circulation after OHCA. The impact of TTM and early angiography (within 6 h of OHCA) versus late or no angiography on the development of AKI during the 7-day period after OHCA was analysed. AKI was defined according to modified KDIGO criteria in patients surviving beyond day 2 after OHCA.

Results: Following exclusions, 853 of 939 patients enrolled in the main trial were analysed. Unadjusted analysis showed that significantly more patients in the 33 °C group had AKI compared to the 36 °C group [211/431 (49%) versus 170/422 (40%) p = 0.01], with a worse severity (p = 0.018). After multivariable adjustment, the difference was not significant (odds ratio 0.75, 95% confidence interval 0.54-1.06, p = 0.10]. Five hundred seventeen patients underwent early coronary angiography. Although the unadjusted analysis showed less AKI and less severe AKI in patients who underwent early angiography compared to patients with late or no angiography, in adjusted analyses, early angiography was not an independent risk factor for AKI (odds ratio 0.73, 95% confidence interval 0.50-1.05, p = 0.09).

Conclusions: In OHCA survivors, TTM at 33 °C compared to management at 36 °C did not show different rates of AKI and early angiography was not associated with an increased risk of AKI.

Trial registration: NCT01020916 . Registered on www.ClinicalTrials.gov 26 November 2009 (main trial).

Keywords: Acute kidney injury; Angiography; Contrast; Induced hypothermia (target temperature management); Out-of-hospital cardiac arrest.

Conflict of interest statement

Ethics approval and consent to participate

Ethics committees in all participating countries approved the protocol. Waived, delayed and/or consent from legal surrogates and delayed written informed consent from patients regaining mental capacity were obtained according to decisions by ethical boards in respective countries.

Consent for publication

Not applicable

Competing interests

MR, SU, MM, JC, NA, MJ, MO, JD and MW have no competing interest to declare.

AW has given consultancy advice to BARD Healthcare 2012 and Baxter Healthcare 2016. GG has received consultation fees from Bard Medical. NN has received a speaker fee from Bard Medical and has been a scientific advisor to BrainCool.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
The frequency of criteria used to determine the worst stage of AKI days 2–7 after CA. AKI stages 2 and 3 are split into the different diagnostic criteria urine output, S-creatinine concentration or a combination thereof. For stage 1, AKI urine output criterion was by study definition not applicable and as a consequence neither was the combination of urine output and creatinine level
Fig. 2
Fig. 2
The maximum stage of AKI during days 2–7 after cardiac arrest stratified by temperature allocation. The category of AKI was worse in the TTM-33 group (p = 0.018, Mann-Whitney U test)
Fig. 3
Fig. 3
The time from cardiac arrest to angiography. The majority of patients had an early angiography (within 6 h of cardiac arrest). Note varied time intervals
Fig. 4
Fig. 4
The mortality in relation to the worst stage of AKI. The worst AKI stage during the first 7 days of intensive care stay vs mortality at 6 months. The mortality was significantly higher in patients with AKI (p < 0.001)

References

    1. Domanovits H, Schillinger M, Müllner M, Thoennissen J, Sterz F, Zeiner A, Druml W. Acute renal failure after successful cardiopulmonary resuscitation. Intensive Care Med. 2001.
    1. Yanta J, Guyette F, Doshi A, Callaway C, Rittenberger J. Renal dysfunction is common following resuscitation from out-of-hospital cardiac arrest. 2013;84:1371–4.
    1. Roman-Pognuz Erik, Elmer Jonathan, Rittenberger Jon C, Guyette Francis X, Berlot Giorgio, De Rosa Silvia, Peratoner Alberto, de Arroyabe Blanca Martinez Lopez, Lucangelo Umberto, Callaway Clifton W. Markers of cardiogenic shock predict persistent acute kidney injury after out of hospital cardiac arrest. Heart & Lung. 2019;48(2):126–130. doi: 10.1016/j.hrtlng.2018.10.025.
    1. Kim Y, Cha K, Cha Y, Kim O, Jung W, Kim T, Han B, Kim H, Lee K, Choi E, et al. Shock duration after resuscitation is associated with occurrence of post-cardiac arrest acute kidney injury. J Korean Med Sci. 2015;30:802–807. doi: 10.3346/jkms.2015.30.6.802.
    1. Geri G, Guillemet L, Dumas F, Charpentier J, Antona M, Lemiale V, Bougouin W, Lamhaut L, Mira J, Vinsonneau C, et al. Acute kidney injury after out-of-hospital cardiac arrest: risk factors and prognosis in a large cohort. Intensive Care Med. 2015;41:1273–1280. doi: 10.1007/s00134-015-3848-4.
    1. Hypothermia after Cardiac Arrest Study Group Mild therapeutic hypothermia to improve the neurologic outcome after cardiac arrest. N Engl J Med. 2002;346:549–556. doi: 10.1056/NEJMoa012689.
    1. Zeiner Andrea, Sunder-Plassmann Gere, Sterz Fritz, Holzer Michael, Losert Heidrun, Laggner Anton N, Müllner Marcus. The effect of mild therapeutic hypothermia on renal function after cardiopulmonary resuscitation in men. Resuscitation. 2004;60(3):253–261. doi: 10.1016/j.resuscitation.2003.11.006.
    1. DeRosa S, Cal MD, Joannidis M, Villa G, Pacheco J, Virzì G, Samoni S, D'ippoliti F, Marcante S, Visconti F, et al. The effect of whole-body cooling on renal function in post-cardiac arrest patients. BMC Nephrol. 2017;18:376. doi: 10.1186/s12882-017-0780-6.
    1. DeRosa S, Antonelli M, Ronco C. Hypothermia and kidney: a focus on ischemia-reperfusion injury. Nephrol Dial Transplant. 2017;32:241–247.
    1. Boodhwani M, Rubens F, Wozny D, Nathan H. Effects of mild hypothermia and rewarming on renal function after coronary artery bypass grafting. Ann Thorac Surg. 2009;87:489–495. doi: 10.1016/j.athoracsur.2008.10.078.
    1. Windecker S, Kolh P, Alfonso F, Collet J, Cremer J, Falk V, Filippatos G, Hamm C, Head S, Jüni P, et al. 2014 ESC/EACTS Guidelines on myocardial revascularization: the Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS) developed with the special contribution of the European Association of Percutaneous Cardiovascular Interventions (EAPCI) Eur Heart J. 2014;35:2541–2619. doi: 10.1093/eurheartj/ehu278.
    1. Callaway CW, Donnino MW, Fink EL, Geocadin RG, Golan E, Kern KB, Leary M, Meurer WJ, Peberdy MA, Thompson TM, et al. Part 8: post-cardiac arrest care: 2015 American Heart Association guidelines update for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2015;132:S465–S482. doi: 10.1161/CIR.0000000000000262.
    1. Kern K: Early coronary angiography versus delayed coronary angiography (PEARL). Identifier: NCT02387398 Available online: https://clinicaltrialsgov/ct2/show/NCT02387398.
    1. Spaulding C: EMERGEncy versus delayed coronary angiogram in survivors of out-of-hospital cardiac arrest (EMERGE). identifier: NCT02876458. .
    1. Nielsen N, Wetterslev J, Cronberg T, Erlinge D, Gasche Y, Hassager C, Horn J, Hovdenes J, Kjaergaard J, Kuiper M, et al. Targeted temperature management at 33 °C versus 36 °C after cardiac arrest. N Engl J Med. 2013;369:2197–2206. doi: 10.1056/NEJMoa1310519.
    1. Jacobs I, Nadkarni V, Bahr J, Berg R, Billi J, Bossaert L, Cassan P, Coovadia A, D'Este K, Finn J, et al. Cardiac arrest and cardiopulmonary resuscitation outcome reports: update and simplification of the Utstein templates for resuscitation registries: a statement for healthcare professionals from a task force of the International Liaison Committee on Resuscitation (American Heart Association, European Resuscitation Council, Australian Resuscitation Council, New Zealand Resuscitation Council, Heart and Stroke Foundation of Canada, InterAmerican Heart Foundation, Resuscitation Councils of Southern Africa) Circulation. 2004;110:3385–3397. doi: 10.1161/01.CIR.0000147236.85306.15.
    1. Nielsen N, Wetterslev J, al-Subaie N, Andersson B, Bro-Jeppesen J, Bishop G, Brunetti I, Cranshaw J, Cronberg T, Edqvist K, et al. Target temperature management after out-of-hospital cardiac arrest--a randomized, parallel-group, assessor-blinded clinical trial--rationale and design. Am Heart J. 2012;163:541–548. doi: 10.1016/j.ahj.2012.01.013.
    1. Khwaja A. KDIGO clinical practice guidelines for acute kidney injury. Nephron Clin Pract. 2012;120:c179–c184.
    1. Tujjar O, Mineo G, Dell’Anna A, Poyatos-Robles B, Donadello K, Scolletta S, Vincent J-L, Taccone F. Acute kidney injury after cardiac arrest. Crit Care. 2015;19:169. doi: 10.1186/s13054-015-0900-2.
    1. Hasper Dietrich, von Haehling Stephan, Storm Christian, Jörres Achim, Schefold Joerg C. Changes in serum creatinine in the first 24 hours after cardiac arrest indicate prognosis: an observational cohort study. Critical Care. 2009;13(5):R168. doi: 10.1186/cc8144.
    1. Chua H, Glassford N, Bellomo R. Acute kidney injury after cardiac arrest. Resuscitation. 2012;6:721–727. doi: 10.1016/j.resuscitation.2011.11.030.
    1. Bro-Jeppesen J, Hassager C, Wanscher M, Østergaard M, Nielsen N, Erlinge D, Friberg H, Køber L, Kjaergaard J. Targeted temperature management at 33 °C versus 36 °C and impact on systemic vascular resistance and myocardial function after out-of-hospital cardiac arrest: a sub-study of the target temperature management trial. Circ Cardiovasc Interv. 2014;7:663–672. doi: 10.1161/CIRCINTERVENTIONS.114.001556.
    1. Larsson JS, Bragadottir G, Redfors B, Ricksten S. Renal effects of norepinephrine-induced variations in mean arterial pressure after liver transplantation: a randomized cross-over trial. Acta Anaesthesiol Scand. 2018;62(9):1229–1236. doi: 10.1111/aas.13156.
    1. Redfors B, Bragadottir G, Sellgren J, Swärd K, Ricksten S. Effects of norepinephrine on renal perfusion, filtration and oxygenation in vasodilatory shock and acute kidney injury. Intensive Care Med. 2011;37:60–67. doi: 10.1007/s00134-010-2057-4.
    1. Grand J, Hassager C, Winther-Jensen M, Rundgren M, Friberg H, Horn H, Wise M, Nielsen N, Kuiper M, Wiberg S, et al. Mean arterial pressure during targeted temperature management and renal function after out-of-hospital cardiac arrest. J Crit Care. 2018;50:234–241. doi: 10.1016/j.jcrc.2018.12.009.
    1. Perner A, Prowle J, Joannidis M, Young P, Hjortrup P, Pettilä V. Fluid management in acute kidney injury. Intensive Care Med. 2017;43:807–815. doi: 10.1007/s00134-017-4817-x.
    1. Raimundo M, Crichton S, Martin J, Syed Y, Varrier M, Wyncoll D, Ostermann M. Increased fluid administration after early acute kidney injury is associated with less renal recovery. Shock. 2015;44:431–437. doi: 10.1097/SHK.0000000000000453.
    1. Petek B, Bravo P, Kim F, Id B, Kudenchuk P, Shuman W, Gunn M, Carlbom D, Gill E, Maynard C, et al. Incidence and risk factors for postcontrast acute kidney injury in survivors of sudden cardiac arrest. Ann Emerg Med. 2016;67:469–476. doi: 10.1016/j.annemergmed.2015.07.516.
    1. Laurent I, Monchi M, Chiche J, Joly L, Spaulding C, Bourgeois B, Cariou A, Rozenberg A, Carli P, Weber S, et al. Reversible myocardial dysfunction in survivors of out-of-hospital cardiac arrest. J Am Coll Cardiol. 2002;40:2110–2116. doi: 10.1016/S0735-1097(02)02594-9.
    1. Noc M, Fajadet J, Lassen JF, Kala P, MacCarthy P, Olivecrona GK, Windecker S, Spaulding C, European Association for Percutaneous Cardiovascular I, Stent for Life G Invasive coronary treatment strategies for out-of-hospital cardiac arrest: a consensus statement from the European association for percutaneous cardiovascular interventions (EAPCI)/stent for life (SFL) groups. EuroIntervention. 2014;10:31–37. doi: 10.4244/EIJV10I1A7.
    1. Joannidis M, Druml W, Forni L, Groeneveld A, Honore P, Hoste E, Ostermann M, Straaten HO-V, Schetz M. Prevention of acute kidney injury and protection of renal function in the intensive care unit: update 2017 : expert opinion of the Working Group on Prevention, AKI section, European Society of Intensive Care Medicine. Intensive Care Med. 2017;43:730–749. doi: 10.1007/s00134-017-4832-y.
    1. Ostermann M, McCullough PA, Forni L, Bagshaw SM, Joannidis M, Shi J, Kashani K, Honore P, Chawla L, Investigators JKoboaS Kinetics of urinary cell cycle arrest markers for acute kidney injury following exposure to potential renal insults. Crit Care Med. 2018;46:375–383. doi: 10.1097/CCM.0000000000002847.
    1. Lamiere N, Kellum J, Group ftKAGW Contrast-induced acute kidney injury and renal support for acute kidney injury: a KDIGO summary (part 2) Crit Care. 2013;2013:205. doi: 10.1186/cc11455.
    1. Forni L, Darmon M, Ostermann M, Straaten HO-V, Pettilä V, Prowle J, Schetz M, Joannidis M. Renal recovery after acute kidney injury. Intensive Care Med. 2017;43:855–866. doi: 10.1007/s00134-017-4809-x.
    1. Ostermann M, Joannidis M. Acute kidney injury 2016: diagnosis and diagnostic workup. Crit Care. 2016;20:299. doi: 10.1186/s13054-016-1478-z.
    1. Joannidis M, Metnitz B, Bauer P, Schusterschitz N, Moreno R, Druml W, Metnitz P. Acute kidney injury in critically ill patients classified by AKIN versus RIFLE using the SAPS 3 database. Intensive Care Med. 2009;35:1692–1702. doi: 10.1007/s00134-009-1530-4.

Source: PubMed

Sponsors en medewerkers

Medische omstandigheden

Geneesmiddelinterventies

3
Abonneren