Year: 2024
Type: article
Abstract: BACKGROUND: Acute kidney injury (AKI) is a serious complication of out-of-hospital cardiac arrest (OHCA). Post-resuscitation cardiogenic shock (CS) is a key contributing factor. Targeting a higher arterial carbon dioxide tension may affect AKI after OHCA in patients with or without CS. METHODS: Pre-planned exploratory study of a multi-national randomised trial comparing targeted mild hypercapnia or targeted normocapnia. The primary outcome was AKI defined by Kidney Disease: Improving Global Outcomes (KDIGO) criteria with modifications. Secondary outcomes included use of renal replacement therapy (RRT) and favourable neurological outcome (Glasgow Outcome Scale Extended, score 5-8) at six-months according to AKI. Exploratory objectives included evaluation of secondary outcomes in patients with both CS and AKI. RESULTS: We studied 1668 of 1700 TAME patients. AKI occurred in 1203 patients (72.1%) with 596 (49.6%) in the targeted mild hypercapnia group and 607 (50.4%) in the targeted normocapnia group. Stage 3 AKI occurred in 193 patients (23.3%) and 196 patients (23.4%), respectively and RRT in 82 (9.9%) vs 75 patients (8.9%), respectively. At six-months, 237 of 429 no-AKI patients (55.2%) had a favourable neurological outcome compared to 445 of 1111 AKI patients (40.1%) (p < 0.0001). AKI occurred more frequently (P < 0.001) in patients with CS, affecting 936 patients (77.8%). For CS and AKI patients, there were no significant differences any secondary outcome. CONCLUSIONS: AKI occurred in approximately two-thirds and RRT in approximately one in ten TAME patients without differences according to treatment allocation. CS significantly increased the prevalence of AKI but this effect was not modified by carbon dioxide allocation.
Source: Resuscitation
Authors: Glenn M. Eastwood, Michael Bailey, Alistair D. Nichol, Rachael Parke, Niklas Nielsen, Josef Dankiewicz, Rinaldo Bellomo, Carol Hodgson, Shay McGuinness, Stephen Bernard, Markus B. Skrifvars, Dion Stub, Fabio S. Taccone, John Archer, Demetrios Kutsogiannis, Gisela Lilja, Tobias Cronberg, Hans Kirkegaard, Gilles Capellier, Giovanni Landoni, Janneke Horn, Theresa Olasveengen, Yaseen Arabi, Yew Woon Chia, Andrej Markota, Matthias Haenggi, Anders M. Grejs, Steffen Christensen, Heidi Munk-Andersen, Asger Granfeldt, Geir Ø. Andersen, Eirik Qvigstad, Arnljot Flaa, Matthew Thomas, Katie Sweet, Jeremy Bewley, Minna Bäcklund, Marjaana Tiainen, Manuela Iten, Anja Levis, Leah Peck, James Walsham, Adam Deane, Angajendra Ghosh, Filippo Annoni, Yan Chen, David Knight, Eden Lesona, Haytham Tlayjeh, Franc Svenšek, Peter J. McGuigan, Jade Cole, David Pogson, Matthias P. Hilty, Joachim P. Düring, Michael J. Bailey, Eldho Paul, Bridget Ady, Kate Ainscough, Anna Hunt, Sinéad Monahan, Tony Trapani, Ciara Fahey
Language: English
Subfield: Emergency Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $4,160
OpenAlex ID: W4405922512