Markers of cardiogenic shock predict persistent acute kidney injury after out of hospital cardiac arrest.

OBJECTIVE: Ischemia and reperfusion injury (IRI) in cardiac arrest patients after return to spontaneous circulation causes dysfunctions in multiple organs. Kidney injury is generally transient but in some patients persists and contributes both to mortality and increased resource utilisation. Ongoing shock may compound renal injury from IRI, resulting in persistent dysfunction. We tested whether cardiac dysfunction was associated with the development of persistent acute kidney injury (PAKI) in the first 72 h after cardiac arrest. METHODS: We performed an observational retrospective study from January 2013 to April 2017. We included consecutive patients treated after out-of-hospital cardiac arrest at a single academic medical center with renal function measured and immediately and for 48 h post arrest. We also recorded each patient's pre arrest baseline creatinine, demographic and clinical characteristics. Our primary outcome of interest was PAKI, defined as acute kidney injury (AKI) on at least 2 measurements 24 h apart. We compared demographics and outcomes between patients with PAKI and those without, and used logistic regression to identify independent predictors of PAKI. RESULTS: Of 98 consecutive patients, we excluded 24 for missing data. AKI was present in 75% of subjects on arrival. PAKI developed in 35% of patients. PAKI patients had a longer hospital length of stay (median 21 vs 11 days) and lower hospital survival (47% vs 71%). Serum lactate levels, dosage of adrenaline during resuscitation and days of dobutamine infusion strongly predicted PAKI. CONCLUSIONS: Among patient who survive cardiac arrest, acute AKI is common and PAKI occurs in more than one third. PAKI is associated both with survival and with length of stay at the hospital. High doses of adrenaline, high serial serum lactate levels, and dose of dobutamine predict PAKI. Evaluation of the trajectory of renal function over the first few days after resuscitation can provide prognostic information about patient recovery.

Protección cardiocerebral post paro cardiaco / Post-cardiac arrest cardiocerebral protection

Introducción: Hasta ahora los cuidados post paro cardiaco constituyen el quinto eslabón de la cadena de supervivencia. Es el más débil y no se han desarrollado en la práctica clínica guías de tratamiento para esta entidad. Objetivo: Reunir los avances recientes en la protección cardiocerebral del síndrome post paro cardiaco. Desarrollo: El desarrollo de las estrategias de protección cardiocerebral post paro cardiaco, se basa en el conocimiento de los mecanismos fisiopatológicos que acontecen tras el retorno a la circulación espontanea. Luego de la valoración inicial se debe decidir la realización de hipotermia o de revascularización coronaria medidas terapéuticas que por su aplicación precoz logran un incremento de la supervivencia. Conclusiones: La protección cardiocerebral post paro cardiaco es compleja y aun queda mucho por investigar.

Introduction: Until now the post-cardiac arrest cares are the fifth link in the survival chain. It is the most weak without development of treatment guidelines in the clinical practice for this entity. Objective: To bring together the recent advances in cardiocerebral protection in the post-cardiac arrest syndrome. Development: The creation of post-cardiac arrest cardiocerebral protection strategies is based in the knowledge of pathophysiology mechanisms present after the spontaneous circulation. After the initial assessment it is necessary to decide the carrying-out of hypothermia or of coronary revascularization therapeutical measures that due to its early application achieve a survival increase. Conclusions: The post-cardiac arrest cardiocerebral protection is complex and thus it is necessary more researches.