The effect of mild therapeutic hypothermia on renal function after cardiopulmonary resuscitation in men
Introduction
Renal failure has been observed in patients resuscitated from cardiac arrest with an incidence of between 12% [1] and 28% [2]. Transient impaired renal function is common in patients surviving cardiac arrest [3]. As there is evidence that hypothermia has positive effects on cerebral outcome after ischaemic brain damage [4], [5], [6] many patients now may be treated with this technique. However, animal [7] and human [8], [9] studies have shown impaired renal function during induced hypothermia.
In an uncontrolled pilot study of 27 patients with suspected ischaemic brain injury due to cardiac arrest we observed a 40% reduction in median serum creatinine levels {(122–73 μmol/l (1.38–0.83 mg/dl)} within 24 h of induced mild hypothermia [10]. These preliminary results might suggest a beneficial effect of induced mild hypothermia on renal function after cardiac arrest and cardiopulmonary resuscitation.
The aim of this explorative study within a randomized controlled multicenter trial, was to examine the effect of total body cooling on creatinine clearance and serum creatinine, compared to standard treatment without cooling, in patients after cardiac arrest.
Section snippets
Participants/patients
This study was an explorative analysis of participants in a multicentre study (HACA-clinical trial, hypothermia after cardiac arrest) designed to investigate the effect of induced mild hypothermia on neurological outcome after global brain ischaemia due to ventricular fibrillation cardiac arrest [6]. In a subgroup of these patients, recruited at the Department of Emergency Medicine at the University of Vienna, School of Medicine (tertiary care hospital with 2100 beds), renal function in
Participant flow and numbers analyzed
From March 1996 until June 2000, 734 patients after successful cardiopulmonary resuscitation were admitted to the Department of Emergency Medicine at the University Hospital of Vienna, one center of the HACA-clinical trial. At the emergency department 88 fulfilled the inclusion criteria and 44 were allocated to either the treatment or control group. In the hypothermia group one patient did not receive allocated intervention, in six patients intervention was discontinued and five had to be
Discussion
The present study showed that mild therapeutic hypothermia, compared to standard treatment without cooling in patients resuscitated from ventricular fibrillation cardiac arrest, entailed a decrease in serum creatinine concentrations. In contrast, the serum creatinine clearance was low on admission in both groups, and showed a rapid improvement in the normothermic group, whereas recovery of serum creatinine clearance was delayed in the hypothermic group. Renal function was not different between
Conclusion
This study showed a “spurious” improvement of renal function based on serum creatinine measurements in patients with cardiac arrest treated with induced mild hypothermia. The creatinine clearance showed no immediate improvement as compared to the rapid recovery observed in patients on standard treatment. The impairment of renal function due to hypothermia had no effect on renal function at 4 weeks after the index event. These findings have implications for the diagnosis of postresuscitation
References (25)
- et al.
Clinical trial of induced hypothermia in comatose survivors of out-of-hospital cardiac arrest
Ann. Emerg. Med.
(1997) - et al.
Subgroup analysis and other (mis)uses of baseline data in clinical trials
Lancet
(2000) - et al.
Renal function following cardiac arrest and resuscitation in the canine
Resuscitation
(1996) - et al.
Acute renal failure after successful cardiopulmonary resuscitation
Intensive Care Med.
(2001) - et al.
Prevalence and determinants of acute renal failure following cardiopulmonary resuscitation
Arch. Intern. Med.
(1993) - et al.
Impairment of renal function in patients resuscitated from cardiac arrest: frequency
Wien Klin. Wochenschr.
(2000) - et al.
Treatment of comatose survivors of out-of-hospital cardiac arrest with induced hypothermia
N. Engl. J. Med.
(2002) - The Hypothermia after Cardiac Arrest Study Group. Mild therapeutic hypothermia to improve the neurologic outcome after...
- et al.
Urinary composition during hypothermia
Am. J. Physiol.
(1956) - et al.
Alterations in renal function during hypothermia in man
Ann. Surg.
(1957)
Moderate hypothermia in patients with severe head injury: cerebral and extracerebral effects
J. Neurosurg.
Mild resuscitative hypothermia to improve neurological outcome after cardiac arrest. A clinical feasibility trial. Hypothermia after cardiac arrest (HACA) study group
Stroke
Cited by (83)
Hyperoxia After Return of Spontaneous Circulation in Cardiac Arrest Patients
2022, Journal of Cardiothoracic and Vascular AnesthesiaFast hypothermia induced by extracorporeal circuit cooling alleviates renal and intestinal injury after cardiac arrest in swine
2021, American Journal of Emergency MedicineTargeted Temperature Management in Brain Injured Patients
2018, Neurosurgery Clinics of North AmericaTargeted Temperature Management in Brain Injured Patients
2017, Neurologic Clinics