Blood Pressure and Oxygen Targets on Kidney Injury After Cardiac Arrest.

Autor: Rasmussen SB; Department of Anesthesiology and Intensive Care (S.B.R., H.S., S.M., H.B.R., M.A.S.M.), Odense University Hospital, Denmark., Jeppesen KK; Department of Cardiology (K.K.J., J.E.M.), Odense University Hospital, Denmark., Kjaergaard J; Department of Cardiology, the Heart Center, Copenhagen University Hospital Rigshospitalet, Denmark (J.K., C.H., R.P.B., J.G., M.W.-J., J.E.M.).; Department of Clinical Medicine, University of Copenhagen, Denmark (J.K., C.H.)., Hassager C; Department of Cardiology, the Heart Center, Copenhagen University Hospital Rigshospitalet, Denmark (J.K., C.H., R.P.B., J.G., M.W.-J., J.E.M.).; Department of Clinical Medicine, University of Copenhagen, Denmark (J.K., C.H.)., Schmidt H; Department of Anesthesiology and Intensive Care (S.B.R., H.S., S.M., H.B.R., M.A.S.M.), Odense University Hospital, Denmark.; Department of Clinical Research, University of Southern Denmark, Odense (H.S., H.B.R., J.E.M.)., Mølstrøm S; Department of Anesthesiology and Intensive Care (S.B.R., H.S., S.M., H.B.R., M.A.S.M.), Odense University Hospital, Denmark., Beske RP; Department of Cardiology, the Heart Center, Copenhagen University Hospital Rigshospitalet, Denmark (J.K., C.H., R.P.B., J.G., M.W.-J., J.E.M.)., Grand J; Department of Cardiology, the Heart Center, Copenhagen University Hospital Rigshospitalet, Denmark (J.K., C.H., R.P.B., J.G., M.W.-J., J.E.M.)., Ravn HB; Department of Anesthesiology and Intensive Care (S.B.R., H.S., S.M., H.B.R., M.A.S.M.), Odense University Hospital, Denmark.; Department of Clinical Research, University of Southern Denmark, Odense (H.S., H.B.R., J.E.M.)., Winther-Jensen M; Department of Cardiology, the Heart Center, Copenhagen University Hospital Rigshospitalet, Denmark (J.K., C.H., R.P.B., J.G., M.W.-J., J.E.M.)., Meyer MAS; Department of Anesthesiology and Intensive Care (S.B.R., H.S., S.M., H.B.R., M.A.S.M.), Odense University Hospital, Denmark., Møller JE; Department of Cardiology (K.K.J., J.E.M.), Odense University Hospital, Denmark.; Department of Cardiology, the Heart Center, Copenhagen University Hospital Rigshospitalet, Denmark (J.K., C.H., R.P.B., J.G., M.W.-J., J.E.M.).; Department of Clinical Research, University of Southern Denmark, Odense (H.S., H.B.R., J.E.M.).
Jazyk: angličtina
Zdroj: Circulation [Circulation] 2023 Dec 05; Vol. 148 (23), pp. 1860-1869. Date of Electronic Publication: 2023 Oct 04.
DOI: 10.1161/CIRCULATIONAHA.123.066012
Abstrakt: Background: Acute kidney injury (AKI) represents a common and serious complication to out-of-hospital cardiac arrest. The importance of post-resuscitation care targets for blood pressure and oxygenation for the development of AKI is unknown.
Methods: This is a substudy of a randomized 2-by-2 factorial trial, in which 789 comatose adult patients who had out-of-hospital cardiac arrest with presumed cardiac cause and sustained return of spontaneous circulation were randomly assigned to a target mean arterial blood pressure of either 63 or 77 mm Hg. Patients were simultaneously randomly assigned to either a restrictive oxygen target of a partial pressure of arterial oxygen (Pao 2 ) of 9 to 10 kPa or a liberal oxygenation target of a Pao 2 of 13 to 14 kPa. The primary outcome for this study was AKI according to KDIGO (Kidney Disease: Improving Global Outcomes) classification in patients surviving at least 48 hours (N=759). Adjusted logistic regression was performed for patients allocated to high blood pressure and liberal oxygen target as reference.
Results: The main population characteristics at admission were: age, 64 (54-73) years; 80% male; 90% shockable rhythm; and time to return of spontaneous circulation, 18 (12-26) minutes. Patients allocated to a low blood pressure and liberal oxygen target had an increased risk of developing AKI compared with patients with high blood pressure and liberal oxygen target (84/193 [44%] versus 56/187 [30%]; adjusted odds ratio, 1.87 [95% CI, 1.21-2.89]). Multinomial logistic regression revealed that the increased risk of AKI was only related to mild-stage AKI (KDIGO stage 1). There was no difference in risk of AKI in the other groups. Plasma creatinine remained high during hospitalization in the low blood pressure and liberal oxygen target group but did not differ between groups at 6- and 12-month follow-up.
Conclusions: In comatose patients who had been resuscitated after out-of-hospital cardiac arrest, patients allocated to a combination of a low mean arterial blood pressure and a liberal oxygen target had a significantly increased risk of mild-stage AKI. No difference was found in terms of more severe AKI stages or other kidney-related adverse outcomes, and creatinine had normalized at 1 year after discharge.
Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03141099.
Competing Interests: Disclosures None.
Databáze: MEDLINE
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