Timothy T Cornell1, David T Selewski2, Jeffrey A Alten3, David Askenazi4, Julie C Fitzgerald5, Alexis Topjian5, Richard Holubkov6, Kent Page6, Beth S Slomine7, James R Christensen7, J Michael Dean6, Frank W Moler2. 1. University of Michigan, Ann Arbor, MI, United States. Electronic address: ttcornel@umich.edu. 2. University of Michigan, Ann Arbor, MI, United States. 3. The Heart Institute, Cincinnati Children's Hospital Medical Center, United States. 4. University of Alabama at Birmingham, United States. 5. Children's Hospital of Philadelphia, Philadelphia, PA, United States. 6. University of Utah, Salt Lake City, UT, United States. 7. Kennedy Krieger Institute and Johns Hopkins University, Baltimore, MD, United States.
Abstract
IMPORTANCE: Many children with return of spontaneous circulation (ROSC) following cardiac arrest (CA) experience acute kidney injury (AKI). The impact of therapeutic hypothermia on the epidemiology of post-CA AKI in children has not been fully investigated. OBJECTIVE: The study aims were to: 1) describe the prevalence of severe AKI in comatose children following out-of-hospital CA (OHCA), 2) identify risk factors for severe AKI, 3) evaluate the impact of therapeutic hypothermia on the prevalence of severe AKI, and 4) evaluate the association of severe AKI with survival and functional outcomes. DESIGN: A post hoc secondary analysis of data from the Therapeutic Hypothermia after Pediatric Cardiac Arrest Out-of-Hospital (THAPCA-OH) trial. SETTING:Thirty-six pediatric intensive care units in the United States and Canada. PARTICIPANTS: Of 282 eligible subjects with an initial creatinine obtained within 24 h of randomization, 148 were randomized totherapeutic hypothermia and 134 were randomized to therapeutic normothermia. MAIN OUTCOMES AND MEASURES: Primary outcome was prevalence of severe AKI, as defined by stage 2 and 3 Kidney Disease Improving Global Outcomes (KDIGO) consensus definition; secondary outcome was survival with a favorable neurobehavioral outcome. For this study, risk factors and outcomes were compared between those with/without severe AKI. RESULTS: Of the 282 subjects enrolled, 180 (64%) developed AKI of which 117 (41% of all enrolled) developed severe AKI. Multivariable modeling found younger age, longer duration of chest compressions, higher lactate level at time of temperature intervention and higher number of vasoactive agents through day 1 of intervention associated with severe AKI. There was no difference in severe AKI between therapeutic hypothermia (39.9%) and therapeutic normothermia (43.3%) groups (p = 0.629). Survival was lower in those with severe AKI at 28 days (21% vs no severe AKI 49%, p < 0.001) and 12 months (21% vs no severe AKI 42%, p < 0.001). One year survival with favorable functional outcome was lower in those with severe AKI. CONCLUSIONS AND RELEVANCE: Severe AKI occurs frequently in children with ROSC after OHCA, especially in younger children and those with higher initial lactates and hemodynamic support. Severe AKI was associated with worse survival and functional outcome. Therapeutic hypothermia did not reduce the incidence of severe AKI.
RCT Entities:
IMPORTANCE: Many children with return of spontaneous circulation (ROSC) following cardiac arrest (CA) experience acute kidney injury (AKI). The impact of therapeutic hypothermia on the epidemiology of post-CAAKI in children has not been fully investigated. OBJECTIVE: The study aims were to: 1) describe the prevalence of severe AKI in comatosechildren following out-of-hospital CA (OHCA), 2) identify risk factors for severe AKI, 3) evaluate the impact of therapeutic hypothermia on the prevalence of severe AKI, and 4) evaluate the association of severe AKI with survival and functional outcomes. DESIGN: A post hoc secondary analysis of data from the Therapeutic Hypothermia after Pediatric Cardiac Arrest Out-of-Hospital (THAPCA-OH) trial. SETTING: Thirty-six pediatric intensive care units in the United States and Canada. PARTICIPANTS: Of 282 eligible subjects with an initial creatinine obtained within 24 h of randomization, 148 were randomized to therapeutic hypothermia and 134 were randomized to therapeutic normothermia. MAIN OUTCOMES AND MEASURES: Primary outcome was prevalence of severe AKI, as defined by stage 2 and 3 Kidney Disease Improving Global Outcomes (KDIGO) consensus definition; secondary outcome was survival with a favorable neurobehavioral outcome. For this study, risk factors and outcomes were compared between those with/without severe AKI. RESULTS: Of the 282 subjects enrolled, 180 (64%) developed AKI of which 117 (41% of all enrolled) developed severe AKI. Multivariable modeling found younger age, longer duration of chest compressions, higher lactate level at time of temperature intervention and higher number of vasoactive agents through day 1 of intervention associated with severe AKI. There was no difference in severe AKI between therapeutic hypothermia (39.9%) and therapeutic normothermia (43.3%) groups (p = 0.629). Survival was lower in those with severe AKI at 28 days (21% vs no severe AKI 49%, p < 0.001) and 12 months (21% vs no severe AKI 42%, p < 0.001). One year survival with favorable functional outcome was lower in those with severe AKI. CONCLUSIONS AND RELEVANCE: Severe AKI occurs frequently in children with ROSC after OHCA, especially in younger children and those with higher initial lactates and hemodynamic support. Severe AKI was associated with worse survival and functional outcome. Therapeutic hypothermia did not reduce the incidence of severe AKI.
Authors: Julie C Fitzgerald; Nicole R Zane; Adam S Himebauch; Michael D Reedy; Kevin J Downes; Alexis A Topjian; Susan L Furth; Neal J Thomas; Marc H Scheetz; Athena F Zuppa Journal: Paediatr Drugs Date: 2019-04 Impact factor: 3.022
Authors: David T Selewski; David J Askenazi; Kianoush Kashani; Rajit K Basu; Katja M Gist; Matthew W Harer; Jennifer G Jetton; Scott M Sutherland; Michael Zappitelli; Claudio Ronco; Stuart L Goldstein; Theresa Ann Mottes Journal: Pediatr Nephrol Date: 2021-01-12 Impact factor: 3.714
Authors: Kenneth E Mah; Jeffrey A Alten; Timothy T Cornell; David T Selewski; David Askenazi; Julie C Fitzgerald; Alexis Topjian; Kent Page; Richard Holubkov; Beth S Slomine; James R Christensen; J Michael Dean; Frank W Moler Journal: Resuscitation Date: 2021-01-12 Impact factor: 5.262