Guillaume Geri1, David Grimaldi2, Thierry Seguin3, Lionel Lamhaut4, Nathalie Marin2, Jean-Daniel Chiche5, Frédéric Pène5, Adrien Bouglé2, Fabrice Daviaud2, Tristan Morichau-Beauchant2, Michel Arnaout2, Benoit Champigneulle2, Lara Zafrani2, Simon Bourcier2, Yen-Lan Nguyen2, Julien Charpentier2, Jean-Paul Mira5, Joël Coste6, Christophe Vinsonneau7, Alain Cariou8. 1. Medical Intensive Care Unit, Cochin University Hospital, APHP, Paris, France; Paris Descartes University, Sorbonne Paris Cité-Medical School, Paris, France; Sudden Death Expertise Centre, INSERM U970 (team 4), Paris Cardiovascular Research Centre, Paris, France. 2. Medical Intensive Care Unit, Cochin University Hospital, APHP, Paris, France. 3. Medical-surgical Intensive Care Unit, Toulouse-Rangueil Hospital, Toulouse, France. 4. Paris Descartes University, Sorbonne Paris Cité-Medical School, Paris, France; Sudden Death Expertise Centre, INSERM U970 (team 4), Paris Cardiovascular Research Centre, Paris, France; SAMU 75, Necker University Hospital, APHP, Paris, France. 5. Medical Intensive Care Unit, Cochin University Hospital, APHP, Paris, France; Paris Descartes University, Sorbonne Paris Cité-Medical School, Paris, France. 6. Paris Descartes University, Sorbonne Paris Cité-Medical School, Paris, France; Biostatistics and Epidemiology Unit, Hôtel Dieu, APHP, Paris, France. 7. Intensive Care Medicine, Germon et Gauthier Hospital, Béthune, France. 8. Medical Intensive Care Unit, Cochin University Hospital, APHP, Paris, France; Paris Descartes University, Sorbonne Paris Cité-Medical School, Paris, France; Sudden Death Expertise Centre, INSERM U970 (team 4), Paris Cardiovascular Research Centre, Paris, France. Electronic address: alain.cariou@aphp.fr.
Abstract
BACKGROUND: After resuscitation of cardiac arrest (CA), an acute circulatory failure occurs in about 50% of cases, which shares many characteristics with septic shock. Most frequently, supportive treatments are poorly efficient to prevent multiple organ failure and death. We evaluated whether an early plasma removal of inflammatory mediators using high cut-off continuous veno-venous hemodialysis (HCO-CVVHD) could improve hemodynamic status and outcome of these patients. PATIENTS AND METHODS: We performed a randomized open-label trial. Patients with post-cardiac arrest shock (defined as requirement of norepinephrine or epinephrine infusion > 1 mg/h) were included. The experimental group received 2 distinct sessions of HCO-CVVHD during the first 48 h following ICU admission. The control group received continuous veno-venous hemofiltration (CVVH) with standard membranes if needed. The primary endpoint was the delay to shock resolution asssessed by the length of catecholamine infusion. Number of vasopressors-free days at day 28, arterial blood pressure measures every 6-hours, daily fluid balance and mortality (ICU and day-28) were evaluated as secondary endpoints. RESULTS:35 patients were included: 17 (median age 68.4, 59% male) in the HCO-CVVHD group and 18 (median age 66.3, 83% male) in the control group. Baseline characteristics did not differ between the two groups. Day-28 mortality rate was 64.7% and 72.2% in the HCO-CVVHD and control group, respectively (p = 0.72). Probability of vasopressors discontinuation over time was similar in the two groups (p for logrank test = 0.67). Number of day-28 catecholamine-free days was 25.1 [0, 26.5] and 24.5 [0, 26.2] in the HCO-CVVHD and control group, respectively (p = 0.65). No difference was observed regarding the daily-dose of vasopressors, arterial pressure profile and fluid balance. CONCLUSION: In cardiac arrest patients, HCO-CVVHD did not decrease the lenght of post-resuscitation shock and had no significant effect on hemodynamic profile. REGISTRATION: NCT00780299.
RCT Entities:
BACKGROUND: After resuscitation of cardiac arrest (CA), an acute circulatory failure occurs in about 50% of cases, which shares many characteristics with septic shock. Most frequently, supportive treatments are poorly efficient to prevent multiple organ failure and death. We evaluated whether an early plasma removal of inflammatory mediators using high cut-off continuous veno-venous hemodialysis (HCO-CVVHD) could improve hemodynamic status and outcome of these patients. PATIENTS AND METHODS: We performed a randomized open-label trial. Patients with post-cardiac arrest shock (defined as requirement of norepinephrine or epinephrine infusion > 1 mg/h) were included. The experimental group received 2 distinct sessions of HCO-CVVHD during the first 48 h following ICU admission. The control group received continuous veno-venous hemofiltration (CVVH) with standard membranes if needed. The primary endpoint was the delay to shock resolution asssessed by the length of catecholamine infusion. Number of vasopressors-free days at day 28, arterial blood pressure measures every 6-hours, daily fluid balance and mortality (ICU and day-28) were evaluated as secondary endpoints. RESULTS: 35 patients were included: 17 (median age 68.4, 59% male) in the HCO-CVVHD group and 18 (median age 66.3, 83% male) in the control group. Baseline characteristics did not differ between the two groups. Day-28 mortality rate was 64.7% and 72.2% in the HCO-CVVHD and control group, respectively (p = 0.72). Probability of vasopressors discontinuation over time was similar in the two groups (p for logrank test = 0.67). Number of day-28 catecholamine-free days was 25.1 [0, 26.5] and 24.5 [0, 26.2] in the HCO-CVVHD and control group, respectively (p = 0.65). No difference was observed regarding the daily-dose of vasopressors, arterial pressure profile and fluid balance. CONCLUSION: In cardiac arrestpatients, HCO-CVVHD did not decrease the lenght of post-resuscitation shock and had no significant effect on hemodynamic profile. REGISTRATION: NCT00780299.
Authors: Christoph Schriefl; Christian Schoergenhofer; Florian Ettl; Michael Poppe; Christian Clodi; Matthias Mueller; Juergen Grafeneder; Bernd Jilma; Ingrid Anna Maria Magnet; Nina Buchtele; Magdalena Sophie Boegl; Michael Holzer; Fritz Sterz; Michael Schwameis Journal: Front Med (Lausanne) Date: 2021-06-09