Abstract 10450: Prognostic Effect of Estimated Glomerular Filtration Rate in Patients With Cardiac Arrest Undergoing Extracorporeal Cardiopulmonary Resuscitation

• Published in: Circulation (New York, N.Y.) Vol. 132; no. Suppl_3 Suppl 3; p. A10450
• Main Authors: Kuroki, Norihiro, Abe, Daisuke, Iwama, Tooru, Tateishi, Kazuya, Kaneko, Masakazu, Harunari, Tomohiko, Yui, Yoshiaki, Yuba, Takao, Sugiyama, Kazuhiro, Akashi, Akiko, Hamabe, Yuichi, Sato, Akira
• Format: Journal Article
• Language: English
• Published: by the American College of Cardiology Foundation and the American Heart Association, Inc 10-11-2015
• ISSN: 0009-7322; 1524-4539
• DOI: 10.1161/circ.132.suppl_3.10450

IntroductionExtracorporeal membrane oxygenation (ECMO) can provide immediate and adequate systemic circulation and oxygenation in patients with refractory cardiac arrest. Even mild renal dysfunction has been identified as an independent cardiovascular risk factor. We hypothesized that renal dysfunction influences resuscitation outcomes. The aim of this study was to elucidate the association between initial renal function just before implantation and clinical outcome in patients undergoing extracorporeal cardiopulmonary resuscitation (ECPR).MethodsA cohort of 298 patients who underwent ECMO at our hospital was registered from January 2005 to April 2015. After excluding 70 patients with non-cardiac arrest, we analyzed the clinical outcome which was defined as all-cause death at 30 days of the remaining 228 patients (58.4±14.8 years old, 81% male, 196 with cardiogenic events, 32 with non-cardiogenic events).The patients were divided into 2 groups according to initial estimated-glomerular filtration rate (eGFR). Non-CKD GroupeGFR ≥60ml/min/1.73m2 (n=70); CKD GroupeGFR <60 (n=158).ResultsThe rate of out-of-hospital cardiac arrest was 40%. In baseline characteristics, Non-CKD group was significantly younger (52.7 vs. 61.3 years old), lower incidence of hypertension (28 vs.52 %) and known coronary artery disease (6 vs 21%) in past history and lower BUN (14.5 vs. 26.2 mg/dl, all p<0.05) than CKD group.Incidence of all-cause death at 30 days was significantly lower in the non-CKD than CKD group (53 vs. 78%, p<0.0001). CKD was an independent predictor of mortality after adjustment for multiple cofounders (OR4.49, 95% CI2.07-9.77, p<0.001). Kaplan-Meier curve showed better outcome in the non-CKD versus CKD group (p<0.01).ConclusionsInitial low e-GFR just before implantation provides worse clinical outcome in patients undergoing ECPR.