Eastwood Glenn M, Bailey Michael, Nichol Alistair D, Parke Rachael, Nielsen Niklas, Dankiewicz Josef, Bellomo Rinaldo
Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Australia; Department of Intensive Care, Austin Hospital, Heidelberg, Australia.
Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Australia.
Resuscitation. 2025 Feb;207:110480. doi: 10.1016/j.resuscitation.2024.110480. Epub 2024 Dec 30.
Acute kidney injury (AKI) is a serious complication of out-of-hospital cardiac arrest (OHCA). Post-resuscitation cardiogenic shock (CS) is a key contributing factor. Targeting a higher arterial carbon dioxide tension may affect AKI after OHCA in patients with or without CS.
Pre-planned exploratory study of a multi-national randomised trial comparing targeted mild hypercapnia or targeted normocapnia. The primary outcome was AKI defined by Kidney Disease: Improving Global Outcomes (KDIGO) criteria with modifications. Secondary outcomes included use of renal replacement therapy (RRT) and favourable neurological outcome (Glasgow Outcome Scale Extended, score 5-8) at six-months according to AKI. Exploratory objectives included evaluation of secondary outcomes in patients with both CS and AKI.
We studied 1668 of 1700 TAME patients. AKI occurred in 1203 patients (72.1%) with 596 (49.6%) in the targeted mild hypercapnia group and 607 (50.4%) in the targeted normocapnia group. Stage 3 AKI occurred in 193 patients (23.3%) and 196 patients (23.4%), respectively and RRT in 82 (9.9%) vs 75 patients (8.9%), respectively. At six-months, 237 of 429 no-AKI patients (55.2%) had a favourable neurological outcome compared to 445 of 1111 AKI patients (40.1%) (p < 0.0001). AKI occurred more frequently (P < 0.001) in patients with CS, affecting 936 patients (77.8%). For CS and AKI patients, there were no significant differences any secondary outcome.
AKI occurred in approximately two-thirds and RRT in approximately one in ten TAME patients without differences according to treatment allocation. CS significantly increased the prevalence of AKI but this effect was not modified by carbon dioxide allocation.
急性肾损伤（AKI）是院外心脏骤停（OHCA）的严重并发症。复苏后心源性休克（CS）是一个关键促成因素。对于有或没有CS的OHCA患者，将动脉二氧化碳分压维持在较高水平可能会影响AKI。
一项多中心随机试验的预先计划的探索性研究，比较目标性轻度高碳酸血症或目标性正常碳酸血症。主要结局是根据肾脏病改善全球预后（KDIGO）标准并加以修改定义的AKI。次要结局包括肾脏替代治疗（RRT）的使用情况，以及根据AKI情况在6个月时获得良好神经功能结局（扩展格拉斯哥预后量表，评分5 - 8）。探索性目标包括评估同时患有CS和AKI的患者的次要结局。
我们研究了1700例TAME患者中的1668例。1203例患者（72.1%）发生AKI，其中目标性轻度高碳酸血症组596例（49.6%），目标性正常碳酸血症组607例（50.4%）。3期AKI分别发生在193例患者（23.3%）和196例患者（23.4%），接受RRT的患者分别为82例（9.9%）和75例（8.9%）。6个月时，429例未发生AKI的患者中有237例（55.2%）获得良好神经功能结局，而1111例发生AKI的患者中有445例（40.1%）（p < 0.0001）。CS患者中AKI的发生率更高（P < 0.001），有936例患者（77.8%）受影响。对于同时患有CS和AKI的患者，任何次要结局均无显著差异。
在TAME患者中，约三分之二的患者发生AKI，约十分之一的患者接受RRT，且根据治疗分配无差异。CS显著增加了AKI的患病率，但这种影响未因二氧化碳分配而改变。
