Acute renal failure after successful cardiopulmonary resuscitation

Objective: To assess the frequency and independent predictors of severe acu te renal failure in patients resuscitated from out-of-hospital ventricular fibrillation cardiac arrest. Design: A cohort study with a minimum follow-up of 6 months. Setting: Emergency department of a tertiary care 2200-bed university hospit al. Patients and participants: Consecutive adult (>18 years) patients admitted from 1 July 1991 to 31 October 1997 after witnessed ventricular fibrillatio n out-of-hospital cardiac arrest and successful resuscitation. Measurements and results: Acute renal failure was defined as a 25% decrease of creatinine clearance within 24 h after admission. Out of 187 eligible p atients (median age 57 years, 146 male), acute renal failure occurred in 22 patients (12%); in 4 patients (18%) renal replacement therapy was performe d. Congestive heart failure (OR 6.0, 95% CI 1.6-21.7; p = 0.007), history o f hypertension (OR 4.4, 95% CI 1.3-14 7; p = 0.02) and total dose of epinep hrine administered (OR 1.1, 95% CI 1.0-1.2; p = 0.009) were independent pre dictors of acute renal failure. Duration of cardiac arrest, pre-existing im paired renal function and blood pressure at admission were not independentl y associated with renal outcome. Conclusions. Severe progressive acute renal failure after cardiopulmonary r esuscitation (CPR) is rare. Pre-existing haemodynamics seem to be more impo rtant for the occurrence of acute renal failure than actual hypoperfusion d uring resuscitation.