High-volume hemofiltration after out-of-hospital cardiac arrest: a randomized study.
OBJECTIVE
The study examined the effect of isovolumic high-volume hemofiltration (HF) alone or combined with mild hypothermia (HT) on survival after out-of-hospital cardiac arrest (OHCA) with initial ventricular fibrillation or asystole.


BACKGROUND
Global inflammation in response to whole-body ischemia-reperfusion is common after OHCA and may worsen the overall prognosis.


METHODS
Sixty-one patients admitted between May 2000 and March 2002 in the intensive care units of two hospitals in France were randomized to one of three groups: control, HF (200 ml/kg/h over 8 h) or HF+HT (32 degrees C for 24 h) induced by cooling the HF substitution fluid. Standard supportive care was provided in all three groups. The primary end point was survival with a follow-up time of six months. The effect of HF on death by intractable shock was the secondary end point.


RESULTS
The six-month survival curves of the three groups were significantly different, with better survival in the HF group (p = 0.026) and in the HF+HT group (p = 0.018). After adjustment on baseline characteristics of cardiac arrest, HF (with or without HT) was associated with improved survival (logistic regression odds ratio, 4.4; 95% confidence interval [CI], 1.1 to 16.6). Compared to control group, the relative risk of death by intractable shock was 0.29 (95% CI, 0.09 to 0.91) in the HF+HT group and 0.21 (95% CI, 0.05 to 0.85) in the HF group.


CONCLUSIONS
The HF may improve the overall prognosis after resuscitation from OHCA. Combination of HF with mild HT is feasible and should be evaluated in larger trials.
Laurent
Ivan
I
Medical ICU, Cochin Teaching Hospital, Rene Descartes University, Paris, France.
Adrie
Christophe
C
Vinsonneau
Christophe
C
Cariou
Alain
A
Chiche
Jean-Daniel
JD
Ohanessian
Alice
A
Spaulding
Christian
C
Carli
Pierre
P
Dhainaut
Jean-François
JF
Monchi
Mehran
M
D000368:Aged; D000704:Analysis of Variance; D002423:Cause of Death; D003131:Combined Modality Therapy; D004632:Emergency Medical Services / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D005602:France; D006323:Heart Arrest / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy*; D006440:Hemofiltration / Q000379:methods*; D006801:Humans; D007036:Hypothermia, Induced / Q000379:methods*; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D010343:Patient Admission; D011336:Probability; D011446:Prospective Studies; D012016:Reference Values; D018570:Risk Assessment; D016019:Survival Analysis; D016896:Treatment Outcome; D014693:Ventricular Fibrillation / Q000175:diagnosis / Q000401:mortality / Q000628:therapy