Capillary leakage in post-cardiac arrest survivors during therapeutic hypothermia - a prospective, randomised study.
BACKGROUND
Fluids are often given liberally after the return of spontaneous circulation. However, the optimal fluid regimen in survivors of cardiac arrest is unknown. Recent studies indicate an increased fluid requirement in post-cardiac arrest patients. During hypothermia, animal studies report extravasation in several organs, including the brain. We investigated two fluid strategies to determine whether the choice of fluid would influence fluid requirements, capillary leakage and oedema formation.


METHODS
19 survivors with witnessed cardiac arrest of primary cardiac origin were allocated to either 7.2% hypertonic saline with 6% poly (O-2-hydroxyethyl) starch solution (HH) or standard fluid therapy (Ringer's Acetate and saline 9 mg/ml) (control). The patients were treated with the randomised fluid immediately after admission and continued for 24 hours of therapeutic hypothermia.


RESULTS
During the first 24 hours, the HH patients required significantly less i.v. fluid than the control patients (4750 ml versus 8010 ml, p = 0.019) with comparable use of vasopressors. Systemic vascular resistance was significantly reduced from 0 to 24 hours (p = 0.014), with no difference between the groups. Colloid osmotic pressure (COP) in serum and interstitial fluid (p < 0.001 and p = 0.014 respectively) decreased as a function of time in both groups, with a more pronounced reduction in interstitial COP in the crystalloid group. Magnetic resonance imaging of the brain did not reveal vasogenic oedema.


CONCLUSIONS
Post-cardiac arrest patients have high fluid requirements during therapeutic hypothermia, probably due to increased extravasation. The use of HH reduced the fluid requirement significantly. However, the lack of brain oedema in both groups suggests no superior fluid regimen. Cardiac index was significantly improved in the group treated with crystalloids. Although we do not associate HH with the renal failures that developed, caution should be taken when using hypertonic starch solutions in these patients.


BACKGROUND
NCT00347477.
Heradstveit
Bård E
BE
Department of Anaesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway. baard.heradstveit@helse-bergen.no
Guttormsen
Anne Berit
AB
Langørgen
Jørund
J
Hammersborg
Stig-Morten
SM
Wentzel-Larsen
Tore
T
Fanebust
Rune
R
Larsson
Elna-Marie
EM
Heltne
Jon-Kenneth
JK
D000328:Adult; D000368:Aged; D019559:Capillary Leak Syndrome / Q000175:diagnosis / Q000209:etiology*; D003422:Critical Care / Q000379:methods; D006323:Heart Arrest / Q000628:therapy*; D006801:Humans; D007036:Hypothermia, Induced; D007552:Isotonic Solutions / Q000009:adverse effects / Q000494:pharmacology* / Q000627:therapeutic use; D008875:Middle Aged; D009664:Norway; D017063:Outcome Assessment, Health Care / Q000379:methods; D011446:Prospective Studies; D000077331:Ringer's Solution; D012462:Saline Solution, Hypertonic / Q000009:adverse effects / Q000494:pharmacology* / Q000627:therapeutic use; D017741:Survivors; D055815:Young Adult
D007552:Isotonic Solutions; D012462:Saline Solution, Hypertonic; D000077331:Ringer's Solution