title: Fluid therapy and acute kidney injury in cardiogenic shock after cardiac arrest.
abstract: OBJECTIVE
  It has recently been suggested that acute kidney injury (AKI) may strongly be influenced by post-resuscitation disease and cardiogenic shock (CS), and may not just be a consequence of cardiac arrest and time without spontaneous circulation. AKI also has been suggested as a strong independent predictor of in-hospital mortality. Therefore the present study aimed at investigating the effect of fluid management on the incidence of AKI in patients with cardiogenic shock after cardiac arrest treated by mild therapeutic hypothermia.
  
  
  METHODS
  Fluid therapy and the incidence of acute kidney injury (AKI) was retrospectively reviewed in 51 patients with cardiogenic shock after cardiac arrest comparing patients with and without hemodynamic (PPV, SVV) and volumetric (ELWI, GEDI) monitoring.
  
  
  RESULTS
  There was no significant difference in baseline or cardiac arrest characteristics between hemodynamic monitored patients and conventional monitored patients. 28 patients were monitored by standard monitoring, in 23 patients monitoring was complemented by a PICCO system. In the first 24h of treatment the total amount of fluid was significantly higher in patients under PICCO monitoring compared to conventional monitoring (4375±1285ml vs. 5449±1438ml, p=0.007). This was associated with a significant reduction in the incidence of AKI (RIFLE 'I'/'F': PICCO-group: 1 (4.3%) vs. conventional group 8 (28.6%), p=0.03).
  
  
  CONCLUSIONS
  The presented data suggest that volume therapy guided by volumetric (ELWI, GEDI) and arterial waveform derived variables (PPV, SVV) can reduce the incidence of AKI in patients with cardiogenic shock after cardiac arrest treated with mild therapeutic hypothermia.
authors: Department of Internal Medicine III, University of Cologne, Cologne, Germany.
authors: Christoph
authors: C
authors: Adler
authors: Hannes
authors: H
authors: Reuter
authors: Catherine
authors: C
authors: Seck
authors: Martin
authors: M
authors: Hellmich
authors: Carsten
authors: C
authors: Zobel
mesh_terms: D058186:Acute Kidney Injury / Q000453:epidemiology* / Q000209:etiology*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005440:Fluid Therapy; D006323:Heart Arrest / Q000150:complications*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012770:Shock, Cardiogenic / Q000209:etiology* / Q000628:therapy*