Clinical Research
Clinical Trial
High-Volume Hemofiltration After Out-of-Hospital Cardiac Arrest: A Randomized Study

https://doi.org/10.1016/j.jacc.2005.04.039Get rights and content
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Objectives

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°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.

Abbreviations and Acronyms

CI
confidence interval
C3a
complement compounds C3a
HF
isovolumic high volume hemofiltration (200 ml/kg/h over 8 h)
HF+HT
isovolumic high volume hemofiltration plus hypothermia (32°C for 24 h)
HT
hypothermia
ICU
intensive care unit
IL
interleukin
OHCA
out-of-hospital cardiac arrest
ROSC
restoration of spontaneous circulation
TCC
terminal complement complex

Cited by (0)

Drs. Laurent and Monchi are currently affiliated with the Department of Intensive Care, Jacques Cartier Institute, Massy, France. For this study, the hemofiltration circuits, catheters, and replacement fluid concentrates were provided by GAMBRO AB, with an estimated cost of €120 per patient treated by hemofiltration.