Original Contribution
Acute kidney injury after cardiac arrest of ventricular fibrillation and asphyxiation swine model,☆☆

https://doi.org/10.1016/j.ajem.2013.10.043Get rights and content

Abstract

Purposes

The purposes of the study are to investigate the renal function in ventricular fibrillation (VF) and asphyxiation cardiac arrest in a swine model and to estimate the value of novel biomarkers in the acute kidney injury (AKI) after cardiac arrest.

Method

Thirty-two healthy inbred Wu-Zhi-Shan miniature piglets were randomized into 2 groups (n = 16 per group). Cardiac arrest was induced by programmed electric stimulation and clamping the endotracheal tube in the VF group and asphyxiation group, respectively. Cardiopulmonary resuscitation was done for return of spontaneous circulation (ROSC).

Results

One hundred percent (16/16) ROSC was observed in the VF group, and 50% (8/16) in the asphyxiation group (P < .01). All AKI biomarkers elevated significantly after ROSC. The novel biomarkers changed much earlier than the creatinine. The concentration of novel biomarkers in the asphyxiation group was higher than the VF group. Live animals had an oliguria and developed AKI. Characteristic morphological injuries in renal tissues were observed under light microscope and transmission electron microscope and were more serious in the asphyxiation group.

Conclusions

Acute kidney injury at early stage of postresuscitation is common in different causes of cardiac arrest. Asphyxiation has more severe kidney injury and gets worse prognosis.

Introduction

Patients who survive in an initial cardiac arrest (CA) have significant morbidity and mortality [1], [2], [3], [4]. Postresuscitation morbidity is often attributed to cerebral, myocardial and prolonged, complete, whole-body ischemia-reperfusion injury (IRI) [5], which is an unnatural pathophysiologic stage created by successful cardiopulmonary resuscitation (CPR). Such ischemic injury should have major effects on the kidneys.

The acute kidney injury (AKI) is a syndrome characterized by the rapid loss of the kidney's excretory function. It is common in any cohort of critically ill patients, such as the survivors of CA. Post-CA AKI is usually considered related to the post-CA syndrome (PCAS) and might affect the long-term survival. However, it does not attract as much important as the cerebral and myocardial injury do. Serum creatinine (sCr) and urine output are the standard diagnostic indexes of the RIFLE (risk, injury, failure, loss, end stage) criteria, Acute Kidney Injury Network (the AKIN criteria), and Kidney Disease: Improving Global Outcomes (KDIGO) Clinical Practice Guidelines for AKI [6], [7]. However, both sCr and urine output have a lack of sensitivity and/or specificity; thus, new biomarkers for earlier and more accurate detection are needed [8], [9]. Neutrophil gelatinase–associated lipocalin (NGAL), cystatin C (CysC), kidney injury molecule 1 (KIM-1), and N-asetil-β-glukosaminidase (NAG), which are the clinical utility of certain novel AKI biomarkers, already evaluated in various clinical conditions and were deemed as good as or better than creatinine (Cr) in detecting AKI, particularly in the early stage [10], [11].

In this study, we hypothesized that postresuscitation AKI was common in both ventricular fibrillation (VF) CA (VFCA) and asphyxiation CA (ASCA). The purpose of this study was to confirm this hypothesis by carrying out the biomarkers on the characteristics of renal function and structures in swine models of CA.

Section snippets

Methods

This prospective laboratory study was approved by the Capital Medical University Institutional Animal Care Committee and the Beijing Chao-Yang Hospital Affiliated to the Capital Medical University Animal Care and Use Committee. All animals received treatments in compliance with the National Research Council's 1996 Guide for the Care and Use of Laboratory Animals. Anesthesia was titrated in all surgical interventions to avoid unnecessary suffering. The study was performed according to

Characteristics of animals

The animal profile (sex and weight), time of preparatory phase, and the extra doses of propofol and fentanyl administered during the preparatory phase did not differ significantly in the 2 groups (Table 1).

Rate of ROSC and survivals

All animals in both groups had CA. The duration between clamping the tube and CA in the ASCA group was between 13 and 20 minutes (16.8 ± 1.3 minutes). Return of spontaneous circulation was observed in 100% (16/16) of animals of the VFCA group and only 50% (8/16) of animals of the ASCA group (P

Discussion

The high mortality of patients who initially achieve ROSC after CA can be attributed to PCAS that involves multiple organs, and epidemiological data suggested that the mortality of PCAS was nearly 70% [5]. Because there is no doubt about the importance of heart and brain, post-CA myocardial dysfunction and brain injury as well as the systemic IRI are always paid close attention. However, the kidney is ignored, although the injured kidneys may play a key role in the systemic derangement present

Conclusions

Our findings suggest that post-CA AKI that occurs at an early stage of postresuscitation is common in both VFCA and ASCA, but ASCA has more severe kidney injury and worse prognosis. The novel AKI biomarkers in serum and urine, such as NGAL, CysC, KIM-1, and NAG, are of significant importance as early predictors of post-CA AKI.

Acknowledgments

The authors thank Yi Zhang, Qin Yin, Zhi-Jun Guo, Shuo Wang, and Qian Zhang for excellent technical assistance.

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    Conflicts of interests: None.

    ☆☆

    Sources of fundation: Beijing Natural Science Foundation (No. 81372025); Technology Foundation for the Tutor of Beijing Excellent Doctoral Dissertation (No. 20121002501).

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