Abstract 92: Efficacy of Continuous Venovenous Hemodiafiltration on Survival of Cardiac Arrest in Humans
Introduction: The efficacy of continuous venovenous hemodiafiltration (CVVHDF) on patients suffering cardiac arrest (CA) is unclear.
Objective: To identify any efficacy of CVVHDF on post cardiac arrest syndrome (PCAS) in humans.
Methods: This was a multicenter study conducted between 2006-09 in Chiba, Japan, involving non-trauma CA adult patients. Patients admitted to acute care units were included. The primary outcome was mortality through the end of the study. Cerebral Performance Category (CPC) score was recorded at 6 months and the blood levels of IL-6 on admission, at 6hr, and 24hr after CA were measured as the secondary outcomes. The application of CVVHDF was left to each physician. The dialysate flow and filtration rate were set at 10-20mL/kg/h and 6-10mL/kg/h, respectively. We evaluated the effect of CVVHDF on survival using the Kaplan-Meier method. A Cox proportional hazard model with a step-wise selection procedure was used to identify independent variables associated with survival time. A matching process based on propensity-score was done to compare neurological outcome and blood IL-6 levels between groups.
Results: A total of 227 patients were included. The survival time in the CVVHDF group (n=33) was significantly longer than non-CVVHDF group (long rank, p<0.001). Three factors were identified as indicators of earlier death; Initial ECG of non-VF, whether or not CA occurred before EMS arrival, and if therapeutic hypothermia was used. When being adjusted for those 3 factors, there was no significant difference in association of CVVHDF with mortality (hazard ratio, 1.33; 95% confidential interval, 0.81-2.18; p=0.26). Between the matched groups, there were no differences in the number of patients with good neurological outcome (p=0.24) and in IL-6 levels at 24hr (p=0.08). IL-6 levels on admission (median and interquartile, 69pg/mL [25-193]) and at 6hr (116pg/mL [33-499]) of non-CVVHDF group were significantly lower than those (350pg/mL [142-1493] and 247pg/mL [89-1104]) of CVVHDF group (p=0.002 and p=0.035, respectively).
Conclusions: We found no association with the use of CVVHDF and mortality of PCAS patients. The use of CVVHDF was not seen to lower the circulating levels of IL-6 levels in this cohort of patients.
Author Disclosures: K. Shinozaki: None. Y. Sato: None. L. Becker: Employment; Significant; University of Pennsylvania. Research Grant; Significant; Philips Medical Systems, NIH, BeneChill Inc., Zoll Medical Corp, Medtronic Foundation. Consultant/Advisory Board; Significant; Philips Medical Systems, NIH Data Safety Monitoring Board, Helar Technology. Other; Significant; Volunteer member of the American Heart Association, Universities for Lecturing of Keio University. S. Oda: None. H. Hirasawa: None.
- © 2014 by American Heart Association, Inc.