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CLINICAL RESEARCH: CLINICAL TRIAL

High-Volume Hemofiltration After Out-of-Hospital Cardiac Arrest

A Randomized Study

Ivan Laurent, MD^_*, Christophe Adrie, MD, Christophe Vinsonneau, MD^_*, Alain Cariou, MD^_*, Jean-Daniel Chiche, MD^_*, Alice Ohanessian, MD, Christian Spaulding, MD, Pierre Carli, MD, Jean-François Dhainaut, MD, PhD^_* and Mehran Monchi, MD^_*,_*

^_* Medical ICU, Cochin Teaching Hospital, Rene Descartes University, Paris, France
General ICU, Delafontaine Hospital, Saint Denis, France
Cardiology Department, Cochin Teaching Hospital, Rene Descartes University, Paris, France
SAMU, Necker Hospital, Rene Descartes University, Paris, France.

Manuscript received February 4, 2005; revised manuscript received March 18, 2005, accepted April 13, 2005.

^_* Reprint requests and correspondence: Dr. Mehran Monchi, Department of Intensive Care Medicine, Institut Jacques Cartier, 6 avenue du Noyer Lambert, 91300 Massy, France. (Email: m.monchi{at}free.fr).

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

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