Prevalence and Determinants of Acute Renal Failure Following Cardiopulmonary Resuscitation

The purpose of this study was to determine the prevalence and determinants of acute renal failure in patients following cardiac arrest.This was a cross-sectional study of 420 consecutive admissions with a diagnosis of cardiac arrest admitted to the Long Island Jewish Medical Center, New Hyde Park, NY, the Long Island Campus for the Albert Einstein College of Medicine, Bronx, NY, over a 2-year period. Fifty-six patients who initially survived cardiopulmonary resuscitation following cardiac arrest and had serial biochemical and renal function data available were studied. The events during cardiopulmonary resuscitation and clinical and biochemical data were compared and contrasted among patients who developed acute renal failure following cardiopulmonary resuscitation (group 1, n = 16) and those who did not (group 2, n = 40).Patients who developed acute renal failure following cardiopulmonary resuscitation (group 1) had longer duration of resuscitation (12.0 +/- 2.1 minutes vs 6.7 +/- 0.9 minutes for group 2) and received larger dosages of epinephrine during cardiopulmonary resuscitation (1.81 +/- 0.36 mg vs 0.90 +/- 0.18 mg for group 2). Patients in group 1 had a significantly higher frequency of congestive heart failure (43.8% vs 12.5% for group 2), coronary artery disease (87.5% vs 37.5% for group 2), and preexisting compromised renal function (50% vs 12.5% for group 2). Patients in group 1 had significantly worsened long-term survival compared with group 2 patients (6.3% vs 47.5% for group 2).We conclude that acute renal failure occurs commonly in the postcardiac arrest period. Administration of the vasoconstrictor epinephrine, congestive heart failure, coronary artery disease, and preexisting renal insufficiency may be significant risk factors for the development of postcardiac arrest acute renal failure. The development of acute renal failure following cardiopulmonary resuscitation predicts a lesser likelihood of survival to discharge from the hospital.