P. Shen1,2,3, J. Xu1,2,4, S. Xia1,2, S. Liu1,2, Z. Li4, M. Zhang1,2 1Department Of Emergency Medicine,Second Affiliated Hospital, Zhejiang University School Of Medicine,Hangzhou, ZHEJIANG, China 2Institute Of Emergency Medicine,Zhejiang University,Hangzhou, ZHEJIANG, China 3Department Of Intensive Care Medicine,The First Hospital Of Jiaxing,Jiaxing, ZHEJIANG, China 4Department Of Emergency Medicine,Yuyao People’s Hospital, Medical School Of Ningbo University,Ningbo, ZHEJIANG, China
Introduction: The poor outcome of traumatic cardiac arrest is partly attributed to post-resuscitation systemic inflammation and multiple organ injury. Continuous renal replacement therapy (CRRT) is used for acute renal failure following resuscitation, however, the optimal timing of CRRT initiation might be controversial. In this study, we investigated the effects of CRRT early initiated after resuscitation on post-cardiac arrest syndrome following severe hemorrhage. We hypothesized that early initiation of CRRT would alleviate post-resuscitation hemodynamic abnormality, systemic inflammation, cardiac and cerebral injuries in a porcine model of hemorrhage-induced traumatic cardiac arrest.
Methods: Sixteen male domestic swines weighing between 28-33 kg were utilized. Forty percent of estimated blood volume was removed over an interval of 20 minutes. Subsequently, ventricular fibrillation was electrically induced and untreated for 5 minutes while defibrillation was attempted after 5 minutes of cardiopulmonary resuscitation. The resuscitated animals were randomized to receive either CRRT (n=7) or sham control (n=9). At 5 minutes after successful resuscitation, CRRT was performed with the mode of continuous venovenous hemofiltration for a total of 6 hours. All animals were observed for 24 hours. Continuous variables were presented as mean ± SD and compared with one way analysis of variance.
Results: After resuscitation, mean arterial pressure was significantly increased and heart rate was significantly decreased in the CRRT group when compared with the control group (6-hr mean arterial pressure, 129±4 vs. 93±9 mmHg, P<0.001; 6-hr heart rate, 116±16 vs. 172±34 beats/min, P=0.003). Post-resuscitation cardiac and neurologic dysfunction were significantly improved in the CRRT group compared to the control group (6-hr ejection fraction, 67±6 vs. 59±5 %, P=0.015; 24-hr neurological deficit score, 95±13 vs. 190±31, P<0.001). Serum troponin I at 6 hours ( 346±28 vs. 433±46 pg/ml, P=0.003) and serum neuron specific enolase at 24 hours (15.9±1.9 vs. 28.5±1.1 ng/ml, P<0.001) were also significantly reduced in the CRRT group. Additionally, significantly lower serum tumor necrosis factor-α (570±71 vs. 1031±39 pg/ml, P<0.001) and interleukin-6 (224±29 vs. 416±16 pg/ml, P<0.001) at 24 hours after resuscitation were achieved with the CRRT compared to the control group.
Conclusion: Early initiation of CRRT significantly improved cardiac and neurological outcomes after resuscitation while alleviated systemic inflammatory response in a porcine model of traumatic cardiac arrest.