Sudden cardiac arrest (SCA) is a disease can cause serious outcomes. In South Korea, the incidence of SCA was 41.5 (per 100,000 people) in 2016. Among them, only 7.6% was survived and neurologically intact survival was 4.2%. The high mortality rate is caused by a unique pathophysiological process involving multi-organ system. Initially, global ischemia during cardiac arrest causes direct organ injuries. However, additional damage develops during and after reperfusion. This process is called as post-cardiac arrest syndrome (PCAS) comprises post-cardiac arrest brain injury, post-cardiac arrest myocardial dysfunction, systemic ischemia/reperfusion response, and persistent precipitation pathology. Although the course and prognosis of brain and myocardial injuries of PCAS are well known, acute kidney injury (AKI) had not been studied well because lack of unified diagnostic criteria. However, after developing an unified definition for diagnosing AKI had been developed by the Kidney Disease: Improving Global Outcomes (KDIGO) AKI Guideline Work Group in 2012, several single center cohort studies including large number of out-of-hospital cardiac arrest (OHCA) patients had been reported recently. As a results, it had been verified that the development of AKI was associated with mortality of the OHCA patients and with poor neurological outcome. If we know the natural course and prognosis of AKI after OHCA, we could decide whether and when we will start the intensive treatment for the AKI such as renal replacement therapy (RRT). We could not predict the natural course, recovery rate, and prognosis of AKI according to the stages of AKI, because most of the AKI after OHCA was stage 1 (52%) or 2 (25%) in the previous study.
This study is prepared to observe the natural course of AKI after OHCA including when to develop and when to recover, and to confirm whether the survivals and neurological outcomes were different according to the stages of AKI or not.

Cohort/Group Label

Targeted temperature management group after out-of-hospital cardiac arrest

Cohort/Group Description

We observe the natural course including development and recovery of the acute kidney injury and outcomes including survival rate and neurological status in all adult patients (≥19 years) with out-of-hospital cardiac arrest irrespective of the cause of arrest who are unconscious after return of spontaneous circulation (Glasgow Coma Scale score <8) and treated with targeted temperature management.

Not collect nor Archive

All adult patients (≥19 years) with out-of-hospital cardiac arrest irrespective of the cause of arrest who are unconscious after return of spontaneous circulation (Glasgow Coma Scale score <8) and treated with targeted temperature management in the 6 research institutions.

Non-probablity sampling: All adults patients visit  to the 6 research institutions are screened on whether they are fit to the inclusion criteria or not.

Gender

Age

Description

All adult patients (≥19 years) with out-of-hospital cardiac arrest irrespective of the cause of arrest who are unconscious after return of spontaneous circulation (Glasgow Coma Scale score <8) and treated with targeted temperature management.

(1) Patients’ age<19 years
(2) Patients who are dead on arrival to the hospital and do not receive cardiopulmonary resuscitation (CPR)
(3) Patients who do not achieve return of spontaneous circulation (ROSC) in spite of CPR
(4) Patients who do not receive targeted temperature management in spite of achieving ROSC
(5) Patients who were diagnosed as end-stage renal disease with dialysis (peritoneal dialysis or hemodialysis) before developing cardiac arrest
(6) Patients who have Do-Not-Attempt-Resuscitation order
(7) Patients who have acute intracranial hemorrhage or acute ischemic stroke
(8) Patients who have active bleeding
(9) Patients’ legal surrogates refuse to participate the study or withdrawal of informed consent during the study period by patients’ legal surrogates or patients’ themselves
(10) Patients’ legal surrogates cannot speak Korean.

The date of acute kidney injury development and recovery which is calculated since the day of achieving return of spontaneous circulation

During admission

Arrest location (home, workplace, sports or recreating, street or highway, public building, nursing home, and educational institution)

During admission

Bystander cardiopulmonary resuscitation (yes or no)

During admission

First monitored rhythm (ventricular fibrillation, pulseless ventricular tachycardia, pulseless electrical activity, and asystole)

During admission

The date of expiration if patients expire at 30th day since return of spontaneous circulation

At the time of 30th day since return of spontaneous circulation

Daily serum creatinine level (mg/dL, if the serum creatinine level will be checked two or more times in a day, highest value will be recorded)

During admission

Renal replacement therapy (yes or no)

During admission

The type of renal replacement therapy (continuous renal replacement therapy or hemodialysis)

During admission

Date of renal replacement therapy (initiation, termination, and duration)

During admission

Discharge date

At the time of discharge

Age (years)

During admission

Sex (male or female)

During admission

Weight (kg)

During admission

Past medical history (hypertension, diabetes mellitus, heart failure, chronic kidney disease)

During admission

Witnessed arrest (witnessed or not witnessed)

During admission

Pathogenesis (medical, trauma, drug overdose, drowning, electrocution, and asphyxia)

During admission

Response time (time interval from call to visit)

During admission

Defibrillation time (time interval from call to the time the first shock)

During admission

Epinephrine dose (mg)

During admission

Coronary angiography (yes or no)

During admission

Extracorporeal membrane oxygenation (yes or no)

During admission

Targeted temperature of TTM (33°C or 36°C)

During admission

Maintenance period of targeted temperature management (24 h or 48 h)

During admission

Urine output (mL/kg/h) in intensive care unit (ICU)

During admission

Event of shock (mean arterial pressure < 70 mmHg) after return of spontaneous circulation

During admission

Survival discharge (yes or no)

At the time of discharge

Modified Rankin scale at discharge

At the time of discharge

Modified Rankin scale at 30th day since return of spontaneous circulation

At the time of 30th day since return of spontaneous circulation