Elease from skeletal muscles during cardiopulmonary resuscitation may …

Elease from skeletal muscles during cardiopulmonary resuscitation may theoretically influence the course of serum creatinine levels. Although we are unable to rule out an effect of muscular release of creatine with certainty, serum creatine kinase levels were not found to correlate with serum creatinine levels or with changes in serum creatinine levels at baseline and over time (P > 0.5 for all comparisons). Moreover, serum creatine kinase was not found to discriminate between favorable and unfavorable outcome (data not shown). Kidney function may be also affected by treatment with therapeutic hypothermia. Although recent investigations did not detect differences in the incidence of acute renal failure under hypothermia, transient effects on renal function cannot be fully excluded [20]. Concerning neurological outcome, we only present CPC scores at ICU discharge. Although some evidence indicates that there are only minor changes regarding neurological outcome after ICU discharge [21], long-term follow up may provide more PubMed ID:https://www.ncbi.nlm.nih.gov/pubmed/15501003 insight into this important endpoint. Moreover, one should keep in mind that classification as CPC 5 may reflect two different clinical situations: Patients dying in a comatose state after therapy withdrawal and patients dying from other complications after regaining consciousness. Nevertheless, although the neurological situation seems completely different, from the patient's point of view CPC 5 is an important Chrysin outcome variable independent of the cause of death. In addition,Likelihood ratio 0.251 0.902 1.607 1.437 1.804 2.95 confidence interval 0.130 to 0.484 0.497 to 1.636 0.746 to 3.461 0.657 to 3.145 0.496 to 6.562 1.148 to 4.Interval likelihood ratios with 95 confidence interval for Crea24. The number of patients with unfavorable vs. favorable outcome is given for respective Crea24 intervals. Crea24: change in serum creatinine in the first 24 hours; CPC: Cerebral Performance Category.Page 5 of(page number not for citation purposes)Critical CareVol 13 NoHasper et al.there is good evidence that the majority of patients after cardiac arrest die after therapy withdrawal [22]. Importantly, our data should not be used to predict outcome in patients after cardiac arrest. Obviously, when predicting neurological outcome one should focus on the brain, not the kidney, and reliable multimodal approaches are available for this purpose [23]. Nevertheless, the demonstrated relation between the kidney and the brain may help to identify patients at a high risk of an unfavorable outcome. Theoretically, this may have implications for ICU care in the future. In patients with sepsis, convincing data demonstrate that early identification and therapy using an early goal-directed therapeutic approach with fluids and vasopressor support improves organ function and outcome [24]. Although somewhat speculative, one might argue that these rather simple approaches may also be effective in patients after cardiac arrest via improvement of both cerebral and kidney function. Moreover, there may be another conclusion which may be drawn from our data. Nearly half of the patients with severe hypoxic brain damage after cardiac arrest did not develop AKI despite profound global ischemia. This result is in marked contrast to the situation typically found in severe shock and multiple-organ failure where acute renal failure is a common condition but relevant encephalopathy a comparably rare event. In this light, our findings support the hypothesis that '.