Identifying Risk for Acute Kidney Injury in Infants and Children Following Cardiac Arrest
Neumayr, Tara, Jeff Gill, and Allan Doctor. “Identifying Risk for Acute Kidney Injury in Infants and Children Following Cardiac Arrest”. Pediatric Critical Care Medicine 18, no. 10 (2017): 446-454
Objective: Our goal was to identify risk factors for acute kidney injury (AKI) in children surviving cardiac arrest (CA). Design: Retrospective analysis of a public-access dataset. Setting: Fifteen children’s hospitals associated with the Pediatric Emergency Care Applied Research Network. Patients: Two hundred ninety-six subjects between 1 day and 18 years of age who experienced in-hospital or out-of-hospital CA between July 1, 2003, and December 31, 2004. Interventions: None. Measurements and Main Results: Our primary outcome was development of AKI as defined by the Acute Kidney Injury Network (AKIN) staged criteria. An ordinal logistic model was developed using 8 candidate variables. We found 6 critical explanatory variables, including total number of epinephrine doses, post-CA blood pressure, arrest location, presence of a chronic lung condition, pH nadir, and presence of an abnormal baseline creatinine. Conclusions: This study is the first to identify risk factors for AKI in children after CA. Our findings regarding the impact of epinephrine dosing are of particular interest and suggest potential for epinephrine toxicity with regard to AKI. The ability to identify and potentially modify risk factors for AKI after CA may lead to improved morbidity and mortality in this challenging population. Key Words: cardiac arrest; children; pediatric; outcome; acute kidney injury; epinephrine.