A922 Sequential measurement of 1 hour creatinine clearance (1-CRCL) in critically ill patients at risk of acute kidney injury (AKI)

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Characteristics and evolution of patients with out of hospital cardiac arrest treated with therapeutic hypothermia

[ES] Introducción: La parada cardiorrespiratoria (PCR) presenta múltiples morbilidades secundarias, especialmente las neurológicas, por tanto es necesario un correcto manejo posparada. El objetivo de este trabajo consiste en analizar las características y los resultados de pacientes sometidos a hipotermia tras una PCR extrahospitalaria resucitada. Material y métodos: Realizamos un estudio prospectivo observacional de dos años, donde se incluyeron pacientes que ingresaron en nuestra unidad mayores de 18 años y con PCR prolongada extrahospitalaria resucitada, en los cuales se realizó un protocolo consensuado de cuidados posresucitación e hipotermia terapéutica. Resultados: Se incluyeron 33 pacientes. Se observó una media de 31,6 min de tiempo de PCR. Un 32,3% presentaron encefalopatía hipóxico-anóxica, siendo más frecuente en fumadores (p = 0,04), y con mayores tiempos de PCR (p= 0,049). También el 66,7% de los pacientes presentaron mayores datos de hipoperfusión (p = 0,049). Conclusión: Observamos que la hipotermia podría ser un instrumento útil en el manejo de las PCR extrahospitalarias. Además, encontramos que el pronóstico neurológico se asocia más a factores no modificables.[EN] Introduction: Cardiac arrest have secondary co-morbidities, especially neurological outcome. Due to this cirumstances is mandatory to optimized postcardiac arrest management. The objective of this research is to analyze patient's characteristics and outcome after out-hospital cardiac arrest in patients that have undergone therapeutic hypothermia. Matherial and methods: We conducted a prospective observational study during a two-year period. We included resuscitated patients over eighteen years old who were admitted in to our intensive care unit. These patients had undergone prolonged resuscitation measures and were included in an implemented post-resuscitation protocol which included therapeutic hypothermia. Results: Thirty-three patients were analyzed. The median time of cardiopulmonary resuscitation was 31.6 minutes. We observed hypoxic/anoxic encephalopathy in 32.3% of cases. This prognosis was associated in those who smoked (p = .04) and with longer time of cardiac arrest (p = .049). Also, the 66.7% of the patients showed a higher incidence of hypoperfusion (p = .049). Conclusion: In our series hypothermia could be a useful tool in post-resucitation cardiac arrest managment. We also found that the neurological prognosis was associated to non-modifiable risk factors

Donor-specific circulating cell free DNA as a noninvasive biomarker of graft injury in heart transplantation

[Background] Considerable effort has been exerted to develop noninvasive diagnostic biomarkers that might replace or reduce the need to perform endomyocardial biopsies. In this context, graft DNA circulating on transplant recipients has been proposed as a potential biomarker of organ rejection or cellular graft injury. [Methods] We propose a digital PCR (dPCR) method based on the amplification of ten specific InDels sufficiently sensitive to detect small amounts of specific donor circulating DNA diluted on the host cell free DNA (cfDNA). We obtained 23 informative mismatches from 30 host and donor organ biopsy pairs. [Results] Patients without heart-related complications showed a high increase in the specific genomic marker levels during the first 24 h after transplantation that dropped to the basal levels on days 3–4 post-surgery. In contrast, patients with complications presented a significantly lagged decay pattern from day one after transplantation. A specific donor cfDNA increase was detected in one patient two days before rejection diagnosis, diminishing the basal levels after successful immunotherapy. A cfDNA increase was also observed during graft injury due to heart damage. [Conclusion] These results suggest that cfDNA monitoring of transplanted patients may be a useful tool to detect and probably anticipate graft rejection.This work was supported by a grant from the Instituto de Salud Carlos III [FIS: PI15/00939]-Fondos FEDER