Patrick H Pun1,2, Matthew E Dupre3,4, Monique A Starks3, Clark Tyson3, Kimberly Vellano5, Laura P Svetkey2, Steen Hansen6, Brian G Frizzelle7, Bryan McNally5, James G Jollis3, Sana M Al-Khatib3, Christopher B Granger3. 1. Duke Clinical Research Institute, patrick.pun@duke.edu. 2. Division of Nephrology, Department of Medicine, and. 3. Duke Clinical Research Institute. 4. Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina. 5. Department of Emergency Medicine, Emory University, Atlanta, Georgia. 6. Unit of Epidemiology and Biostatistics, Aalborg University Hospital, Aalborg, Denmark; and. 7. Carolina Population Center, University of North Carolina, Chapel Hill, North Carolina.
Abstract
BACKGROUND: Out-of-hospital cardiac arrest, the leading cause of death among patients on hemodialysis, occurs frequently within outpatient dialysis centers. Practice guidelines recommend resuscitation training for all dialysis clinic staff and on-site defibrillator availability, but the extent of staff involvement in cardiopulmonary resuscitation (CPR) efforts and its association with outcomes is unknown. METHODS: We used data from the Cardiac Arrest Registry to Enhance Survival and the Centers for Medicare & Medicaid Services dialysis facility database to identify patients who had cardiac arrest within outpatient dialysis clinics between 2010 and 2016 in the southeastern United States. We compared outcomes of patients who received dialysis staff-initiated CPR with those who did not until the arrival of emergency medical services (EMS). RESULTS: Among 398 OHCA events in dialysis clinics, 66% of all patients presented with a nonshockable initial rhythm. Dialysis staff initiated CPR in 81.4% of events and applied defibrillators before EMS arrival in 52.3%. Staff were more likely to initiate CPR among men and witness cardiac arrests, and were more likely to provide CPR within larger dialysis clinics. Staff-initiated CPR was associated with a three-fold increase in the odds of hospital discharge and favorable neurologic status on discharge. There was no overall association between staff-initiated defibrillator use and outcomes, but there was a nonsignificant trend toward improved survival to hospital discharge in the subgroup with shockable initial cardiac arrest rhythms. CONCLUSIONS: Dialysis staff-initiated CPR was associated with a large increase in survival but was only performed in 81% of cardiac arrest events. Further investigations should focus on understanding the potential facilitators and barriers to CPR in the dialysis setting.
BACKGROUND: Out-of-hospital cardiac arrest, the leading cause of death among patients on hemodialysis, occurs frequently within outpatient dialysis centers. Practice guidelines recommend resuscitation training for all dialysis clinic staff and on-site defibrillator availability, but the extent of staff involvement in cardiopulmonary resuscitation (CPR) efforts and its association with outcomes is unknown. METHODS: We used data from the Cardiac Arrest Registry to Enhance Survival and the Centers for Medicare & Medicaid Services dialysis facility database to identify patients who had cardiac arrest within outpatient dialysis clinics between 2010 and 2016 in the southeastern United States. We compared outcomes of patients who received dialysis staff-initiated CPR with those who did not until the arrival of emergency medical services (EMS). RESULTS: Among 398 OHCA events in dialysis clinics, 66% of all patients presented with a nonshockable initial rhythm. Dialysis staff initiated CPR in 81.4% of events and applied defibrillators before EMS arrival in 52.3%. Staff were more likely to initiate CPR among men and witness cardiac arrests, and were more likely to provide CPR within larger dialysis clinics. Staff-initiated CPR was associated with a three-fold increase in the odds of hospital discharge and favorable neurologic status on discharge. There was no overall association between staff-initiated defibrillator use and outcomes, but there was a nonsignificant trend toward improved survival to hospital discharge in the subgroup with shockable initial cardiac arrest rhythms. CONCLUSIONS: Dialysis staff-initiated CPR was associated with a large increase in survival but was only performed in 81% of cardiac arrest events. Further investigations should focus on understanding the potential facilitators and barriers to CPR in the dialysis setting.
Authors: Ruediger W Lehrich; Patrick H Pun; Nadine D Tanenbaum; Stephen R Smith; John P Middleton Journal: J Am Soc Nephrol Date: 2006-12-06 Impact factor: 10.121
Authors: Samantha L Gelfand; Nwamaka D Eneanya; Amanda K Leonberg-Yoo; Jeffrey S Berns Journal: J Am Soc Nephrol Date: 2019-05-06 Impact factor: 10.121
Authors: Patrick H Pun; Matthew E Dupre; Clark Tyson; Sana M Al-Khatib; Christopher B Granger Journal: J Am Soc Nephrol Date: 2019-05-06 Impact factor: 10.121
Authors: Samuel A Hofacker; Matthew E Dupre; Kimberly Vellano; Bryan McNally; Monique Anderson Starks; Myles Wolf; Laura P Svetkey; Patrick H Pun Journal: Resuscitation Date: 2020-08-27 Impact factor: 5.262
Authors: Marta Obremska; Katarzyna Madziarska; Dorota Zyśko; Jerzy R Ładny; Robert Gałązkowski; Mariusz Gąsior; Klaudiusz Nadolny Journal: Int Urol Nephrol Date: 2020-12-18 Impact factor: 2.370