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Outcomes for Hemodialysis Patients Given Cardiopulmonary Resuscitation for Cardiac Arrest at Outpatient Dialysis Clinics.

Publication ,  Journal Article
Pun, PH; Dupre, ME; Starks, MA; Tyson, C; Vellano, K; Svetkey, LP; Hansen, S; Frizzelle, BG; McNally, B; Jollis, JG; Al-Khatib, SM ...
Published in: J Am Soc Nephrol
March 2019

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.

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Published In

J Am Soc Nephrol

DOI

EISSN

1533-3450

Publication Date

March 2019

Volume

30

Issue

3

Start / End Page

461 / 470

Location

United States

Related Subject Headings

  • Urology & Nephrology
  • 3202 Clinical sciences
  • 1103 Clinical Sciences
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Pun, P. H., Dupre, M. E., Starks, M. A., Tyson, C., Vellano, K., Svetkey, L. P., … CARES Surveillance Group, . (2019). Outcomes for Hemodialysis Patients Given Cardiopulmonary Resuscitation for Cardiac Arrest at Outpatient Dialysis Clinics. J Am Soc Nephrol, 30(3), 461–470. https://doi.org/10.1681/ASN.2018090911
Pun, Patrick H., Matthew E. Dupre, Monique A. Starks, Clark Tyson, Kimberly Vellano, Laura P. Svetkey, Steen Hansen, et al. “Outcomes for Hemodialysis Patients Given Cardiopulmonary Resuscitation for Cardiac Arrest at Outpatient Dialysis Clinics.J Am Soc Nephrol 30, no. 3 (March 2019): 461–70. https://doi.org/10.1681/ASN.2018090911.
Pun PH, Dupre ME, Starks MA, Tyson C, Vellano K, Svetkey LP, et al. Outcomes for Hemodialysis Patients Given Cardiopulmonary Resuscitation for Cardiac Arrest at Outpatient Dialysis Clinics. J Am Soc Nephrol. 2019 Mar;30(3):461–70.
Pun, Patrick H., et al. “Outcomes for Hemodialysis Patients Given Cardiopulmonary Resuscitation for Cardiac Arrest at Outpatient Dialysis Clinics.J Am Soc Nephrol, vol. 30, no. 3, Mar. 2019, pp. 461–70. Pubmed, doi:10.1681/ASN.2018090911.
Pun PH, Dupre ME, Starks MA, Tyson C, Vellano K, Svetkey LP, Hansen S, Frizzelle BG, McNally B, Jollis JG, Al-Khatib SM, Granger CB, CARES Surveillance Group. Outcomes for Hemodialysis Patients Given Cardiopulmonary Resuscitation for Cardiac Arrest at Outpatient Dialysis Clinics. J Am Soc Nephrol. 2019 Mar;30(3):461–470.

Published In

J Am Soc Nephrol

DOI

EISSN

1533-3450

Publication Date

March 2019

Volume

30

Issue

3

Start / End Page

461 / 470

Location

United States

Related Subject Headings

  • Urology & Nephrology
  • 3202 Clinical sciences
  • 1103 Clinical Sciences