Cardiac Arrest in Outpatient Hemodialysis Units: A National Cross-Sectional Survey of Dialysis Technicians.

RATIONALE & OBJECTIVE: Cardiac arrest is the leading cause of death for hemodialysis patients and often occurs within outpatient dialysis units. Approximately one-fifth of dialysis unit resuscitations are not initiated until emergency medical service personnel arrive. Little is known about the training and preparedness of dialysis patient care technicians (PCTs) to provide cardiopulmonary resuscitation (CPR). STUDY DESIGN: Cross-sectional national survey. SETTING & PARTICIPANTS: Survey of National Association of Nephrology Technicians/Technologists members. ANALYTICAL APPROACH: Descriptive statistics were performed for all survey variables. A Likert scale (5 point) was used for self-efficacy questions about the critical steps of basic life support (BLS), and subgroups were compared using χ2 test. The top 3 challenges for performing high-quality CPR were ranked by the participants. RESULTS: The survey participants were 100 dialysis PCTs representing 31 US states, with 97% reporting BLS training within the last 2 years. Eighty percent had witnessed a dialysis clinic cardiac arrest. The participants had high levels of confidence for performing each step of BLS (65% ± 7% selecting 5/5 on the Likert scale), but only 33% reported the same confidence level in their dialysis team's ability to resuscitate a patient. Dialysis PCTs with more work experience and in larger units reported significantly higher team confidence. For positioning, 51% indicated that optimal CPR should be performed directly in the dialysis chair, and 47% indicated that moving the patient from the chair to the floor was necessary. Participants cited delays in recognizing cardiac arrest and fear of harming the patient as the most significant barriers to performing CPR in dialysis clinics. LIMITATIONS: Small sample size and sampling bias may limit generalizability. CONCLUSIONS: Although the participants reported having up-to-date training and high confidence in their BLS skills, their confidence in team resuscitation was comparably low, and there was no consensus on positioning for CPR. Quality improvement efforts should focus on team training and the unique barriers to CPR presented by the dialysis clinic setting. PLAIN-LANGUAGE SUMMARY: Despite the need for a rapid response to cardiac arrest, cardiopulmonary resuscitation (CPR) is not always initiated by staff in the dialysis unit before the arrival of emergency medical services. Little is known about the barriers that dialysis patient care technicians (PCTs) face in performing CPR in outpatient dialysis units. We surveyed dialysis PCTs on their experience with CPR training and performance. We found that dialysis PCTs were up to date on training and were individually confident in their CPR skills but were less confident in their teams' abilities to perform effective CPR. There was a lack of agreement on how to position patients for CPR. Future efforts should focus on improving team training and addressing the unique challenges of treating cardiac arrests that occur in the dialysis clinic.

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