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

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 dialysis patient care technicians (PCTs) training and preparedness to provide cardiopulmonary resuscitation (CPR).Cross-sectional national survey.Survey of National Association of Nephrology Technicians/Technologists members.Descriptive statistics were performed for all survey variables. 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 participants.100 dialysis PCTs representing 31 U.S. states participated in the survey with 96.8% reporting BLS training within the last 2 years. Eighty percent had witnessed a dialysis clinic cardiac arrest. 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. 51% indicated that optimal CPR should be performed directly in the dialysis chair whereas 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.Small sample size and sampling bias may limit generalizability.Although participants reported up-to-date training and high confidence in BLS skills, 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.

Duke Scholars

Author Benjamin Peter Catanese Medicine, Nephrology

Author Grace Rim