ACC 2018: First study of staff CPR in dialysis clinics finds rates sub-optimal

March 12, 2018 – CPR by dialysis clinic staff was associated with a three-fold increase in odds of survival to hospital discharge.

Hemodialysis patients are one of the highest risk groups for out-of-hospital cardiac arrest (OHCA), which occurs 20 times more frequently than in the general population, accounting for more than 25 percent of all hemodialysis patient deaths. Sudden cardiac arrest events occur frequently within outpatient dialysis facilities, where up to 23 percent of all OHCAs take place. Earlier reports suggest that only 56 percent of patients with dialysis clinic OHCA survive to hospital admission, and only 8 percent are alive after one year.

Patrick PunIn a new analysis of 400 cases of cardiac arrest at dialysis clinics, staff initiated CPR prior to emergency medical services or first-responder arrival in 81.3 percent of events and initiated automated external defibrillator (AED) application in 52.6 percent of events.

The findings were presented Monday at the American College of Cardiology 67th Annual Scientific Session in Orlando, Florida.

These cases are included in the Cardiac Arrest Registry to Enhance Survival (CARES) comprehensive prospective registry of patients with OHCA, coordinated by Emory University. Data were collected between 2010 and 2016 from 71 participating counties in North Carolina (covering a population of around 8 million) and nine metropolitan Atlanta counties in Georgia (with a population of 5.2 million).

“It’s reassuring that bystander CPR improves outcomes in dialysis clinics just as it does in other settings, but it’s also concerning that the rate of dialysis staff-initiated CPR isn’t closer to 100 percent considering that all staff should be CPR-trained,” said lead author Patrick Pun, MD, MHS, associate professor of medicine and nephrology.

“We found that dialysis staff initiated CPR three times more often when they directly witnessed the cardiac arrest,” he said. “This suggests that improved monitoring of hemodialysis patients during and directly after dialysis could improve outcomes for out-of-hospital cardiac arrest. Further research is needed into understanding what other facilitators and barriers to CPR exist in the unique environment of the dialysis clinic.”

Dialysis staff-initiated AED application was not associated with improvement in outcomes, which could be due to the fact that 66 percent of patients presented with an unshockable heart rhythm.

In addition to Pun, Duke authors of the presentation included Matthew Dupre, PhD; Monique Anderson, MD; Clark Tyson; James Jollis, MD; and Christopher Granger, MD.