January 21, 2020 – Despite gaps in resuscitation care between patients on dialysis and patients not receiving dialysis, study results showed similar survival rates for both groups.
A recent study led by the DCRI leveraged real-world data to shed new light on resuscitation for patients on maintenance dialysis when they experience in-hospital cardiac arrest.
Rates of survival for in-hospital cardiac arrest are low across the board at around 22 percent, and patients maintained on dialysis are at exceptionally high risk. Previous studies have suggested that patients receiving dialysis have lower survival rates compared to patients who do not receive dialysis, and some have questioned whether lower quality resuscitation care could help explain worse outcomes for this group.
The most recent study, led by the DCRI’s Monique Starks, MD (pictured left), and Patrick Pun, MD, (pictured right), and published in the Clinical Journal of the American Society of Nephrology, showed similar rates of survival to hospital discharge between dialysis and non-dialysis patients. However, results did indicate opportunities for improvement in the quality of resuscitation care for patients on dialysis, as they were less likely to receive defibrillation within two minutes and had lower composite scores for resuscitation quality.
The study included 31,144 patients from 372 sites drawn from the Get With The Guidelines-Resuscitation registry, and 27 percent of the study cohort received maintenance dialysis. This data was also linked to Medicare and Medicaid data to enable additional analysis.
The finding of similar survival between dialysis and non-dialysis patients receiving resuscitation was surprising and differed from previous literature, Pun said. This group was also more likely to have better neurological function at time of discharge than its counterpart. These differences in results could be attributable to the fact that this study uses a different data source—registry data rather than billing codes, which can lack specificity. The differences could also be explained by the study team’s efforts to avoid confounding—for example, matching patients from the different groups on several factors, including by year of event and by hospital.
“Although many factors should be considered when providers and patients discuss options in the event of a cardiac arrest, our study suggests that CPR is not a futile intervention for patients on dialysis,” Pun said. “Our findings also present the opportunity to further improve resuscitation outcomes in patients on maintenance dialysis by improving patient monitoring and resuscitation response times.”
Other DCRI faculty contributors to this publication include Eric Peterson, MD, MPH; and Roland Matsouaka, PhD. Staff statistical support was provided by Judith Stafford, MS and Jingjing Wu, MS (formerly of the DCRI).