Patients who suffer a cardiac arrest while at dialysis clinics are often not given life-saving CPR, according the to the findings of a new study.
Staff at outpatient dialysis clinics are required to be trained in cardiopulmonary resuscitation (CPR), and trained to use automated external defibrillators (AEDs). Despite this requirement, rates of CPR at dialysis clinics involving patients who suffer cardiac arrest are not as high as expected, according to researchers from Duke University.
The findings were published in the February 2019 issue of the Journal of the American Society of Nephrology, evaluating data from the Cardiac Arrest Registry to Enhance Survival and the Centers for Medicare & Medicaid Services. Researchers examined data for patients who had cardiac arrest at outpatient dialysis clinics between 2010 and 2016 in the southeastern United States. The study did not include patients with do not resuscitate orders.
Nearly 400 patients suffered cardiac arrest at a clinic during the study period. Dialysis clinic staff conducted CPR on patients before emergency responders arrived 81% of the time. They used AEDs on patients only 52% of the time.
While the CPR rate may seem high, researchers are concerned since every staff member should be trained in CPR. Thus, resuscitation efforts should be much closer to 100%.
When the staff initiated CPR, patients had triple the chance of surviving and having a favorable neurologic status when they were later discharged from the hospital.
According to the findings, clinic staff were more likely to conduct CPR on men. They were also more likely to start CPR if they worked at larger dialysis clinics. Similarly, when a staff member witnessed cardiac arrest, they were also more likely to begin CPR.
Cardiac arrest is when the heart stops beating suddenly because the electrical function of the heart is interrupted. It causes the heart to quiver erratically and stop pumping oxygenated blood to the rest of the body.
Cardiac arrest often occurs among hemodialysis patients at outpatient centers. They are 20 times more likely to experience cardiac arrest than the average person. Among hemodialysis patients, it is the leading cause of death and accounts for more than 25% of all deaths among those patients.
Roughly half of hemodialysis patients who suffer cardiac arrest do not survive to the hospital. Among those who do survive, they have higher rates of needing to be placed in a nursing home and are less functional.
“Although the bystander CPR rate in dialysis clinics was higher than those typically observed…occurring in homes and public areas, it is surprisingly low given the highly monitored environment of the dialysis clinic with the availability of basic life support-trained staff serving a high-risk population,” the researchers concluded. “The combination of bystander CPR and bystander AED placement has been shown to result in the best outcomes compared with later initiation of these care elements, and there is no reason why such care should not also be consistently applied in dialysis centers.”