CPR is effective in saving lives of dialysis patients experiencing cardiac arrest—but, too often, dialysis clinic staff fail to perform the procedure, according to a study published in February in the Journal of the American Association of Nephrology. These two conclusions indicate that many clinics could respond more effectively to these patients and should review their protocols, says lead author and Duke nephrologist Patrick Pun, MD, MHS.
Sudden cardiac arrest is the leading cause of death among dialysis patients, accounting for more than 25 percent of deaths. These events occur more frequently on the days that patients receive hemodialysis treatment—even in clinics. Only 56 percent of patients who have cardiac arrests in dialysis clinics survive to hospital admission, despite being surrounded by medical professionals.
Pun says the survival percentages raise an important question: Can more be done for these patients?
To answer this question, Pun and his colleagues used the Cardiac Arrest Registry to Enhance Survival (CARES) database to identify and examine 398 cardiac arrests in North Carolina and Georgia outpatient dialysis clinics between 2010 and 2016. They found that dialysis clinic staff initiated CPR in about 80 percent of events and applied defibrillators in about half of the cases.
The CPR use resulted in a three-fold increase in survival in the cardiac arrest patients.
“The use of CPR and defibrillation by bystanders before the arrival of emergency medical personnel has been shown to dramatically improve survival in the general population,” Pun says. “But there has been some question raised as to whether or not dialysis patients actually benefit from CPR because they have a very poor prognosis when they have cardiac arrest. We found that when dialysis staff provided CPR, there was a substantial improvement in survival.”
The study demonstrated no association between defibrillator use and outcomes, but CPR was associated not only with better survival but with more favorable neurologic status on hospital discharge.
The study found that staff in larger dialysis clinics were more likely to initiate CPR. CPR was also more likely to be used with male patients and when staff witnessed the cardiac arrest.
“We need further research to understand what barriers might exist to providing CPR in dialysis clinics,” Pun says. “Dialysis practice guidelines recommend that clinic staff have basic life support training and defibrillators available, so we were hoping to see CPR provision in dialysis clinics to be much closer to 100 percent. But there was a 20 percent deficit where CPR was not provided for unknown reasons until emergency services arrived.”
“We need to pay closer attention to how our staff are trained and equipped to perform CPR and understand how to improve participation in CPR because our study shows that this one basic, simple thing to do to manage cardiac arrest can save lives. We need to understand how to better improve our implementation of best practices when it comes to CPR and dialysis,” Pun says.