Black and Asian patients are significantly less likely than white patients to receive CPR from hemodialysis clinic staff during cardiac arrest events, according to a study published in August 2020 in the Resuscitation Journal.
Duke nephrologist Patrick H. Pun, MD, MHS, the senior author, says the findings highlight the need for improved training and preparation for arrests in hemodialysis clinics. Pun’s research focuses on sudden cardiac death among patients undergoing dialysis. He previously examined the outcome of cardiac arrest events in outpatient hemodialysis clinics in a February 2019 analysis in the Journal of the American Society of Nephrology that raised questions about staff training and preparation for emergency events.
“Sudden cardiac death remains a big problem among dialysis patients,” Pun says. “Many times these deaths occur at home, or outside the dialysis unit. But not infrequently, they happen during dialysis and within the facility where they receive care.” During the analysis, the researchers learned that in nearly 20% of cardiac arrests in the clinics, CPR was not attempted until the EMS arrived.
In the most recent study published in Resuscitation Journal, the researchers identified 1568 cardiac arrests occurring in 809 hemodialysis clinics across the United States. After adjusting for differences in patient and clinic characteristics, they found that that dialysis staff-initiated CPR at a rate of 91% for white patients, but only about 85% for black patients and 77% for Asian patients. No significant differences were observed between staff-initiated CPR rates among white, Hispanic/Latinx patients. The study found that an AED was applied by dialysis staff in 62% of patients. The researchers did not find a relationship between patient race/ethnicity and the use of an AED by the clinic staff.
Administering CPR in dialysis clinics requires additional training
The study could not determine whether the race or ethnicity of the dialysis staff able to perform CPR on patients during arrest was also a factor in the response. Additionally, Pun noted that administering CPR to a patient who is receiving dialysis is more complicated than other settings and presents challenges that require further study; there are no specific guidelines on how to best perform CPR for hemodialysis patients who arrest in a dialysis chair and are connected to a dialysis machine.
Because patients who regularly visit dialysis clinics are recognized as high-risk, a better understanding of how to improve clinic cardiac resuscitation procedures is required, Pun says. “In spite of these factors, no one has ever really looked to see how well the staff perform CPR when a cardiac arrest occurs inside a dialysis clinic,” Pun says.
“Although racial disparities in the incidence and management of kidney disease are well documented, honestly, we were surprised to discover that these disparities extend to performance of CPR within these dialysis clinics where the staff has received training,” Pun says. “I hope this motivates the dialysis community to learn more and to try to understand the ‘why’ in these cases and improve care for all patients.”
In addition to Pun, study authors included Matthew E. Dupre, PhD, Duke Clinical Research Institute, Monique Anderson Starks, MD, Myles Wolf, MD, Laura P. Svetkey, MD. The lead author is former Duke medical student Samuel A. Hofacker, MD, who recently began his residency training at Massachusetts General Hospital.