A recent JASN study was published in the March 2019 issue of Journal of the American Society of Nephrology (JASN) entitled, “Outcomes for Hemodialysis Patients Given Cardiopulmonary Resuscitation for Cardiac Arrest at Outpatient Dialysis Clinics”.

Please access the abstract and full report on the JASN website.

To get a behind-the-scenes look into the study, Kidney News Online asked ASN Member, Patrick H. Pun, MD, MHS, first author on the study and Associate Professor of Medicine at Duke University School of Medicine and Member of the Duke Clinical Research Institute.

1. How would you briefly describe the findings of this study?

Sudden cardiac arrest is the leading cause of death among hemodialysis patients, and cardiac arrests occur more frequently on days that patients receive hemodialysis treatment. The outcomes of cardiac arrests occurring in outpatient dialysis facilities are poor. Previous studies have suggested that traditional sudden cardiac arrest therapies such as implantable defibrillators might not be as effective in hemodialysis patients. Our study aimed to determine whether or not provision of basic CPR by dialysis staff improves outcomes from cardiac arrests.

Using an existing cardiac arrest registry designed to study resuscitation practices and outcomes for out-of-hospital cardiac arrest, we were able identify 398 cardiac arrests occurring within outpatient dialysis facilities between 2010-2016 throughout the state of North Carolina and the metropolitan Atlanta area. After excluding patients with do-not-resuscitate orders and adjusting for confounding factors, there was a nearly 3-fold increase in the chances of survival to hospital discharge when dialysis staff members provided CPR before the arrival of emergency medical services on site. However, for about 1 in every 5 cardiac arrests, CPR was not provided by dialysis staff. Further, dialysis staff applied automated defibrillators to patients in only about half of the cardiac arrests. We found staff in larger dialysis clinics were more likely to provide CPR, and that men were more likely to receive CPR from staff compared to women.

2. What do you believe is the importance of the findings?

Although we certainly need new approaches and treatments to reduce sudden cardiac deaths and poor survival outcomes following cardiac arrest, our study suggests that the well-established, basic treatment of providing bystander CPR could help to significantly improve survival in hemodialysis patients. Because of this, it is also important that we understand if there are common underlying reasons why dialysis staff did not provide CPR all the time, and how we can address those issues to improve CPR rates. 

3. What effect do you think your team’s proof of these findings will have on the future of treating patients in outpatient dialysis?

In the short term, I hope it will result in more attention towards better equipping and training our dialysis staff to provide rapid high-quality CPR to all patients who desire resuscitation all of the time, as a part of our overall effort to deliver high quality dialysis care. Ultimately, I hope it will help to improve survival outcomes from cardiac arrest.

4. The article concludes by stating that further investigations into the barriers and facilitators to CPR in the dialysis setting are needed. Does your team plan to continue with these investigations? If not, how should others approach the topic?

It will be important to validate our study findings in a broader sample of dialysis clinic cardiac arrests, which we are currently pursuing. We also have an ongoing investigation to gain insight from dialysis staff about what particular challenges they face in providing CPR in dialysis clinics. With this information, we can develop new resuscitation protocols and training materials adapted to the unique environment of the dialysis clinic and examine whether they improve CPR rates and patient outcomes.

If you have any further questions on this study or the broader topic, please contact Kidney News Online at info@kidneynews.org .