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Dialysis Staff-Initiated CPR Ups Outcomes in Cardiac Arrest

THURSDAY, Feb. 7, 2019 -- For patients with out-of-hospital cardiac arrest (OHCA) occurring in outpatient dialysis clinics, dialysis staff-initiated cardiopulmonary resuscitation (CPR) is associated with improved outcomes, according to a study published online Feb. 7 in the Journal of the American Society of Nephrology.

Patrick H. Pun, M.D., from the Duke University School of Medicine in Durham, North Carolina, and colleagues identified patients with cardiac arrest within outpatient dialysis clinics between 2010 and 2016 in the southeastern United States. Outcomes were compared for patients who received dialysis staff-initiated CPR and those who received CPR when the emergency medical services (EMS) arrived.

Sixty-six percent of all patients with 398 OHCA events in dialysis clinics presented with a nonshockable initial rhythm. The researchers found that in 81.4 percent of events, dialysis staff initiated CPR; defibrillators were applied before EMS arrival in 52.3 percent of the events. Staff were more likely to provide CPR for men, when witnessing cardiac arrest, and in larger dialysis clinics. The odds of hospital discharge and favorable neurologic status on discharge were increased threefold with staff-initiated CPR. No correlation was seen between staff-initiated defibrillator use and outcomes.

"These findings suggest important opportunities to improve care and survival in this high-risk population," the authors write. "Further investigation is needed to understand potential facilitators and barriers to performing CPR in the unique setting of the outpatient dialysis clinic."

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Posted: February 2019

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