Key result
In-hospital CPR in dialysis patients carries ~70% mortality, with longer duration predicting failure.
Why the study?
Previous studies showing poor CPR outcomes in dialysis patients were largely derived from claims data and lacked detailed characterization of CPR events.
Observational (n=184)
No
Odds Ratio: 1.41 (95% CI 1.24–1.61)
p-value: p=<0.001
In-hospital CPR in patients on maintenance dialysis is associated with a high overall mortality of 70%, with only 10% surviving to be discharged home, highlighting poor prognosis in this population.
High CPR mortality in dialysis patients warrants goals-of-care discussions; leaves open whether interventions can improve outcomes.
Rationale & Objective Previous studies showing poor cardiopulmonary resuscitation (CPR) outcomes in the dialysis population have largely been derived from claims data and are somewhat limited by a lack of detailed characterization of CPR events. We aimed to analyze CPR-related outcomes in individuals receiving maintenance dialysis. Study Design Retrospective chart review. Setting & Participants Using electronic medical records from a single academic health care system, we identified all hospitalized adult patients receiving maintenance dialysis who had undergone in-hospital CPR between 2006 and 2014. Exposure Initial in-hospital CPR. Outcomes Overall survival, predictors of unsuccessful CPR, predictors of death during the same hospitalization among initial survivors, predictors of discharge-to-home status. Analytical Approach We provide descriptive statistics for the study variables and used t tests, χ 2 tests, or Fisher exact tests to compare differences between the groups. We built multivariable logistic regression models to examine the CPR-related outcomes. Results A total of 184 patients received in-hospital CPR: 51 (28%) did not survive the initial CPR event, and 77 CPR survivors died (additional 42%) later during the same hospitalization (overall mortality 70%). Only 18 (10%) were discharged home, with the remaining 32 (17%) discharged to a rehabilitation facility or a nursing home. In the multivariable model, the only predictor of unsuccessful CPR was CPR duration (OR, 1.41; 95% CI, 1.24-1.61; P <0.001). Predictors of death during the same hospitalization after surviving the initial CPR event were CPR duration (OR, 1.15; 95% CI 1.04-1.27; P =0.007) and older age (OR, 1.64; 95% CI, 1.23-2.2; P <0.001). Older people also had lower odds of discharge-to-home status (OR, 0.25; 95% CI, 0.11-0.54; P <0.001). Limitations Retrospective study design, single-center study, no information on functional status. Conclusions Patients receiving maintenance dialysis experience high mortality following in-hospital CPR and only 10% are discharged home. These data may help clinicians provide useful prognostic information while engaging in goals of care conversations.
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Saeed et al. (2021) conducted an observational in Maintenance dialysis (n=184). In-hospital CPR was evaluated on Unsuccessful CPR (OR 1.41, 95% CI 1.24-1.61, p=<0.001). In-hospital CPR in patients receiving maintenance dialysis was associated with 70% overall mortality, and longer CPR duration predicted unsuccessful CPR (OR 1.41; 95% CI 1.24-1.61; P<0.001).
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