Key result
ESRD on hemodialysis links to ~147% higher odds of ROSC after OHCA versus non-ESRD.
Why the study?
End-stage renal disease patients on long-term hemodialysis have an elevated risk of sudden cardiac death, but their odds of return of spontaneous circulation and hospital outcomes after out-of-hospital cardiac arrest were not previously studied.
Does end-stage renal disease on hemodialysis affect the incidence of out-of-hospital cardiac arrest and the likelihood of return of spontaneous circulation compared to non-ESRD patients?
Cohort (n=203,752)
Does end-stage renal disease on hemodialysis affect the incidence of out-of-hospital cardiac arrest and the likelihood of return of spontaneous circulation compared to non-ESRD patients?
Odds Ratio: 2.47 (95% CI 1.9–3.21)
Absolute Event Rate: 42.33% vs 17.95%
p-value: p=<0.001
Although ESRD patients on hemodialysis have a higher risk of out-of-hospital cardiac arrest, they have a higher likelihood of return of spontaneous circulation and better short-term survival compared to non-ESRD patients.
End-stage renal disease (ESRD) patients on long-term hemodialysis (HD) have an elevated risk of sudden cardiac death. This study hypothesizes, for the first time, that these patients have a higher odds of return of spontaneous circulation (ROSC) and subsequent better hospital-outcomes, post out-of-hospital cardiac arrest (OHCA), as opposed to non-ESRD patients. A national database from Taiwan was utilized, in which 101,876 ESRD patients undergoing HD and propensity score-matched non-ESRD patients were used to conduct two analyses: (i) Cox-proportional-hazards-regression for OHCA incidence and (ii) logistic-regression analysis of attaining ROSC after OHCA, both for ESRD patients in comparison to non-ESRD patients. Kaplan-Meier analyses were conducted to determine the difference of survival rates after ROSC between the two cohorts. ESRD patients were found to be at a higher risk of OHCA (adjusted-HR = 2.11, 95% CI: (1.89−2.36), p < 0.001); however, they were at higher odds of attaining ROSC (adjusted-OR = 2.47, 95% CI: 1.90−3.21, p < 0.001), as opposed to non-ESRDs. Further, Kaplan-Meier analysis demonstrated ESRD patients with a better 30-day hospital survival rate than non-ESRD patients. Although ESRD patients had a higher risk of OHCA, they demonstrated higher possibility of ROSC and a better short-term hospital outcome than non-ESRDs. Chronic toxin tolerance and the training of vascular-compliance during regular HD may be possible explanations for better outcomes in ESRD patients.
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Hsieh et al. (2022) conducted a cohort in Out-of-hospital cardiac arrest (n=203,752). End-stage renal disease (ESRD) undergoing hemodialysis vs. Non-ESRD patients was evaluated on Return of spontaneous circulation (ROSC) after out-of-hospital cardiac arrest (OR 2.47, 95% CI 1.90-3.21, p=<0.001). End-stage renal disease patients undergoing regular hemodialysis had significantly higher odds of attaining return of spontaneous circulation after out-of-hospital cardiac arrest compared to non-ESRD patients (adjusted OR 2.47).
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