IN-HOSPITAL CARDIAC ARREST DURING CONTINUOUS RENAL REPLACEMENT THERAPY: A RETROSPECTIVE REVIEW

Abstract

SESSION TITLE: Wednesday Abstract Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/23/2019 09:45 AM - 10:45 AM PURPOSE: In the United States, the incidence of in-hospital cardiac arrest (IHCA) is approximately 200,000 adult cases per year. In this patient population overall, achieving return of spontaneous circulation (ROSC) is reported to be up to 54.1%. Survival to discharge varies between institutions, but is generally in the 15-20% range. Continuous renal replacement therapy (CRRT) was introduced in 1977 and is now become a common modality in the treatment of critically ill patients in the setting of multiple organ failure with hemodynamic instability. Research evaluating the efficacy of cardiopulmonary resuscitation during CRRT has been sparce. This study seeks to examine outcomes of patients undergoing CRRT who suffer IHCA. METHODS: A single-center retrospective review of IHCA events at a 1,025 bed quaternary care center over 5 years (2013-2017) was conducted. Inclusion criteria: IHCA during the study period. Exclusion criteria: incomplete data gathering in the post-arrest audit documentation. Multiple patient characteristics, including: demographics, initial arrest arrhythmia and active CRRT at time of arrest were identified. RESULTS: 1106 of 1216 charts were included in the final analysis. 211 (19%) patients were receiving CRRT at time of arrest. Comparing CRRT vs. non-CRRT groups: ROSC was achieved in 71% vs 70% (OR 1.2, CI 0.86-1.69, p= 0.2859) and survival to discharge was 21% vs 29% (OR 0.65, CI 0.42-1.00, p=0.0512), respectively. Initial arrest arrhythmia was similar (p-values >0.05) between groups (CRRT vs. non-CRRT), with pulseless electrical activity (PEA) representing the majority (67% and 68%, respectively). Mean number of vasopressors at time of cardiac arrest was significantly higher in the CRRT group (1.84 vs. 0.69; p<0.0001, CI 0.85-1.45). CONCLUSIONS: Overall, survival to discharge after IHCA was similar to other studies. ROSC rates were substantially higher, despite comparable arrhythmia proportions, than previously reported. There was no statistically significant difference in the achievement of ROSC or survival to discharge when comparing CRRT vs non-CRRT patients; despite a significantly higher number of pre-arrest vasopressors in the CRRT group. CLINICAL IMPLICATIONS: With similar outcome rates, despite generally representing a sicker patient population, these findings suggest that IHCA during CRRT is not futile and should not preclude initiation of rescusitative measures. DISCLOSURES: No relevant relationships by Jessica Meyer, source=Web Response No relevant relationships by Adan (Adam) Mora, source=Web Response No relevant relationships by Casey Morris, source=Web Response No relevant relationships by Alejandro Perez, source=Web Response No relevant relationships by Rahul Sawhney, source=Web Response No relevant relationships by Ginger Tsai-Nguyen, source=Web Response