Outcome of cardiac arrests attended by emergency medical services staff at community outpatient dialysis centers

Abstract

Cardiac arrest is the leading cause of death among dialysis patients in the United States. We measured the outcome of cardiac arrests attended by Emergency Medical Services (EMS) staff at hemodialysis facilities in a 14-year population-based retrospective study to identify cardiac arrest cases at a dialysis unit. Associated factors were determined using unconditional logistic regression. Of the 102 cardiac arrests identified around the time of dialysis, 10 occurred before, 72 during, and 20 after hemodialysis. The initial measured abnormality was ventricular fibrillation or tachycardia in 72 cases. Of those who survived transportation to a hospital, survival to discharge was 24 with 15% survival at 1 year. Compared to arrests that occurred prior to dialysis, the odds of ventricular fibrillation were 5-fold greater in patients on dialysis but 14-fold greater in those arresting after dialysis. One-third of cases occurred after the introduction of automated external defibrillators, and in half of the cases these devices were attached prior to EMS arrival. Once these devices were attached, most were used for defibrillation. We conclude that ventricular arrhythmias are the predominant features among arrested in-center dialysis patients with most occurrences during dialysis. The role of these devices in dialysis units will need a larger study to evaluate their efficacy.