Out-of-hospital cardiac arrest in dialysis patients

Marta Obremska,Katarzyna Madziarska,Robert Gałązkowski,Dorota Zyśko,Mariusz Gąsior,Klaudiusz Nadolny,Jerzy R Ładny

doi:10.1007/s11255-020-02694-6

Abstract

PurposeThe aim of the study was to assess whether a history of dialysis is related to cardiopulmonary resuscitation (CPR) attempts and survival to hospital admission in patients with out-of-hospital cardiac arrest (OHCA).MethodsThe databases of the POL-OHCA registry and of emergency medical calls in the Command Support System of the State of Emergency Medicine (CSS) were searched to identify patients with OHCA and a history of dialysis. A total of 264 dialysis patient with OHCA were found: 126 were dead on arrival of emergency medical services (EMS), and 138 had OHCA with CPR attempts. Data from the POL-OHCA registry for patients with CPR attempts, including age, sex, place of residence, first recorded rhythm, defibrillation during CPR, and priority dispatch codes, were collected and compared between patients with and without dialysis.ResultsCPR attempts by EMS were undertaken in 138 dialyzed patients (52.3%). The analysis of POL-OHCA data revealed no differences in age, sex, place of residence, first recorded rhythm, and priority dispatch codes between patients with and without dialysis. Defibrillation was less frequent in dialysis patients (P = 0.04). A stepwise logistic regression analysis revealed no association between survival to hospital admission and a history of hemodialysis (odds ratio = 1.12; 95% CI 0.74–1.70, P = 0.60).ConclusionsA history of dialysis in patients with OHCA does not affect the rate of CPR attempts by EMS or a short-term outcome in comparison with patients without dialysis. Defibrillation during CPR is less common in patients on dialysis than in those without.

Highlights

MethodsThe number of people receiving dialysis in Poland reaches 540 per million inhabitants and has been growing by about 1.3% per year, but it is still lower than the average number reported for other European Union countries (710 per million) [1]
The final study sample included 264 patients with of-hospital cardiac arrest (OHCA) and a history of dialysis, including 138 patients who underwent cardiopulmonary resuscitation (CPR) and 126 patients who were pronounced dead on arrival of emergency medical services (EMS)
Among the 138 patients with CPR attempts, resuscitation efforts were unsuccessful in 87 patients and 51 patients survived to hospital admission or helicopter EMS (HEMS) transport

Summary

Introduction

MethodsThe number of people receiving dialysis in Poland reaches 540 per million inhabitants and has been growing by about 1.3% per year, but it is still lower than the average number reported for other European Union countries (710 per million) [1]. It is known that early initiation of cardiopulmonary resuscitation (CPR) is associated with better survival and quality of life in patients with cardiac arrest [4]. All-cause mortality rates in dialysis patients are constantly decreasing, the frequency of sudden cardiac death (SCD) remains stable [5]. The annual risk of SCD is higher in patients on dialysis than in general population, patients not receiving dialysis in end-stage renal disease (ESRD), or even patients with heart failure [6]. Studies on cardiac arrest in dialysis patients concern the incidence of cardiac arrest during hemodialysis session, which may be provided at a dialysis center located in or out of hospital [7,8,9]. Ventricular arrhythmias are more likely to cause sudden cardiac arrest (SCA) during hemodialysis sessions [14, 15]. Studies based on electrocardiogram recordings have shown that in the nondialysis period, SCA is more often caused by bradycardia and subsequent asystole [16, 17]

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