TY - JOUR
T1 - In-hospital cardiac arrest resuscitation practices and outcomes in maintenance dialysis patients
AU - American Heart Association's Get With The Guidelines-Resuscitation Investigators
AU - Starks, Monique Anderson
AU - Wu, Jingjing
AU - Peterson, Eric D.
AU - Stafford, Judith A.
AU - Matsouaka, Roland A.
AU - Boulware, L. Ebony
AU - Svetkey, Laura P.
AU - Chan, Paul S.
AU - Pun, Patrick H.
N1 - Funding Information:
Dr. Pun is supported by National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) grant 5R03DK113324. Dr. Peterson, Dr. Pun, Dr. Stafford, Dr. Svetkey, and Dr. Wu are supported by NIDDK grant P30DK096493. This work was also funded, in part, internally by the Duke Clinical Research Institute, Durham, NC.
Funding Information:
The authors would like to thank Barbara Lytle, MS, for her project leadership. Ms. Lytle has not received compensation for her contributions, apart from their employment at the institution where this study was conducted. All authors have been involved in the study design, analysis, and manuscript revision. All authors read and approved the final manuscript. Dr. Starks is the guarantor who accepts full responsibility for the work and the conduct of the study, had access to the data, and controlled the decision to publish. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.. Dr. Pun is supported by National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) grant 5R03DK113324. Dr. Peterson, Dr. Pun, Dr. Stafford, Dr. Svetkey, and Dr. Wu are supported by NIDDK grant P30DK096493. This work was also funded, in part, internally by the Duke Clinical Research Institute, Durham, NC.
Publisher Copyright:
© 2020 by the American Society of Nephrology.
PY - 2020/2/7
Y1 - 2020/2/7
N2 - Background and objectives Patients on maintenance dialysis with in-hospital cardiac arrest have been reported to have worse outcomes relative to those not on dialysis; however, it is unknown if poor outcomes are related to the quality of resuscitation. Using the Get With The Guidelines-Resuscitation (GWTG-R) registry, we examined processes of care and outcomes of in-hospital cardiac arrest for patients on maintenance dialysis compared with nondialysis patients. Design, setting, participants, & measurements We used GWTG-R data linked to Centers for Medicare and Medicaid data to identify patients with ESKD receiving maintenance dialysis from 2000 to 2012. We then case-matched adult patients on maintenance dialysis to nondialysis patients in a 1:3 ratio on the basis of age, sex, race, hospital, and year of arrest. Logistic regression models with generalized estimating equations were used to assess the association of in-hospital cardiac arrest and outcomes by dialysis status. Results After matching, there were a total of 31,144 GWTG-R patients from 372 sites, of which 8498 (27%) were on maintenance dialysis. Patients on maintenance dialysis were less likely to have a shockable initial rhythm (20% versus 21%) and less likely to be within the intensive care unit at the time of arrest (46% versus 47%) compared with nondialysis patients; they also had lower composite scores for resuscitation quality (89% versus 90%) and were less likely to have defibrillation within 2 minutes (54% versus 58%). After adjustment, patients on maintenance dialysis had similar adjusted odds of survival to discharge (odds ratio [OR], 1.05; 95% confidence interval [95% CI], 0.97 to 1.13), better acute survival (OR, 1.33; 95% CI, 1.26 to 1.40), and were more likely to have favorable neurologic status (OR, 1.12; 95% CI, 1.04 to 1.22) compared with nondialysis patients. Conclusions Although there appears to be opportunities to improve the quality of in-hospital cardiac arrest care for among those on maintenance dialysis, survival to discharge was similar for these patients compared with nondialysis patients.
AB - Background and objectives Patients on maintenance dialysis with in-hospital cardiac arrest have been reported to have worse outcomes relative to those not on dialysis; however, it is unknown if poor outcomes are related to the quality of resuscitation. Using the Get With The Guidelines-Resuscitation (GWTG-R) registry, we examined processes of care and outcomes of in-hospital cardiac arrest for patients on maintenance dialysis compared with nondialysis patients. Design, setting, participants, & measurements We used GWTG-R data linked to Centers for Medicare and Medicaid data to identify patients with ESKD receiving maintenance dialysis from 2000 to 2012. We then case-matched adult patients on maintenance dialysis to nondialysis patients in a 1:3 ratio on the basis of age, sex, race, hospital, and year of arrest. Logistic regression models with generalized estimating equations were used to assess the association of in-hospital cardiac arrest and outcomes by dialysis status. Results After matching, there were a total of 31,144 GWTG-R patients from 372 sites, of which 8498 (27%) were on maintenance dialysis. Patients on maintenance dialysis were less likely to have a shockable initial rhythm (20% versus 21%) and less likely to be within the intensive care unit at the time of arrest (46% versus 47%) compared with nondialysis patients; they also had lower composite scores for resuscitation quality (89% versus 90%) and were less likely to have defibrillation within 2 minutes (54% versus 58%). After adjustment, patients on maintenance dialysis had similar adjusted odds of survival to discharge (odds ratio [OR], 1.05; 95% confidence interval [95% CI], 0.97 to 1.13), better acute survival (OR, 1.33; 95% CI, 1.26 to 1.40), and were more likely to have favorable neurologic status (OR, 1.12; 95% CI, 1.04 to 1.22) compared with nondialysis patients. Conclusions Although there appears to be opportunities to improve the quality of in-hospital cardiac arrest care for among those on maintenance dialysis, survival to discharge was similar for these patients compared with nondialysis patients.
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U2 - 10.2215/CJN.05070419
DO - 10.2215/CJN.05070419
M3 - Article
C2 - 31911423
AN - SCOPUS:85079095634
SN - 1555-9041
VL - 15
SP - 219
EP - 227
JO - Clinical Journal of the American Society of Nephrology
JF - Clinical Journal of the American Society of Nephrology
IS - 2
ER -