TY - JOUR
T1 - Outcomes Following In-Hospital Cardiopulmonary Resuscitation in People Receiving Maintenance Dialysis
AU - Saeed, Fahad
AU - Murad, Haris F.
AU - Wing, Richard E.
AU - Li, Jianbo
AU - Schold, Jesse D.
AU - Fiscella, Kevin A.
N1 - Funding Information:
Dr Saeed is a recipient of the Carl W. Gottschalk Research Scholar Grant from the American Society of Nephrology and a K23 award from NIDDK (K23DK121939), and a grant by the Renal Research Institute. The funders had no role in the design of the study.
Publisher Copyright:
© 2021
PY - 2022/1
Y1 - 2022/1
N2 - Rationale & Objective: Previous studies showing poor cardiopulmonary resuscitation (CPR) outcomes in the dialysis population have largely been derived from claims data and are somewhat limited by a lack of detailed characterization of CPR events. We aimed to analyze CPR-related outcomes in individuals receiving maintenance dialysis. Study Design: Retrospective chart review. Setting & Participants: Using electronic medical records from a single academic health care system, we identified all hospitalized adult patients receiving maintenance dialysis who had undergone in-hospital CPR between 2006 and 2014. Exposure: Initial in-hospital CPR. Outcomes: Overall survival, predictors of unsuccessful CPR, predictors of death during the same hospitalization among initial survivors, predictors of discharge-to-home status. Analytical Approach: We provide descriptive statistics for the study variables and used t tests, χ2 tests, or Fisher exact tests to compare differences between the groups. We built multivariable logistic regression models to examine the CPR-related outcomes. Results: A total of 184 patients received in-hospital CPR: 51 (28%) did not survive the initial CPR event, and 77 CPR survivors died (additional 42%) later during the same hospitalization (overall mortality 70%). Only 18 (10%) were discharged home, with the remaining 32 (17%) discharged to a rehabilitation facility or a nursing home. In the multivariable model, the only predictor of unsuccessful CPR was CPR duration (OR, 1.41; 95% CI, 1.24-1.61; P < 0.001). Predictors of death during the same hospitalization after surviving the initial CPR event were CPR duration (OR, 1.15; 95% CI 1.04-1.27; P = 0.007) and older age (OR, 1.64; 95% CI, 1.23-2.2; P < 0.001). Older people also had lower odds of discharge-to-home status (OR, 0.25; 95% CI, 0.11-0.54; P < 0.001). Limitations: Retrospective study design, single-center study, no information on functional status. Conclusions: Patients receiving maintenance dialysis experience high mortality following in-hospital CPR and only 10% are discharged home. These data may help clinicians provide useful prognostic information while engaging in goals of care conversations.
AB - Rationale & Objective: Previous studies showing poor cardiopulmonary resuscitation (CPR) outcomes in the dialysis population have largely been derived from claims data and are somewhat limited by a lack of detailed characterization of CPR events. We aimed to analyze CPR-related outcomes in individuals receiving maintenance dialysis. Study Design: Retrospective chart review. Setting & Participants: Using electronic medical records from a single academic health care system, we identified all hospitalized adult patients receiving maintenance dialysis who had undergone in-hospital CPR between 2006 and 2014. Exposure: Initial in-hospital CPR. Outcomes: Overall survival, predictors of unsuccessful CPR, predictors of death during the same hospitalization among initial survivors, predictors of discharge-to-home status. Analytical Approach: We provide descriptive statistics for the study variables and used t tests, χ2 tests, or Fisher exact tests to compare differences between the groups. We built multivariable logistic regression models to examine the CPR-related outcomes. Results: A total of 184 patients received in-hospital CPR: 51 (28%) did not survive the initial CPR event, and 77 CPR survivors died (additional 42%) later during the same hospitalization (overall mortality 70%). Only 18 (10%) were discharged home, with the remaining 32 (17%) discharged to a rehabilitation facility or a nursing home. In the multivariable model, the only predictor of unsuccessful CPR was CPR duration (OR, 1.41; 95% CI, 1.24-1.61; P < 0.001). Predictors of death during the same hospitalization after surviving the initial CPR event were CPR duration (OR, 1.15; 95% CI 1.04-1.27; P = 0.007) and older age (OR, 1.64; 95% CI, 1.23-2.2; P < 0.001). Older people also had lower odds of discharge-to-home status (OR, 0.25; 95% CI, 0.11-0.54; P < 0.001). Limitations: Retrospective study design, single-center study, no information on functional status. Conclusions: Patients receiving maintenance dialysis experience high mortality following in-hospital CPR and only 10% are discharged home. These data may help clinicians provide useful prognostic information while engaging in goals of care conversations.
KW - Advance care planning
KW - CPR prognosis
KW - ESRD goals of care
KW - dialysis
KW - end-of-life care
KW - in-hospital CPR outcomes
UR - http://www.scopus.com/inward/record.url?scp=85121922971&partnerID=8YFLogxK
U2 - 10.1016/j.xkme.2021.08.014
DO - 10.1016/j.xkme.2021.08.014
M3 - Article
C2 - 35072044
AN - SCOPUS:85121922971
SN - 2590-0595
VL - 4
JO - Kidney Medicine
JF - Kidney Medicine
IS - 1
M1 - 100380
ER -