Longer CPR duration correlates with unsuccessful CPR, death for patients on dialysis
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For patients receiving maintenance dialysis, longer CPR duration correlated with unsuccessful CPR and death during the same hospital stay, according to data published in Kidney Medicine.
Further, older patients on dialysis showed a lower odds of discharge to home following CPR survival and hospitalization.
“Prior studies have shown poor survival after receiving CPR among persons receiving maintenance dialysis,” Fahad Saeed, MD, FASN, from the department of medicine in the division of nephrology and palliative care at the University of Rochester Medical Center in New York, and colleagues wrote. “However, much of the prior literature is derived from large claims-based data sets that largely lack CPR details. To bridge this gap in the literature, we examined the outcomes of in-hospital CPR in a single tertiary care hospital.”
In a retrospective chart review, researchers assessed 184 adults receiving maintenance dialysis who underwent in-hospital CPR between January 2006 and December 2014. All medical information was derived from Cleveland Clinic Foundation hospital electronic medical records.
Using multivariable logistic regression models, researchers determined independent predictors for unsuccessful CPR, death during the same hospitalization and discharge-to-home status for patients who survived CPR. Additionally, researchers used t tests, ² tests or Fisher exact tests to identify differences between groups.
Among the 184 patients, 51 did not survive initial CPR and 77 survivors died later during the same hospitalization. A total of 18 patients were discharged home, whereas the remaining 32 patients were discharged to a rehabilitation center or nursing home. Analyses revealed CPR duration was a predictor of unsuccessful CPR. Specifically, each additional minute of CPR was associated with 41% greater odds of death. Similarly, CPR duration and older age served as predictors of death during the same hospitalization after surviving CPR.
“Our study has several clinical and research implications. It provides useful data to clinicians for advanced care planning (ACP) and goals of care discussions. Furthermore, it offers prognostic data on CPR outcomes for older persons receiving maintenance dialysis. Such data may also be helpful in relieving the moral distress of clinicians after an unsuccessful CPR for futile cases,” Saeed and colleagues wrote. “We wish to emphasize that our study provides general guidance for ACP and goals of care discussions, and individual patient factors will need to be considered for decisions to continue or terminate CPR efforts. Finally, our study calls for the development of future research calculators to estimate the chances of survival and quality of life after CPR.”
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