Emergency Medical Services-Attended Cardiac Arrests At Outpatient Dialysis Facilities In A Community.

Background Over 400,000 people in the United States have End Stage Renal Disease (ESRD), for whom cardiac arrest is the leading cause of death. However, little is known about the incidence, characteristics, and outcomes of cardiac arrests at hemodialysis facilities. Study Design and Methods We conducted a population-based retrospective cohort study using Emergency Medical Services databases to identify and examine 14.5 years of cardiac arrest cases for which resuscitation was attempted at hemodialysis facilities. The utilization and impact of automated external defibrillators (AED) in dialysis facilities was also examined. Results Of the 110 cardiac arrests identified (mean age 65.4, 55 males), 10 occurred before, 72 during, and 20 after hemodialysis. Overall, the initially observed rhythm was ventricular fibrillation (VF) or ventricular tachycardia (VT) in 72 (66%) cases. A significantly greater proportion of VF/VT cases occurred during or after dialysis onset. Twenty-six (24%) patients survived to discharge from the hospital. The absolute risk of cardiac arrest was 54.28 per estimated 1000 person-years spent at a dialysis facility. Thirty-four of the cases occurred in dialysis facilities after an AED had been placed onsite; in 18 (53%) of these 34 cases the AED was attached to the patient and a shock was delivered in 15 (83%) of the 18 cases. There were no significant differences in outcomes of patients who arrested before versus after AED placement in dialysis facilities. Conclusion The varying incidence of VF depending on the time of cardiac arrest relative to hemodialysis therapy suggests multiple mechanisms contributing to cardiac arrests in dialysis facilities. Progress has been made with the placement of AEDs in dialysis facilities; however, the AEDs are not being utilized to their full potential.