Outcomes of In-Hospital Cardiopulmonary Resuscitation in Maintenance Dialysis Patients

Abstract

Outcomes of cardiopulmonary resuscitation (CPR) in hospitalized patients with ESRD requiring maintenance dialysis are unknown. Outcomes of in-hospital CPR in these patients were compared with outcomes in the general population using data from the Nationwide Inpatient Sample (NIS; 2005-2011). The study population included all adults (≥ 18 years old) from the general population and those with a history of ESRD. Baseline characteristics, in-hospital complications, and discharge outcomes were compared between the two groups. The effects of in-hospital CPR on mortality, length of stay, hospitalization charges, and discharge destination were analyzed. Yearly national trends in survival, discharge to home, and length of stay were also examined using the Cochran-Armitage trend test. During the study period, 56,069 patients with ESRD underwent in-hospital CPR compared with 323,620 patients from the general population. Unadjusted in-hospital mortality rates were higher in patients with ESRD (73.9% versus 71.8%, P<0.001) on univariate analysis. After adjusting for age, gender, and potential confounders, patients with ESRD had higher odds of mortality (odds ratio, 1.24; 95% confidence interval, 1.11 to 1.3; P<0.001). Survival after CPR improved in the year 2011 compared with 2005 (31% versus 21%, P<0.001). Multivariate analysis also revealed that a greater proportion of patients with ESRD who survived were discharged to skilled nursing facilities. In conclusion, outcomes after in-hospital CPR are improving in patients with ESRD but remain worse than outcomes in the general population. Patients with ESRD who survive are more likely to be discharged to nursing homes.

Keywords: cardiovascular; chronic dialysis; epidemiology and outcomes.

Figure 1.

Mean length of stay in patients with ESRD undergoing CPR during 2005–2011. Mean length of stay was not significantly different: 10 days in 2011 versus 12 days in 2005 (P=0.1).

Figure 2.

Withdrawal of care trend in patients undergoing CPR during 2005–2011, expressed in percentage. In the year 2011, 7.2% of patients with ESRD withdrew care as compared with 0.8% in 2005, P<0.001.

Figure 3.

Survival trend in patients undergoing CPR during 2005–2011, expressed in percentage. Survival improved in 2011 (31% in the year 2011 versus 21% in the year 2005, P<0.001).

Figure 4.

Discharge to home trend in patients undergoing CPR during 2005–2011, expressed in percentage. In the year 2011, 19% of patients with ESRD were discharged home as compared with 9% in the year 2005, P<0.001.