Trends in in-hospital cardiopulmonary resuscitation and survival in adults receiving maintenance dialysis

JAMA Intern Med. 2015 Jun;175(6):1028-35. doi: 10.1001/jamainternmed.2015.0406.

Abstract

Importance: Understanding cardiopulmonary resuscitation (CPR) practices and outcomes can help to support advance care planning in patients receiving maintenance dialysis.

Objective: To characterize patterns and outcomes of in-hospital CPR in US adults receiving maintenance dialysis.

Design, setting, and participants: This national retrospective cohort study studied 663,734 Medicare beneficiaries 18 years or older from a comprehensive national registry for end-stage renal disease who initiated maintenance dialysis from January 1, 2000, through December 31, 2010.

Exposures: Receipt of in-hospital CPR from 91 days after dialysis initiation through the time of death, first kidney transplantation, or end of follow-up on December 31, 2011.

Main outcomes and measures: Incidence of CPR and survival after the first episode of CPR recorded in Medicare claims during follow-up.

Results: The annual incidence of CPR for the overall cohort was 1.4 events per 1000 in-hospital days (95% CI, 1.3-1.4). A total of 21.9% CPR recipients (95% CI, 21.4%-22.3%) survived to hospital discharge, with a median postdischarge survival of 5.0 months (interquartile range, 0.7-16.8 months). Among patients who died in the hospital, 14.9% (95% CI, 14.8%-15.1%) received CPR during their terminal admission. From 2000 to 2011, there was an increase in the incidence of CPR (1.0 events per 1000 in-hospital days; 95% CI, 0.9-1.1; to 1.6 events per 1000 in-hospital days; 95% CI, 1.6-1.7; P for trend <.001), the proportion of CPR recipients who survived to discharge (15.2%; 95% CI, 11.1%-20.5%; to 28%; 95% CI, 26.7%-29.4%; P for trend <.001), and the proportion of in-hospital deaths preceded by CPR (9.5%; 95% CI, 8.4%-10.8%; to 19.8%; 95% CI, 19.2%-20.4%; P for trend <.001), with no substantial change in duration of postdischarge survival.

Conclusions and relevance: Among a national cohort of patients receiving maintenance dialysis, the incidence of CPR was higher and long-term survival worse than reported for other populations.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Cardiopulmonary Resuscitation / mortality
  • Cardiopulmonary Resuscitation / trends*
  • Female
  • Heart Arrest / complications*
  • Heart Arrest / therapy
  • Hospital Mortality
  • Hospitalization
  • Humans
  • Kidney Failure, Chronic / complications*
  • Male
  • Middle Aged
  • Registries*
  • Renal Dialysis*
  • Retrospective Studies
  • United States / epidemiology