Aim: Intraprocedural cardiac arrest is a serious complication among patients receiving hemodialysis. However, the frequency and reaction to these events remain unclear. This study aimed to explore the clinical picture of cardiac arrest during hemodialysis.
Methods: Ten cardiac arrests that had occurred during 217,984 hemodialysis treatments in five Japanese hospitals, between 2008 and 2017, were reviewed. We investigated the underlying disease, vital signs, emergency responses, and outcomes using patient medical records.
Results: The cardiac arrest rate ranged from 1.1 to 7.5 per 100,000 hemodialysis sessions. All included cases of cardiac arrest occurred in a hemodialysis unit and had been witnessed and reported by supervising clinicians. The initial rhythm was ventricular fibrillation/ventricular tachycardia in six patients (60%) and pulseless electrical activity/asystole in four patients (40%). Seven (70%) patients showed a return of spontaneous circulation (ROSC), and two (20%) patients were discharged with a cerebral performance category score of 1. There was a statistically significant difference in the ROSC rate (P = 0.048) only in the event of an emergency call. The SpO2 and respiratory rates had not been recorded in six patients. There was no significant difference in ROSC between initial rhythms of ventricular fibrillation/ventricular tachycardia and pulseless electrical activity/asystole.
Conclusion: We evaluated the frequency of cardiac arrest during hemodialysis. Overall assessment including respiratory status is needed at initiation of hemodialysis. In case of a sudden change in a patient's status, high-quality resuscitation treatment that includes an emergency call can improve prognosis.
Keywords: Cardiac arrest; cardiopulmonary resuscitation; chronic kidney failure; hemodialysis; sudden death.
© 2020 The Authors. Acute Medicine & Surgery published by John Wiley & Sons Australia, Ltd on behalf of Japanese Association for Acute Medicine.
Conflict of interest statement
Approval of the research protocol: This study was approved by the Bioethics Committee of St. Marianna University School of Medicine (approval no. 3985). Informed consent: N/A. Registry and registration no. of the study/trial: N/A. Animal studies: N/A. Conflict of interest: None.
Neurological outcomes in patients transported to hospital without a prehospital return of spontaneous circulation after cardiac arrest.Crit Care. 2013 Nov 20;17(6):R274. doi: 10.1186/cc13121. Crit Care. 2013. PMID: 24252433 Free PMC article.
Neurological outcomes in children dead on hospital arrival.Crit Care. 2015 Nov 18;19:410. doi: 10.1186/s13054-015-1132-1. Crit Care. 2015. PMID: 26581332 Free PMC article.
The dynamic pattern of end-tidal carbon dioxide during cardiopulmonary resuscitation: difference between asphyxial cardiac arrest and ventricular fibrillation/pulseless ventricular tachycardia cardiac arrest.Crit Care. 2011;15(1):R13. doi: 10.1186/cc9417. Epub 2011 Jan 11. Crit Care. 2011. PMID: 21223550 Free PMC article.
Cardiopulmonary resuscitation (CPR) plus delayed defibrillation versus immediate defibrillation for out-of-hospital cardiac arrest.Cochrane Database Syst Rev. 2014 Sep 12;2014(9):CD009803. doi: 10.1002/14651858.CD009803.pub2. Cochrane Database Syst Rev. 2014. PMID: 25212112 Free PMC article. Review.
Cardiopulmonary resuscitation in children.Curr Opin Crit Care. 2009 Jun;15(3):203-8. doi: 10.1097/mcc.0b013e32832931e1. Curr Opin Crit Care. 2009. PMID: 19469022 Review.
- Annual Dialysis Data Report , JSDR Renal Data Registry [Cited 1 Apr 2019]. Available from: http://docs.jsdt.or.jp/overview/index.html.
- Converse RL Jr, Jacobsen TN, Toto RD et al Sympathetic overactivity in patients with chronic renal failure. N. Engl. J. Med. 1992; 327: 1912–18. - PubMed
- Annuk M, Zilmer M, Lind L, Linde T, Fellström B. Oxidative stress and endothelial function in chronic renal failure. J. Am. Soc. Nephrol. 2001; 12: 2747–52. - PubMed
- Middleton RJ, Parfrey PS, Foley RN. Left ventricular hypertrophy in the renal patient. J. Am. Soc. Nephrol. 2001; 12: 1079–84. - PubMed