Davis T R, Young B A, Eisenberg M S, Rea T D, Copass M K, Cobb L A
School of Medicine, University of Washington, Seattle, Washington, USA.
Kidney Int. 2008 Apr;73(8):933-9. doi: 10.1038/sj.ki.5002749. Epub 2008 Jan 2.
Cardiac arrest is the leading cause of death among dialysis patients in the United States. We measured the outcome of cardiac arrests attended by Emergency Medical Services (EMS) staff at hemodialysis facilities in a 14-year population-based retrospective study to identify cardiac arrest cases at a dialysis unit. Associated factors were determined using unconditional logistic regression. Of the 102 cardiac arrests identified around the time of dialysis, 10 occurred before, 72 during, and 20 after hemodialysis. The initial measured abnormality was ventricular fibrillation or tachycardia in 72 cases. Of those who survived transportation to a hospital, survival to discharge was 24 with 15% survival at 1 year. Compared to arrests that occurred prior to dialysis, the odds of ventricular fibrillation were 5-fold greater in patients on dialysis but 14-fold greater in those arresting after dialysis. One-third of cases occurred after the introduction of automated external defibrillators, and in half of the cases these devices were attached prior to EMS arrival. Once these devices were attached, most were used for defibrillation. We conclude that ventricular arrhythmias are the predominant features among arrested in-center dialysis patients with most occurrences during dialysis. The role of these devices in dialysis units will need a larger study to evaluate their efficacy.
心脏骤停是美国透析患者的主要死因。在一项为期14年的基于人群的回顾性研究中，我们测量了紧急医疗服务（EMS）人员在血液透析设施中处理心脏骤停的结果，以确定透析单位的心脏骤停病例。使用无条件逻辑回归确定相关因素。在透析前后约102例心脏骤停病例中，10例发生在透析前，72例发生在透析期间，20例发生在透析后。最初测量到的异常情况为72例心室颤动或心动过速。在被送往医院的患者中，出院生存率为24例，1年生存率为15%。与透析前发生的心脏骤停相比，透析患者发生心室颤动的几率高出5倍，但透析后发生心脏骤停的患者高出14倍。三分之一的病例发生在自动体外除颤器引入之后，并且在一半的病例中，这些设备在EMS到达之前已连接。一旦连接这些设备，大多数都用于除颤。我们得出结论，心室心律失常是中心内透析患者心脏骤停的主要特征，大多数发生在透析期间。这些设备在透析单位中的作用需要更大规模的研究来评估其疗效。
