Saeed Fahad, Murad Haris F, Wing Richard E, Li Jianbo, Schold Jesse D, Fiscella Kevin A
Department of Medicine, Division of Nephrology, University of Rochester School of Medicine and Dentistry, Rochester, NY.
Division of Palliative Care, University of Rochester School of Medicine and Dentistry, Rochester, NY.
Kidney Med. 2021 Oct 23;4(1):100380. doi: 10.1016/j.xkme.2021.08.014. eCollection 2022 Jan.
RATIONALE & OBJECTIVE: Previous studies showing poor cardiopulmonary resuscitation (CPR) outcomes in the dialysis population have largely been derived from claims data and are somewhat limited by a lack of detailed characterization of CPR events. We aimed to analyze CPR-related outcomes in individuals receiving maintenance dialysis.
Retrospective chart review.
SETTING & PARTICIPANTS: Using electronic medical records from a single academic health care system, we identified all hospitalized adult patients receiving maintenance dialysis who had undergone in-hospital CPR between 2006 and 2014.
Initial in-hospital CPR.
Overall survival, predictors of unsuccessful CPR, predictors of death during the same hospitalization among initial survivors, predictors of discharge-to-home status.
We provide descriptive statistics for the study variables and used tests, χ tests, or Fisher exact tests to compare differences between the groups. We built multivariable logistic regression models to examine the CPR-related outcomes.
A total of 184 patients received in-hospital CPR: 51 (28%) did not survive the initial CPR event, and 77 CPR survivors died (additional 42%) later during the same hospitalization (overall mortality 70%). Only 18 (10%) were discharged home, with the remaining 32 (17%) discharged to a rehabilitation facility or a nursing home. In the multivariable model, the only predictor of unsuccessful CPR was CPR duration (OR, 1.41; 95% CI, 1.24-1.61; < 0.001). Predictors of death during the same hospitalization after surviving the initial CPR event were CPR duration (OR, 1.15; 95% CI 1.04-1.27; = 0.007) and older age (OR, 1.64; 95% CI, 1.23-2.2; < 0.001). Older people also had lower odds of discharge-to-home status (OR, 0.25; 95% CI, 0.11-0.54; < 0.001).
Retrospective study design, single-center study, no information on functional status.
Patients receiving maintenance dialysis experience high mortality following in-hospital CPR and only 10% are discharged home. These data may help clinicians provide useful prognostic information while engaging in goals of care conversations.
既往研究表明，透析人群心肺复苏（CPR）结局不佳，这些研究大多源自索赔数据，且在一定程度上因缺乏对CPR事件的详细特征描述而受到限制。我们旨在分析接受维持性透析的个体的CPR相关结局。
回顾性病历审查。
利用单一学术医疗系统的电子病历，我们确定了2006年至2014年间所有在住院期间接受过CPR的成年维持性透析住院患者。
首次住院期间的CPR。
总生存率、CPR未成功的预测因素、初始幸存者中同一住院期间死亡的预测因素、出院回家状态的预测因素。
我们提供研究变量的描述性统计，并使用检验、χ检验或Fisher精确检验来比较组间差异。我们构建多变量逻辑回归模型来研究CPR相关结局。
共有184例患者接受了住院CPR：51例（28%）在首次CPR事件中未存活，77例CPR幸存者在同一住院期间后期死亡（额外42%）（总死亡率70%）。只有18例（10%）出院回家，其余32例（17%）出院后前往康复机构或养老院。在多变量模型中，CPR未成功的唯一预测因素是CPR持续时间（比值比[OR]，1.41；95%置信区间[CI]，1.24 - 1.61；P < 0.001）。初始CPR事件存活后同一住院期间死亡的预测因素是CPR持续时间（OR，1.15；95% CI，1.04 - 1.27；P = 0.007）和年龄较大（OR，1.64；95% CI，1.23 - 2.2；P < 0.001）。老年人出院回家的几率也较低（OR，0.25；95% CI，0.11 - 0.54；P < 0.001）。
回顾性研究设计、单中心研究、无功能状态信息。
接受维持性透析的患者在住院CPR后死亡率很高，只有10%出院回家。这些数据可能有助于临床医生在进行治疗目标讨论时提供有用的预后信息。
