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Abstract: FR-PO404

Cardiac Arrest in Hospitalized Maintenance Hemodialysis Patients

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Scovner, Katherine Mikovna, BWH, Boston, Massachusetts, United States
  • Neves, João Sérgio, Department of Endocrinology, Diabetes and Metabolism, São João Hospital, Faculty of Medicine, University of Porto, Lisbon, Portugal
  • Correa, Simon, BWH, Boston, Massachusetts, United States
  • Short, Samuel, BWH, Boston, Massachusetts, United States
  • Kibbelaar, Zoé A., BWH, Boston, Massachusetts, United States
  • McCausland, Finnian R., BWH, Boston, Massachusetts, United States
Background

Sudden cardiac death accounts for half of cardiac-related deaths in maintenance hemodialysis (HD) patients. Data regarding the frequency of shockable rhythms at presentation to or during a hospital stay is limited.

Methods

A retrospective cohort study was performed to evaluate the characteristics, laboratory values and treatment of HD patients with a hospital stay due to or complicated by cardiac arrest between 2015-2018. Arrests following continuous renal replacement therapy were excluded (n=4). Differences in predictors of interest according to the use of defibrillation during cardiac arrest were analyzed by chi2 tests or t-tests.

Results

Of the 34 subjects included, mean age was 64 years, 83% were male, 29% were black, 53% had heart failure and 44% had atrial fibrillation. 25 arrested during admission, while 9 had out-of-hospital arrests. 71% died during their admission. 29% had ventricular tachycardia (VT) or fibrillation (VF) during their arrest; 70% of these received at least one shock. 50% had asystole/pulseless electrical activity (PEA) without VT or VF. The remaining 21% rhythms were not described; one of these had no documentation regarding whether or not defibrillation was used. The median duration since the preceding HD session was 24 hours (25-75th percentile:12-45) with pre-arrest serum electrolytes as follows: potassium 4.9±0.7mmol/L, bicarbonate 22±4.6mmol/L, phosphorus 4.6±1.9mg/dL and calcium 8.8±0.8mg/dL. Comparisons according to receipt of defibrillation are presented in Table 1.

Conclusion

Asystole/PEA appear to be more frequent than VT/VF in HD patients with a hospital stay due to or complicated by cardiac arrest. Of patients with VT/VF, 30% were not defibrillated. Further studies are needed to better understand the etiology and treatment of cardiac arrest in HD patients during hospitalization.

Table 1.
Characteristics of Defibrillated vrs Not Defibrillated Patients