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

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

Susan P Y Wong  1 , William Kreuter  2 , J Randall Curtis  3 , Yoshio N Hall  4 , Ann M O'Hare  4
Affiliations

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

Susan P Y Wong et al. JAMA Intern Med. 2015 Jun.

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.

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Conflict of interest statement

The authors disclose no financial conflict of interest.

Figures

Figure 1
Figure 1
Study Cohort
Figure 2
Figure 2
Incidence of cardiopulmonary resuscitation (CPR) (trend, p<0.001)
Figure 3
Figure 3
Survival to discharge and median post-discharge survival after inhospital cardiopulmonary resuscitation (all trends, p<0.001)
See this image and copyright information in PMC

Comment in

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