Clinical findings and outcomes of intra-hemodialysis cardiopulmonary resuscitation

Renal failure with severe uremia is still an important cause of mortality, despite effective renal replacement therapy. Cardiopulmonary arrest (CPA) i s the most severe complication during hemodialysis (HD). To acquire more in formation about cardiopulmonary resuscitation (CPR) during HD, we retrospec tively enrolled 24 patients (11 males and 13 females) who had CPR during HD in a medical center during a 3-year period. Their mean age was 66.8 +/- 16 .8 years, The CPR rate of the patients from our outpatient department (0.02 %) was significantly lower than that from general wards (0.11%), the intens ive care unit (ICU, 0.16%), or the emergency room (ER, 0.38%). Eighteen pat ients (75%) were initially resuscitated successfully. Only 11 patients (45. 8%) survived more than 24 h after CPR, and 2 patients (8.3%) survived more than 1 month, but none survived until discharge. The rates of surviving 24 h and surviving to discharge during HD were lower than those in the general wards, the ICU or the ER. Sepsis (33.3%) and cardiogenic shock (25%) were the two leading causes of death. For analyzing factors affecting the outcom e of CPR, we divided the patients into 2 groups by survival time (less than or equal to 24 vs. >24 h). Patients with heart disease or with prolonged C PR durations (>30 min) had shorter survival. No significant survival differ ence between the 2 groups was found due to factors of age, sex, diabetic ne phropathy, pre-arrest morbidity scores, pre-arrest laboratory data, renal f ailure pattern, HD duration, the preceding HD time and ultrafiltrated volum e.