Dataset Information

End-Stage Renal Disease Patients Undergoing Hemodialysis Have Higher Possibility of Return of Spontaneous Circulation during Out-of-Hospital Cardiac Arrest and Non-Inferior Short-Term Survival.

ABSTRACT: End-stage renal disease (ESRD) patients on long-term hemodialysis (HD) have an elevated risk of sudden cardiac death. This study hypothesizes, for the first time, that these patients have a higher odds of return of spontaneous circulation (ROSC) and subsequent better hospital-outcomes, post out-of-hospital cardiac arrest (OHCA), as opposed to non-ESRD patients. A national database from Taiwan was utilized, in which 101,876 ESRD patients undergoing HD and propensity score-matched non-ESRD patients were used to conduct two analyses: (i) Cox-proportional-hazards-regression for OHCA incidence and (ii) logistic-regression analysis of attaining ROSC after OHCA, both for ESRD patients in comparison to non-ESRD patients. Kaplan-Meier analyses were conducted to determine the difference of survival rates after ROSC between the two cohorts. ESRD patients were found to be at a higher risk of OHCA (adjusted-HR = 2.11, 95% CI: (1.89-2.36), p < 0.001); however, they were at higher odds of attaining ROSC (adjusted-OR = 2.47, 95% CI: 1.90-3.21, p < 0.001), as opposed to non-ESRDs. Further, Kaplan-Meier analysis demonstrated ESRD patients with a better 30-day hospital survival rate than non-ESRD patients. Although ESRD patients had a higher risk of OHCA, they demonstrated higher possibility of ROSC and a better short-term hospital outcome than non-ESRDs. Chronic toxin tolerance and the training of vascular-compliance during regular HD may be possible explanations for better outcomes in ESRD patients.

SUBMITTER: Hsieh MS

PROVIDER: S-EPMC9659049 | biostudies-literature | 2022 Nov

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

End-Stage Renal Disease Patients Undergoing Hemodialysis Have Higher Possibility of Return of Spontaneous Circulation during Out-of-Hospital Cardiac Arrest and Non-Inferior Short-Term Survival.

Hsieh Ming-Shun MS Chattopadhyay Amrita A Lu Tzu-Pin TP Liao Shu-Hui SH Chang Chia-Ming CM Lee Yi-Chen YC Lo Wei-En WE Wu Jia-Jun JJ Hsieh Vivian Chia-Rong VC Hu Sung-Yuan SY How Chorng-Kuang CK

Journal of clinical medicine 20221106 21

End-stage renal disease (ESRD) patients on long-term hemodialysis (HD) have an elevated risk of sudden cardiac death. This study hypothesizes, for the first time, that these patients have a higher odds of return of spontaneous circulation (ROSC) and subsequent better hospital-outcomes, post out-of-hospital cardiac arrest (OHCA), as opposed to non-ESRD patients. A national database from Taiwan was utilized, in which 101,876 ESRD patients undergoing HD and propensity score-matched non-ESRD patient ...[more]

PMID: 36362810

Similar Datasets

Project description:IntroductionThe return of spontaneous circulation after cardiac arrest (RACA) score is a well-validated model for estimating the probability of return of spontaneous circulation (ROSC) in patients with out-of-hospital cardiac arrest (OHCA) by incorporating several variables, including gender, age, arrest aetiology, witness status, arrest location, initial cardiac rhythms, bystander cardiopulmonary resuscitation (CPR), and emergency medical services (EMS) arrival time. The RACA score was initially designed for comparisons between different EMS systems by standardising ROSC rates. End-tidal carbon dioxide (EtCO2) is a quality indicator of CPR. We aimed to improve the performance of the RACA score by adding minimum EtCO2 measured during CPR to develop the EtCO2 + RACA score for OHCA patients transported to an emergency department (ED).MethodsThis was a retrospective analysis using prospectively collected data for OHCA patients resuscitated at an ED during 2015-2020. Adult patients with advanced airways inserted and available EtCO2 measurements were included. We used the EtCO2 values recorded in the ED for analysis. The primary outcome was ROSC. In the derivation cohort, we used multivariable logistic regression to develop the model. In the temporally split validation cohort, we assessed the discriminative performance of the EtCO2 + RACA score by the area under the receiver operating characteristic curve (AUC) and compared it with the RACA score using the DeLong test.ResultsThere were 530 and 228 patients in the derivation and validation cohorts, respectively. The median measurements of EtCO2 were 8.0 times (interquartile range [IQR] 3.0-12.0 times), with the median minimum EtCO2 of 15.5 millimeters of mercury (mm Hg) (IQR 8.0-26.0 mm Hg). The median RACA score was 36.4% (IQR 28.9-48.0%), and a total of 393 patients (51.8%) achieved ROSC. The EtCO2 + RACA score was validated with good discriminative performance (AUC, 0.82, 95% CI 0.77-0.88), outperforming the RACA score (AUC, 0.71, 95% CI 0.65-0.78) (DeLong test: P < 0.001).ConclusionThe EtCO2 + RACA score may facilitate the decision-making process regarding allocations of medical resources in EDs for OHCA resuscitation.

Project description:IntroductionMicrocirculatory alterations are predictive of poor outcomes in patients with shock and after cardiac arrest in animal models. However, microcirculatory alterations during human cardiac arrest have not yet been studied.MethodsWe prospectively included adult patients receiving resuscitation after witnessed out-of-hospital cardiac arrest. Exclusion criteria were hypovolemia, hypo- or hyperthermia (< 34.0 °C, > 37.5 °C), peripheral arterial disease, Raynaud's disease, and logistical issues (e.g., shortage of space). Capillary refill time was measured on the finger (CRT-F) and the earlobe (CRT-E) every other minute until return of spontaneous circulation (any ROSC) or termination of resuscitation. The primary endpoint was any ROSC, secondary endpoints were 30-day-mortality and good neurological outcome (defined as cerebral performance category 1-2). Based on the data structure, CRT-F and CRT-E values were grouped post-hoc into quartiles and tertiles. A cluster-robust standard error logistic regression was performed for the primary outcome. Trend analyses were made for each individual.ResultsAfter screening of 141 patients, 50 were included in the analysis (median age 75 years, 28% female, any ROSC 32%). The median CRT-F was > 10 [7-> 10] seconds; the median CRT-E was 3 [3-4] seconds. The any ROSC rate for patients in CRT-F quartile 1 (3-5 s) was 71.4%, 31.7% in quartile 2 (6-8 s), 23.1% in quartile 3 (9-10 s), and 10% in quartile 4 (> 10 s). The odds ratio of 0.39 (95% CI 0.20-0.73, p = 0.004) indicated, that with an increase of CRT-F by a quartile, the chance of achieving any ROSC decreased by 61%. Patients with a decreasing CRT-F achieved any ROSC in 70%, whereas patients with constant or increasing CRT-F had any ROSC in only 21% (p = 0.008). In contrast, CRT-E showed no association with any ROSC (T1 [1-2 s.]: 16.7%, T2 [3 s.]: 27.5%, T3 [4-> 10 s.]: 22.4%, OR by tertiles: 1.18, 95% CI 0.58-2.44, p = 0.646).ConclusionDuring out-of-hospital cardiac arrest, shorter CRT-F, but not CRT-E, is associated with a higher chance of any ROSC.Trial registrationThis trial was pre-registered on clinicaltrials.gov with the number: NCT04791995 on March 2nd, 2021.

Dataset Information

End-Stage Renal Disease Patients Undergoing Hemodialysis Have Higher Possibility of Return of Spontaneous Circulation during Out-of-Hospital Cardiac Arrest and Non-Inferior Short-Term Survival.

Publications

End-Stage Renal Disease Patients Undergoing Hemodialysis Have Higher Possibility of Return of Spontaneous Circulation during Out-of-Hospital Cardiac Arrest and Non-Inferior Short-Term Survival.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets