Factors Affecting Outcomes of Cardiopulmonary Resuscitation in a Nephro-Urology Unit: A Retrospective Analysis

Abstract Background Availability of cardiopulmonary resuscitation (CPR) data from India is limited in published literature and data on patients with renal disease even more so. Documented survival-to-discharge rates worldwide range from 8 to 15% in renal disease as compared to 25% in the general population. Methods An institution-wide format for collection of cardiac arrest data was introduced in late 2015. We have analyzed all adult onsite cardiac arrests from January 2016 to December 2019. Patient characteristics and CPR parameters were both studied in detail. Primary endpoint was defined as survival to discharge. Association between patient and treatment characteristics and survival to discharge was studied. Results Successful CPR resulting in patient discharge occurred in 28 (31.4%) out of 89 patients. A very strong association was found between mortality and prolonged CPR (p <0.00001). Events occurring out of hours (p = 0.0029), patients admitted in the intensive care unit (ICU) (p = 0.03), initiated on inotropes (p = 0.003), and patients already on a ventilator (p = 0.0018) had poorer outcomes. Sepsis as the etiology emerged as the most significant association with mortality (p = 0.0007). Patient characteristics such as age, sex, presence or absence of chronic kidney disease, type of dialysis treatment, and vintage were found to be insignificant. Conclusion Analysis revealed survival to discharge of 31.4%. Sepsis in association with renal disease has been found to be consistent with higher risk for mortality. Other factors such as an out of hours event, admission to ICU, early intubation and inotrope initiation were associated with worse outcomes. How to cite this article Sharma S, Raman P, Sinha M, Deo AS. Factors Affecting Outcomes of Cardiopulmonary Resuscitation in a Nephro-Urology Unit: A Retrospective Analysis. Indian J Crit Care Med 2022;26(3):322–326.

[1]  Alik Dakessian,et al.  Out of hospital cardiac arrest outcomes: Impact of weekdays versus weekends admission on survival to hospital discharge. , 2019, Resuscitation.

[2]  W. Ullah,et al.  Duration of in-hospital cardiopulmonary resuscitation and its effect on survival , 2019, Indian heart journal.

[3]  J. Hollenberg,et al.  Comorbidity and survival in out-of-hospital cardiac arrest. , 2018, Resuscitation.

[4]  N. Efstathiou,et al.  How does the length of cardiopulmonary resuscitation affect brain damage in patients surviving cardiac arrest? A systematic review , 2018, Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine.

[5]  J. Herlitz,et al.  Survival and neurological outcome in the elderly after in-hospital cardiac arrest. , 2017, Resuscitation.

[6]  J. Nally,et al.  Outcomes of In-Hospital Cardiopulmonary Resuscitation in Patients with CKD. , 2016, Clinical journal of the American Society of Nephrology : CJASN.

[7]  D. Kattula,et al.  Profile and outcome of sudden cardiac arrests in the emergency department of a tertiary care hospital in South India , 2016, Journal of emergencies, trauma, and shock.

[8]  A. J. Kim,et al.  Liver cirrhosis leads to poorer survival in patients with end-stage renal disease , 2016, The Korean journal of internal medicine.

[9]  M. Donnino,et al.  Part 10: Special Circumstances of Resuscitation: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. , 2015, Circulation.

[10]  J. Soar,et al.  European Resuscitation Council Guidelines for Resuscitation 2015: Section 4. Cardiac arrest in special circumstances. , 2015, Resuscitation.

[11]  S. Navaneethan,et al.  Cause-Specific Deaths in Non-Dialysis-Dependent CKD. , 2015, Journal of the American Society of Nephrology : JASN.

[12]  M. Tonelli,et al.  Cause of Death in Patients with Reduced Kidney Function. , 2015, Journal of the American Society of Nephrology : JASN.

[13]  S. Mahdavi,et al.  Cardiopulmonary Resuscitation Success Rates in 402 Patients with and without Renal Impairment at Canada Largest Community Hospital , 2013 .

[14]  S. Kronick,et al.  Duration of resuscitation efforts and survival after in-hospital cardiac arrest: an observational study , 2012, The Lancet.

[15]  Chih-Chiang Chien,et al.  Long-term survival and predictors for mortality among dialysis patients in an endemic area for chronic liver disease: a national cohort study in Taiwan , 2012, BMC Nephrology.

[16]  A. Shrivastava,et al.  Impact of advanced cardiac life support training program on the outcome of cardiopulmonary resuscitation in a tertiary care hospital , 2011, Indian journal of critical care medicine : peer-reviewed, official publication of Indian Society of Critical Care Medicine.

[17]  J. Ornato,et al.  Survival from in-hospital cardiac arrest during nights and weekends. , 2008, JAMA.

[18]  V. Pettilä,et al.  Survival and quality of life of patients requiring acute renal replacement therapy , 2005, Intensive Care Medicine.

[19]  I. Teitelbaum,et al.  Renal Replacement Therapy in Patients with Chronic Liver Disease , 2005, Seminars in dialysis.

[20]  C. Magnant,et al.  Predicting in-hospital mortality during cardiopulmonary resuscitation. , 1996, Resuscitation.

[21]  Alvin,et al.  Outcomes of cardiopulmonary resuscitation in dialysis patients. , 1992, Journal of the American Society of Nephrology : JASN.

[22]  Michael L Ruygrok Duration of Resuscitation Efforts and Survival after In-hospital Cardiac Arrest: An Observational Study , 2013 .

[23]  M. Leblanc,et al.  Predictors and outcome of cardiopulmonary resuscitation (CPR) calls in a large haemodialysis unit over a seven-year period. , 2006, Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association.