A recent study reported in the journal Kidney Medicine has shown a negative correlation between longer CPR duration and odds of survival in patients on maintenance dialysis, particularly in older adults.

In this study, the researchers set out to examine the outcomes of in-hospital CPR in 184 hospitalized adult patients on maintenance dialysis between January 2006 and December 2014. For this, the medical records of all patients in a single tertiary care hospital were retrospectively analysed.

The overall mortality was 70%. Further analysis revealed that 28% (n=51 patients) did not survive despite CPR, while 42% (n = 77) of those who survived the initial in-hospital CPR died during the same period of hospitalization. Thirty-two patients (17%) were discharged to a nursing home or rehabilitation facility, while the rest of the 18 (10%) patients were discharged home.

The duration of CPR was found to be the only variable to influence the outcome of CPR. Longer CPR duration was more likely to be unsuccessful with an odds ratio of 1.41. Each extra minute of CPR increased the risk of death by 41%.

Among patients who survived the initial in-hospital CPR, longer duration of CPR was also predictive of death during the same hospitalization (OR 1.15). Older patients were also more likely to die (OR 1.64) and also had lower odds of discharge-to-home (OR 0.25).

Only 10% of patients were discharged home in this study demonstrating the adverse impact of longer duration of CPR on chances of survival as is also evident from the high mortality following in-hospital CPR. These prognostic findings may help physicians in “advanced care planning (ACP) and goals of care discussions” with patients and their families. The authors write, “We wish to emphasize that our study provides general guidance for ACP and goals of care discussions, and individual patient factors will need to be considered for decisions to continue or terminate CPR efforts.”

Reference

1. Saeed F, et al. Outcomes Following in-hospital cardiopulmonary resuscitation in people receiving maintenance dialysis. Kidney Medicine. 2022 Jan;4(1):100380.