Association between patient race and staff resuscitation efforts after cardiac arrest in outpatient dialysis clinics: A study from the CARES surveillance group.
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BACKGROUND:Cardiac arrest is the leading cause of death among patients receiving hemodialysis. Despite guidelines recommending CPR training and AED presence in dialysis clinics, rates of CPR and AED use by dialysis staff are suboptimal. Given that racial disparities exist in bystander CPR administration in non-healthcare settings, we examined the relationship between patient race/ethnicity and staff-initiated CPR and AED application within dialysis clinics. METHODS:We analyzed data prospectively collected in the Cardiac Arrest Registry to Enhance Survival across the U.S. from 2013 to 2017 and the Centers for Medicare & Medicaid Services dialysis facility database to identify outpatient dialysis clinic cardiac arrest events. Using multivariable logistic regression models, we examined relationships between patient race/ethnicity and dialysis staff-initiated CPR and AED application. RESULTS:We identified 1568 cardiac arrests occurring in 809 hemodialysis clinics. The racial/ethnic composition of patients was 31.3% white, 32.9% Black, 10.7% Hispanic/Latinx, 2.7% Asian, and 22.5% other/unknown. Overall, 88.0% of patients received CPR initiated by dialysis staff, but rates differed by race: 91% of white patients, 85% of black patients, and 77% of Asian patients (p = 0.005). After adjusting for differences in patient and clinic characteristics, black (OR = 0.41, 95% CI 0.25-0.68) and Asian patients (OR = 0.28, 95% CI 0.12-0.65) were significantly less likely than white patients to receive staff-initiated CPR. No significant difference between staff-initiated CPR rates among white, Hispanic/Latinx, and other/unknown patients was observed. An AED was applied by dialysis staff in 62% of patients. In adjusted models, there was no relationship between patient race/ethnicity and staff AED application. CONCLUSIONS:Black and Asian patients are significantly less likely than white patients to receive CPR from dialysis staff. Further understanding of practices in dialysis clinics and increased awareness of this disparity are necessary to improve resuscitation practices.
Published Version (Please cite this version)10.1016/j.resuscitation.2020.07.036
Publication InfoHofacker, Samuel A; Dupre, Matthew E; Vellano, Kimberly; McNally, Bryan; Starks, Monique Anderson; Wolf, Myles; ... Pun, Patrick H (2020). Association between patient race and staff resuscitation efforts after cardiac arrest in outpatient dialysis clinics: A study from the CARES surveillance group. Resuscitation, 156. pp. 42-50. 10.1016/j.resuscitation.2020.07.036. Retrieved from https://hdl.handle.net/10161/21671.
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Associate Professor in Population Health Sciences
Dr. Dupre is an Associate Professor in the Department of Population Health Sciences and the Department of Sociology. He is also a Senior Fellow at the Center for Aging and Human Development and member of the Cardiovascular Outcomes Group at the Duke Clinical Research Institute. Dr. Dupre is a medical sociologist who specializes in research on aging and the life course, health disparities, and cardiovascular disease (CVD) outcomes in older adults. As an interdisciplinary researcher, he has foc
Associate Professor of Medicine
My current research interest is in understanding the mechanisms of cardiovascular disease among patients with chronic kidney disease, with a particular focus on the epidemic of sudden cardiac death. The ultimate goal is to reduce the impact of sudden death through improved risk stratification and novel risk mitigation therapies. Current investigations are focused on identifying novel genetic and biomarker risk factors among CKD patients, understanding the interplay of hemodialysis-specific expos
Professor of Medicine
Laura P. Svetkey, MD MHS is Professor of Medicine/Nephrology, Vice Chair for Faculty Development and Diversity in the Department of Medicine, and School of Medicine Faculty Ombudsperson. She is also the Director of Duke’s CTSA-sponsored internal career development award program (KL2) and the Investigator Development Core of Duke’s REACH Equity Disparities Research Center. Dr. Svetkey has over 30 years of experience in the investigation of hypertension, obe
Charles Johnson, M.D. Distinguished Professor of Medicine
The focus of my research is disordered mineral metabolism across the spectrum of chronic kidney disease, including dialysis, kidney transplantation and earlier stages.My research has been published in leading general medicine and subspecialty journals, including the New England Journal of Medicine, JAMA, the Journal of Clinical Investigation, Circulation, Cell Metabolism, Journal of the American Society of Nephrolog
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