Evaluating and Improving Cardiac Arrest Resuscitation Efforts in Hemodialysis Clinics

心脏骤停（SCA）是血液透析患者死亡的主要原因，据估计， 23%的SCA发生在门诊透析诊所。尽管透析诊所的SCA是机智的- 在经过培训的医疗保健专业人员的帮助下，使用复苏设备，SCA后的存活率仅为 百分之八这些不良结局的潜在原因包括（1）室性快速性心律失常的比例较低， 二端交流阻抗骤停，更容易逆转;（2）自动体外除颤器（AED）使用不足; （3）临床工作人员对旁观者心肺复苏（CPR）的操作不理想。然而，在这方面， 这些因素对透析患者SCA存活率的影响还没有被评估。的 本申请的总体目标是解决关于当前复苏实践的这些知识缺口， es并确定透析诊所内最佳复苏的障碍，长期目标是改善 患有SCA的血液透析患者的生存率。根据初步数据，中心假设是， 室性快速性心律失常在透析单位中很常见，但在透析诊所中使用CPR和AED 由于存在各种可修改的障碍，这一假设将使用北卡罗来纳州进行检验- 心脏骤停登记提高生存率（NC CARES），一项创新的前瞻性临床登记， 院外心脏骤停患者，以识别和描述门诊透析中发生的SCA事件 设施，以实现前三个相互关联的具体目标：（1）确定事件的比例 呈现初始可电击室性快速性心律失常，以确定成功的可能性- 在透析诊所全面治疗SCA;（2）确定血液透析诊所SCA复苏的现行做法 包括提供心肺复苏术和使用AED，并将这些做法与SCA的做法进行比较， 其他非透析门诊卫生保健设施;（3）确定心室之间的关系， 心律失常、心脏骤停复苏实践和血液透析诊所的患者结局。最终目的 这项建议的一部分将是对透析诊所工作人员进行定性访谈，以获得关于潜力的观点， 在透析诊所中使用CPR和AED的主要促进者和障碍，随后开发了一个经过验证的表面， 可以在未来的研究步骤中使用的工具。这项研究将是第一次全面评估SCA的重新- 透析诊所中的诱导努力及其与结果的关系。调查结果将为以下两点定义 潜在的有效干预，并创建一个新的有效的调查工具，可以指导发展， 量身定制的干预措施，以改善复苏工作。虽然范围有限，但与R 03机甲一致- 然而，这些调查有可能提出简单，易于实施的干预措施，这将有助于提高 为成千上万的透析患者提供复苏并降低死亡率。

Sudden cardiac arrest (SCA) is the leading cause of death for hemodialysis patients, and it is estimated that up to 23% of these SCA occur within outpatient dialysis clinics. Even though SCAs in dialysis clinics are wit- nessed by trained health care professionals with access to resuscitation equipment, post-SCA survival is only 8%. Potential reasons for these poor outcomes include (1) a low proportion of ventricular tachyarrhythmia car- diac arrests, which are more readily reversible; (2) underutilization of automated external defibrillators (AEDs); and (3) sub-optimal performance of bystander cardiopulmonary resuscitation (CPR) by clinic staff. However, the contribution of these factors toward poor SCA survival in dialysis patients has not been evaluated. The overall objective of this application is to address these knowledge gaps regarding current resuscitation practic- es and to identify barriers to optimal resuscitation within dialysis clinics, with the long-term goal of improving survival for hemodialysis patients suffering from SCA. Based on preliminary data, the central hypothesis is that ventricular tachyarrhythmias are common in dialysis units, but CPR and AED utilization within dialysis clinics are suboptimal due to a variety of modifiable barriers. This hypothesis will be examined using the North Caroli- na Cardiac Arrest Registry to Enhance Survival (NC CARES), an innovative prospective clinical registry of out- of-hospital cardiac arrest patients, to identify and characterize SCA events occurring within outpatient dialysis facilities in order to accomplish the first three inter-related specific aims: (1) to identify the proportion of events presenting with an initial shockable ventricular tachyarrhythmia in order to determine the potential for success- fully treating SCA in dialysis clinics; (2) to define current practices in SCA resuscitation by hemodialysis clinic staff, including provision of CPR and use of AEDs, and compare these practices with those used for SCA in other non-dialysis outpatient health care facilities; and (3) to determine the relationships between ventricular arrhythmias, cardiac arrest resuscitation practices, and patient outcomes in hemodialysis clinics. The final aim of this proposal will be to conduct qualitative interviews with dialysis clinic staff to gain perspectives on poten- tial facilitators and barriers to CPR and AED use in dialysis clinics and subsequently develop a validated sur- vey tool that can be used in future research steps. This study will be the first thorough evaluation of SCA re- suscitation efforts in dialysis clinics and their association with outcomes. The findings will both define points for potential effective intervention and create a new validated survey instrument that can guide the development of tailored interventions to improve resuscitation efforts. Although limited in scope, consistent with the R03 mech- anism, these investigations have the potential to suggest simple, easily implemented interventions that will im- prove resuscitation and reduce mortality for thousands of dialysis patients.