Evaluating and Improving Cardiac Arrest Resuscitation Efforts in Hemodialysis Clinics

心脏骤停(SCA)是血液透析患者的主要死亡原因，据估计 这些SCA中有23%发生在门诊透析诊所。即使透析诊所的SCA是机智的- 由训练有素的医疗保健专业人员提供复苏设备，SCA后的存活率仅为 8%。这些不良预后的潜在原因包括：(1)室性快速性心律失常发生率低。 DIAC停搏，更容易逆转；(2)自动体外除颤器(AED)使用不足； 以及(3)临床工作人员对旁观者心肺复苏(CPR)的表现不佳。然而， 这些因素对透析患者SCA存活率低的影响尚未得到评估。这个 此应用程序的总体目标是解决有关当前复苏实践的这些知识差距- ES和确定透析诊所内最佳复苏的障碍，长期目标是改善 患有SCA的血液透析患者的存活率。根据初步数据，中心假设是 室性快速性心律失常在透析单元中很常见，但CPR和AED在透析诊所中的应用 由于各种可修改的障碍，它们并不是最优的。这一假设将通过北卡罗来纳州- NA心脏骤停登记以提高存活率(NC CARE)，这是一种创新的、具有前瞻性的体外循环临床登记。 院外心脏骤停患者，以识别和表征发生在门诊透析中的SCA事件 设施，以实现头三个相互关联的具体目标：(1)确定活动的比例 最初出现电击性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)明确血液透析诊所在SCA复苏方面的现行做法 工作人员，包括提供心肺复苏和使用AED，并将这些做法与#年政制事务局局长所使用的做法进行比较 其他非透析性门诊保健设施；(3)确定心脑血管 血液透析诊所的心律失常、心脏骤停复苏实践和患者预后。最终目标 这项建议的重点是对透析诊所的工作人员进行定性采访，以了解对潜力的看法- TAL促进剂和在透析诊所使用CPR和AED的障碍，随后开发一种有效的 可在未来研究步骤中使用的VEY工具。这项研究将是对SCA再评估的第一次彻底评估。 透析诊所的停药努力及其与预后的关系。这两项发现都将为 潜在的有效干预并创建一种新的经过验证的调查工具，可以指导 量身定做的干预措施，以改善复苏工作。虽然范围有限，但与R03机械一致- 这些调查有可能提出简单、容易实施的干预措施，从而促进- 证明复苏并降低数千名透析患者的死亡率。

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.