When cardiac arrests occur in outpatient dialysis facilities, Black patients have a lower probability of receiving cardiopulmonary resuscitation (CPR) and automated external defibrillator (AED) application from clinic staff compared with White patients, a new study finds.
According to the 2013-2017 National Cardiac Arrest Registry to Enhance Survival (CARES) and Medicare Annual Dialysis Facility Report registries, 1554 patients (including 485 White, 508 Black, and 561 other race patients) experienced cardiac arrest in US dialysis facilities.
After accounting for all relevant patient characteristics, quality measures, facility resources, and facility comorbidities, Black patients had significant 57% decreased odds of receiving staff CPR compared with White patients, Patrick H. Pun, MD, MHS, of Duke University, Durham, North Carolina, and colleagues reported in Kidney360. The investigators found no racial disparity in staff application of AED.
The racial divide in receipt of CPR was larger among older than younger patients starting around age 45 years.
Among the patients who had cardiac arrest, Black patients were significantly more likely than White patients to dialyze in larger facilities (26 vs 21 dialysis stations), facilities with fewer registered nurses per station (0.29 vs 0.33), and facilities with lower quality scores (number of citations: 6.8 vs 6.3). Facilities treating Black patients had a significantly higher proportion of patients with a history of cardiac arrest (40.5% vs 35.1%), HIV (3.0% vs 1.3%), hepatitis B (2.1% vs 1.6%), and Medicaid enrollment (15.1% vs 10.9%).
All of these differences in facility resources and quality were adjusted in models and did not explain the racial disparities in CPR and AED use.
Overall, CPR from dialysis staff was not given to 15% of Black, 9% of White, and 12% of other race patients experiencing cardiac arrest, the investigators reported. AED was not administered by clinic staff to 40% of Black, 34% of White, and 40% of other race patients.
In-center cardiac arrest is associated with poor survival outcomes, Dr Pun’s team pointed out.
“Evidence supports early provision of cardiopulmonary resuscitation (CPR) and rapid defibrillation by bystanders to increase survival after cardiac arrest, including cardiac arrest within hemodialysis clinics,” the investigators wrote. “In a prior study of a national cohort of hemodialysis clinic cardiac arrests, we found that immediate CPR initiated by dialysis clinic staff resulted in a three-fold increase in the odds of survival to hospital discharge.”
The investigators concluded: “Efforts to improve cardiac arrest recognition, quality of dialysis-specific CPR training and protocols, and implementation of implicit bias training may be needed to reduce racial disparities and improve overall care.”
Pun PH, Svetkey LP, McNally B, Dupre ME. Facility-level factors and racial disparities in cardiopulmonary resuscitation within US dialysis clinics. Kidney360. Published online March 11, 2022. doi:10.34067/KID.0008092021