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Cardiac arrest in the dialysis unit
1.
2.
3. Introduction
• Sudden cardiac death
–Most common cause of death in hemodialysis
patients
–Usually preceded by ventricular arrhythmias
4. • Hyperkalemia
–Contributes to 2–5% of deaths among
hemodialysis patients
–Accounts for up to 24% of emergency
hemodialysis sessions
5. • Frequency of cardiac
arrest
–Highest on the first
session of hemodialysis
of the week
• Monday or Tuesday
–Fluid and electrolyte
disturbances peak after
the weekend interval
6. • Primary prevention of cardiac arrest in dialysis
patients
– Avoidance of low potassium dialysate solutions
– Proper use of medication
• Beta blockers
• ACE inhibitors
9. Initial Steps
• Call the resuscitation team and seek
expert help immediately
• Follow the universal ALS algorithm
• Assign a trained dialysis nurse to operate
the dialysis machine
10. • Stop ultrafiltration (i.e. fluid
removal)
• Give a fluid bolus
• Return the patient’s blood
volume
• Disconnect patient from the
dialysis machine
11. • Leave dialysis access open
and use for drug
administration
• Beware of wet surfaces (i.e.
dialysis machines may leak)
• Minimise delay in delivering
defibrillation
12.
13. • Ensure high quality chest compressions
• Minimise interruptions to compressions
• Give oxygen
• Use waveform capnography
DURING CPR
14. • Continuous compressions when
advanced airway in place
• Vascular access (intravenous or
intraosseous)
• Give adrenaline every 3-5 min
• Give amiodarone after 3 shocks
18. CODE BLUE
ACLS Algorithm
Stop UF
Give PNSS 200 mL
Return patient’s blood
Leave access open for drug administration
Minimize delay in defibrillation
20. Defibrillation
• Shockable rhythm (VF/pVT)
–More common in patients undergoing
hemodialysis than in the general population
• RECOMMENDATION:
–Disconnect patient from the dialysis
equipment prior to defibrillation
21. • Ensure familiarity with dialysis
equipment
–Check if equipment is defibrillator-proof
• In accordance with the International
Electrotechnical Committee (IEC) standards
• Automated external defibrillators
–Can facilitate early defibrillation by first
responders in nurse-led dialysis centres
22. Vascular access
• Use dialysis access in life-threatening
situations and cardiac arrest
23. Potentially Reversible Causes
• All of the standard reversible causes apply
to dialysis patients
–4 Hs and 4 Ts
• Most common causes
–Electrolyte disorders (particularly hyperkalemia)
–Fluid overload (e.g. pulmonary edema)
26. • Early post resuscitation period
–Dialysis may be required
–Guided by fluid status and serum
biochemistry
• Patient transfer to an area with dialysis
facilities is essential
–Intensive care unit
–Renal high dependency unit