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Cardiac arrest in the dialysis unit


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Cardiac arrest in the dialysis unit

  1. 1. Introduction • Sudden cardiac death –Most common cause of death in hemodialysis patients –Usually preceded by ventricular arrhythmias
  2. 2. • Hyperkalemia –Contributes to 2–5% of deaths among hemodialysis patients –Accounts for up to 24% of emergency hemodialysis sessions
  3. 3. • 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
  4. 4. • Primary prevention of cardiac arrest in dialysis patients – Avoidance of low potassium dialysate solutions – Proper use of medication • Beta blockers • ACE inhibitors
  5. 5. SPECIAL CONSIDERATIONS Cardiac Arrest During Hemodialysis
  6. 6. Hala! Wala na may heart beat. CODE BLUE! CODE BLUE!
  7. 7. 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
  8. 8. • Stop ultrafiltration (i.e. fluid removal) • Give a fluid bolus • Return the patient’s blood volume • Disconnect patient from the dialysis machine
  9. 9. • Leave dialysis access open and use for drug administration • Beware of wet surfaces (i.e. dialysis machines may leak) • Minimise delay in delivering defibrillation
  10. 10. • Ensure high quality chest compressions • Minimise interruptions to compressions • Give oxygen • Use waveform capnography DURING CPR
  11. 11. • Continuous compressions when advanced airway in place • Vascular access (intravenous or intraosseous) • Give adrenaline every 3-5 min • Give amiodarone after 3 shocks
  12. 12. Hypoxia Hypovolaemia Hypo-/ hyperkalaemia/ metabolic Hypothermia/ hyperthermia TREAT REVERSIBLE CAUSES
  13. 13. Thrombosis – coronary or pulmonary Tension pneumothorax Tamponade – cardiac Toxins
  14. 14. • Ultrasound imaging • Mechanical chest compressions to facilitate transfer/treatment • Coronary angiography and percutaneous coronary intervention • Extracorporeal CPR CONSIDER
  15. 15. CODE BLUE ACLS Algorithm Stop UF Give PNSS 200 mL Return patient’s blood Leave access open for drug administration Minimize delay in defibrillation
  17. 17. 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
  18. 18. • 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
  19. 19. Vascular access • Use dialysis access in life-threatening situations and cardiac arrest
  20. 20. 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)
  21. 21. POST RESUSCITATION CARE Cardiac Arrest During Hemodialysis
  22. 22. • 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
  23. 23. Reference • European Resuscitation Council Guidelines for Resuscitation 2015 – Section 4. Cardiac arrest in special circumstances A. Truhláˇr et al. / Resuscitation 95 (2015) 148–201 Published October 2015 by European Resuscitation Council vzw © European Resuscitation Council vzw www.erc.edu | info@erc.edu