CPR choices of dialysis patients suggest many lack context

August 24, 2020

Globally some 2 million people with failed kidneys undergo hemodialysis treatment. Their survival depends on being connected to a blood-cleansing machine, usually three times a week for three to four hours each time. The regimen can be grueling and limit patients' ability to travel far from home.

With this backdrop, researchers queried 876 dialysis patients about whether, in the event of a cardiac arrest, they would want to be resuscitated. Nearly 85% said they definitely or probably would want CPR, according to a paper published today in JAMA Network Open.

The respondents' appreciation for life should be recognized, the study's lead author said, but the findings also raise concern that many patients are unaware of important context that should inform such a preference.

"People who live with kidney failure are much more likely to develop cardiovascular problems than the general population, and their median survival after a cardiac arrest is five months, compared with almost three years for the general population. Among survivors, only 8% to 15% live for more than a year," said Dr. Gwen Bernacki, an acting instructor of cardiology at the University of Washington School of Medicine.

In the study, patients were not pre-informed of the likely poor outcomes in these circumstances. The survey results led Bernacki to infer that such consequential conversations are not happening enough between doctors and patients who receive dialysis.

"What's in question is whether this patient population understands their likely quality of life, should they survive a cardiac arrest. There should be a broader discussion about resuscitation in the setting of receiving dialysis," she said. "Engaging dialysis patients in difficult conversations topics is every provider's job, but it may be that too few of us are comfortable broaching sensitive topics. Most of us aren't trained in palliative care."

The concern is that these conversations are not happening at all, or that CPR is a topic overlooked in discussions about possible outcomes and patients' wishes for future care.

The study posed secondary questions about patients' preference for mechanical ventilation, whether longevity or comfort is prioritized in their future care, and whether they had considered stopping dialysis. Some participants' responses to the main CPR question seemed disconnected from responses to secondary questions, Bernacki observed - supporting her assertion that patients' choices about CPR probably were not informed by bigger-picture considerations about what is most important to them.

For instance, 43% of patients who desired resuscitation also wanted future care to focus on comfort, even though CPR aligns more logically with longevity-focused care (which was prioritized by 23% of those desiring CPR). Also, 25% of those who wanted CPR did not want mechanical ventilation, despite the fact that CPR often involves intubation - the placement of a tube through the mouth and into the airway.

Among patients who wanted no resuscitation efforts, only 60% had documented those wishes. "That's concerning because resuscitation is often done by default and so if not documented, CPR might happen automatically even if this not what patients want," Bernacki said.
-end-
The research was supported by the National Heart, Lung, and Blood Institute (T32HL125195-04) and the National Institute of Diabetes and Digestive and Kidney Diseases (U01DK102150).

University of Washington Health Sciences/UW Medicine

Related Science Articles from Brightsurf:

75 science societies urge the education department to base Title IX sexual harassment regulations on evidence and science
The American Educational Research Association (AERA) and the American Association for the Advancement of Science (AAAS) today led 75 scientific societies in submitting comments on the US Department of Education's proposed changes to Title IX regulations.

Science/Science Careers' survey ranks top biotech, biopharma, and pharma employers
The Science and Science Careers' 2018 annual Top Employers Survey polled employees in the biotechnology, biopharmaceutical, pharmaceutical, and related industries to determine the 20 best employers in these industries as well as their driving characteristics.

Science in the palm of your hand: How citizen science transforms passive learners
Citizen science projects can engage even children who previously were not interested in science.

Applied science may yield more translational research publications than basic science
While translational research can happen at any stage of the research process, a recent investigation of behavioral and social science research awards granted by the NIH between 2008 and 2014 revealed that applied science yielded a higher volume of translational research publications than basic science, according to a study published May 9, 2018 in the open-access journal PLOS ONE by Xueying Han from the Science and Technology Policy Institute, USA, and colleagues.

Prominent academics, including Salk's Thomas Albright, call for more science in forensic science
Six scientists who recently served on the National Commission on Forensic Science are calling on the scientific community at large to advocate for increased research and financial support of forensic science as well as the introduction of empirical testing requirements to ensure the validity of outcomes.

World Science Forum 2017 Jordan issues Science for Peace Declaration
On behalf of the coordinating organizations responsible for delivering the World Science Forum Jordan, the concluding Science for Peace Declaration issued at the Dead Sea represents a global call for action to science and society to build a future that promises greater equality, security and opportunity for all, and in which science plays an increasingly prominent role as an enabler of fair and sustainable development.

PETA science group promotes animal-free science at society of toxicology conference
The PETA International Science Consortium Ltd. is presenting two posters on animal-free methods for testing inhalation toxicity at the 56th annual Society of Toxicology (SOT) meeting March 12 to 16, 2017, in Baltimore, Maryland.

Citizen Science in the Digital Age: Rhetoric, Science and Public Engagement
James Wynn's timely investigation highlights scientific studies grounded in publicly gathered data and probes the rhetoric these studies employ.

Science/Science Careers' survey ranks top biotech, pharma, and biopharma employers
The Science and Science Careers' 2016 annual Top Employers Survey polled employees in the biotechnology, biopharmaceutical, pharmaceutical, and related industries to determine the 20 best employers in these industries as well as their driving characteristics.

Three natural science professors win TJ Park Science Fellowship
Professor Jung-Min Kee (Department of Chemistry, UNIST), Professor Kyudong Choi (Department of Mathematical Sciences, UNIST), and Professor Kwanpyo Kim (Department of Physics, UNIST) are the recipients of the Cheong-Am (TJ Park) Science Fellowship of the year 2016.

Read More: Science News and Science Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.