Treatment and prevention of sudden cardiac arrest in dialysis patients
- Charles A Herzog, MD
Charles A Herzog, MD
- Professor of Medicine
- Hennepin County Medical Center/University of Minnesota
- J Michael Mangrum, MD
J Michael Mangrum, MD
- Associate Professor of Medicine
- University of Virginia
- Rod Passman, MD, MSCE
Rod Passman, MD, MSCE
- Professor of Medicine
- Northwestern University Feinberg School of Medicine
Dialysis patients are at extraordinarily high risk for death. In 2011, the annual mortality rate for prevalent United States dialysis patients was 198 deaths/1000 patient-years .
Cardiac disease is the major cause of death, accounting for approximately 40 percent of all-cause mortality in dialysis patients . In the United States Renal Data System (USRDS) database, the single, largest, specific cause of death is attributed to arrhythmic mechanisms or sudden cardiac arrest (SCA) [1,2]. (See "Patient survival and maintenance dialysis".)
In the past, the term sudden cardiac death (SCD) has been used, even if a patient was successfully resuscitated. Such cases have been referred to as "aborted SCD" or "resuscitated SCD," and patients who experienced such events were said to be "sudden death survivors." Clearer and more rational definitions of SCA and SCD were proposed in 2006 by the American College of Cardiology/American Heart Association/Heart Rhythm Society (ACC/AHA/HRS) :
"[Sudden] cardiac arrest is the sudden cessation of cardiac activity so that the victim becomes unresponsive, with no normal breathing and no signs of circulation. If corrective measures are not taken rapidly, this condition progresses to sudden death. Cardiac arrest should be used to signify an event as described above, that is reversed, usually by CPR and/or defibrillation or cardioversion, or cardiac pacing. Sudden cardiac death should not be used to describe events that are not fatal."
Throughout this topic review, we will use the terms "SCA" and "SCD" as defined in the 2006 ACC/AHA/HRS document.
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- Linda Becker, personal communication.
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- External defibrillators in the dialysis unit
- General measures unique to dialysis patients
- - Dialysate composition
- - Nocturnal hemodialysis
- - Use of specific medications
- SECONDARY PREVENTION
- Implantable cardioverter-defibrillator
- - Sudden cardiac arrest during hemodialysis session
- - Issues in implantable cardioverter-defibrillator placement
- PRIMARY PREVENTION
- Heart failure
- - Medical therapy
- - Implantable defibrillators
- - Wearable cardioverter-defibrillator
- Post-myocardial infarction
- - Medical therapy
- - Implantable cardioverter-defibrillator
- - Wearable cardioverter-defibrillator
- SUMMARY AND RECOMMENDATIONS