CPR, ACLS, BLS

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

7. SPECIAL CONSIDERATIONS
Cardiac Arrest During Hemodialysis

8. Hala! Wala na
may heart beat.
CODE BLUE!
CODE BLUE!

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

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

15. Hypoxia
Hypovolaemia
Hypo-/ hyperkalaemia/
metabolic
Hypothermia/
hyperthermia
TREAT REVERSIBLE CAUSES

16. Thrombosis – coronary
or pulmonary
Tension pneumothorax
Tamponade – cardiac
Toxins

17. • Ultrasound imaging
• Mechanical chest compressions to
facilitate transfer/treatment
• Coronary angiography and
percutaneous coronary intervention
• Extracorporeal CPR
CONSIDER

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

19. MODIFICATIONS TO
CARDIOPULMONARY
RESUSCITATION
Cardiac Arrest During Hemodialysis

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)

25. POST
RESUSCITATION
CARE
Cardiac Arrest During Hemodialysis

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

27. 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