TY - JOUR
T1 - Indicators of Clinical Trajectory in Patients with Cancer Who Receive Cardiopulmonary Resuscitation
AU - Chawla, Sanjay
AU - Gutierrez, Cristina
AU - Rajendram, Prabalini
AU - Seier, Kenneth
AU - Tan, Kay See
AU - Stoudt, Kara
AU - Von-Maszewski, Marian
AU - Morales-Estrella, Jorge L.
AU - Kostelecky, Natalie T.
AU - Voigt, Louis P.
N1 - Funding Information:
Funding: Research reported in this publication was supported in part by the Core Grant under award number P30 CA008748, and by the Department of Anesthesiology and Critical Care Medicine at Memorial Sloan Kettering Cancer Center.
Funding Information:
The authors would like to thank the following contributors for their participation and work in data collection and reviewing individual medical records for indicators: Meaghen Finan, MD; Lisa Canecchia, ACNP; Taylen Richards, BA; Madeleine Hicks, BA; Mary Lou Warren, DNP, RN, CNS-CC; Jason W. Myers, ACNP-BC; Kristen L. Bratcher, ACNP-BC; Jeanne Y. Campbell, MPAS, PA-C; and Virginia V. Schneider, MPAS, PA-C. The authors would also like to thank Marvin Radford at MDACC for sharing the list of all Code Blues in the institution, and the MDACC CPR committee for facilitating access to their database and their continuous work to improve outcomes of our patients. Research reported in this publication was supported in part by the Core Grant under award number P30 CA008748, and by the Department of Anesthesiology and Critical Care Medicine at Memorial Sloan Kettering Cancer Center.
Publisher Copyright:
© 2023 Harborside Press. All rights reserved.
PY - 2023/1
Y1 - 2023/1
N2 - Background: Patients with cancer who require cardiopulmonary resuscitation (CPR) historically have had low survival to hospital discharge; however, overall CPR outcomes and cancer survival have improved. Identifying patients with cancer who are unlikely to survive CPR could guide and improve end-of-life discussions prior to cardiac arrest. Methods: Demographics, clinical variables, and outcomes including immediate and hospital survival for patients with cancer aged $18 years who required in-hospital CPR from 2012 to 2015 were collected. Indicators capturing the overall declining clinical and oncologic trajectory (ie, no further therapeutic options for cancer, recommendation for hospice, or recommendation for do not resuscitate) prior to CPR were determined a priori and manually identified. Results: Of 854 patients with cancer who underwent CPR, the median age was 63 years and 43.6% were female; solid cancers accounted for 60.6% of diagnoses. A recursive partitioning model selected having any indicator of declining trajectory as the most predictive factor in hospital outcome. Of our study group, 249 (29%) patients were found to have at least one indicator identified prior to CPR and only 5 survived to discharge. Patients with an indicator were more likely to die in the hospital and none were alive at 6 months after discharge. These patients were younger (median age, 59 vs 64 years; P#.001), had a higher incidence of metastatic disease (83.0% vs 62.9%; P,.001), and were more likely to undergo CPR in the ICU (55.8% vs 36.5%; P,.001) compared with those without an indicator. Of patients without an indicator, 145 (25%) were discharged alive and half received some form of cancer intervention after CPR. Conclusions: Providers can use easily identifiable indicators to ascertain which patients with cancer are at risk for death despite CPR and are unlikely to survive to discharge. These findings can guide discussions regarding utility of resuscitation and the lack of further cancer interventions even if CPR is successful.
AB - Background: Patients with cancer who require cardiopulmonary resuscitation (CPR) historically have had low survival to hospital discharge; however, overall CPR outcomes and cancer survival have improved. Identifying patients with cancer who are unlikely to survive CPR could guide and improve end-of-life discussions prior to cardiac arrest. Methods: Demographics, clinical variables, and outcomes including immediate and hospital survival for patients with cancer aged $18 years who required in-hospital CPR from 2012 to 2015 were collected. Indicators capturing the overall declining clinical and oncologic trajectory (ie, no further therapeutic options for cancer, recommendation for hospice, or recommendation for do not resuscitate) prior to CPR were determined a priori and manually identified. Results: Of 854 patients with cancer who underwent CPR, the median age was 63 years and 43.6% were female; solid cancers accounted for 60.6% of diagnoses. A recursive partitioning model selected having any indicator of declining trajectory as the most predictive factor in hospital outcome. Of our study group, 249 (29%) patients were found to have at least one indicator identified prior to CPR and only 5 survived to discharge. Patients with an indicator were more likely to die in the hospital and none were alive at 6 months after discharge. These patients were younger (median age, 59 vs 64 years; P#.001), had a higher incidence of metastatic disease (83.0% vs 62.9%; P,.001), and were more likely to undergo CPR in the ICU (55.8% vs 36.5%; P,.001) compared with those without an indicator. Of patients without an indicator, 145 (25%) were discharged alive and half received some form of cancer intervention after CPR. Conclusions: Providers can use easily identifiable indicators to ascertain which patients with cancer are at risk for death despite CPR and are unlikely to survive to discharge. These findings can guide discussions regarding utility of resuscitation and the lack of further cancer interventions even if CPR is successful.
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U2 - 10.6004/jnccn.2022.7072
DO - 10.6004/jnccn.2022.7072
M3 - Article
C2 - 36634611
AN - SCOPUS:85146195402
SN - 1540-1405
VL - 21
SP - 51
EP - 59
JO - JNCCN Journal of the National Comprehensive Cancer Network
JF - JNCCN Journal of the National Comprehensive Cancer Network
IS - 1
ER -