Outcome of cardiopulmonary resuscitation in cancer patients admitted to an intensive care unit in a tertiary cancer center

Purpose: Once cancer patients are critically ill and develop an in-hospital cardiac arrest, the likelihood of survival to hospital discharge is small. The purpose of this study was to analyze the outcome of patients resuscitated in the medical intensive care unit (MICU) of a tertiary cancer center and make recommendations regarding the appropriateness of cardiopulmonary resuscitation (CPR) in these patients. Methods: Patients who underwent CPR following cardiac arrest in the MICU between January 1993 to December 1997 at The University of Texas M. D. Anderson Cancer Center were identified from resuscitation records. Cardiac arrest was defined by loss of palpable pulse. Patients who had respiratory arrest, seizures, or hypotension without loss of pulse were excluded. Demographic, malignancy, and outcome data were obtained from patient medical records. Descriptive statistics were used to summarize the data and describe the patients. Results: 144 MICU patients received CPR following cardiac arrest during the study interval. The majority of patients had leukemia (44%) and solid tumor malignancies (31%). Initially, 53 (37%) patients had restoration of spontaneous circulation, however only one (0.7%) patient survived to be discharged home. The patient who survived had an unexpected acute ventricular dysrhythmia and was resuscitated promptly. Conclusions: Once the patient with cancer becomes critically ill and develops a cardiac arrest, the chances of survival are poor. Cancer patients requiring admission to an MICU should receive full supportive care up to the point of being treated with cardiac compressions. Clinical Implications: Realistic outcome data can be presented to patients and families regarding the near futility of resuscitation. Assurances that care short of resuscitation will remain appropriate, aggressive, and in accordance with their wishes may optimize compassionate care while avoiding compromise of potentially life-sustaining interventions.