The outcome of cancer patients undergoing cardiopulmonary resuscitation in a tertiary cancer center

Purpose: The survival of cancer patients undergoing cardiopulmonary resuscitation has been studied extensively. Previously published resuscitation reports were based largely on data that preceded the patient self-determination act of 1991; most did not distinguish between patients experiencing arrest as a result of metabolic vs. mechanical etiologies. The purpose of this study is to analyze results and survival rates for resuscitated cancer patients, and to offer prognostic considerations based upon whether patients experienced metabolic or mechanical arrests, and on whether the arrest occurred in an intensive care unit (ICU) or on a regular hospital floor. Methods: Resuscitation records and hospital outcomes were reviewed over a five year period. Resuscitation was attempted in 244 patients. The arrests occurred in either an ICU, or on an inpatient bed unit. Survival vs. 1) Metabolic or mechanical etiology, and 2) ICU or non-ICU arrests were analyzed using Fisher's Exact test. Results: Of the 244 patients undergoing resuscitation, 85 (35%) survived the initial event. Seven percent of resuscitated patients were discharged. Patients undergoing initial arrest on inpatient floors were more likely to be discharged than patients who experienced their initial arrest in the ICU (14% vs. 2%, p=.001). Patients with mechanical cardiopulmonary impairment as the cause of arrest had a higher survival than did patients who succumbed from metabolic causes (20% vs. 2%, p<.001). Metabolic causes accounted for 84% of ICU arrests; all were anticipated. Conclusions: Anticipated ICU arrests are mostly metabolic, and carry an unlikely probability of success; continued routine use of resuscitation in that setting is inappropriate. Sudden arrest, or arrest associated with mechanical impairment to ventilation or circulation is associated with a better prognosis, and remains appropriate. Clinical Implications: Appropriate use of resuscitative techniques will reduce patient suffering, help to optimize resource utilization in critical care areas, and reduce healthcare costs.