Outcomes of Cardiopulmonary Resuscitation of Oncologic Patients in Emergency Department (original) (raw)
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BMC Palliative Care, 2019
Background In-hospital cardiopulmonary resuscitation (CPR) is one of undesirable situations. We tried to identify and characterize a potentially avoidable CPR in cancer patients who were hospitalized in hematology and oncology wards. Methods A potentially avoidable CPR was determined based on chemotherapy setting, disease status and clinical situation at the time when a cardiopulmonary arrest occurred, by using a consensus-driven medical records review of two physicians. Results One hundred thirty-seven patients among 12,437 patients hospitalized at hematology and oncology wards between March 2003 and June 2015 (1.1%) underwent a CPR. Eighty-eight patients (64.2%) were men. The majority of patients with a CPR had lung cancer (41, 29.9%), hematologic malignancy (24, 17.5%), stomach cancer (23, 16.8%) or lymphoma (20, 14.6%). A potentially avoidable CPR was identified in 51 patients (37.2%). In a multivariate analysis, advanced diseases and certain tumor types (e.g., lung cancer, lymp...
Impact of Cardiopulmonary Resuscitation on Survival in Cancer Patients
JACC: CardioOncology, 2020
C ancer patients have particularly low rates of return of spontaneous circulation (ROSC) and survival to hospital discharge following cardiopulmonary resuscitation (CPR) compared with non-cancer patients (1). The quality of life at discharge of those who survive after CPR is often diminished, and a significant percentage survive for only a short time following discharge (2). Among survivors, there is a high likelihood of changing their code status to do not resuscitate (DNR) post-cardiac arrest. Although variations in the rates of survival to hospital discharge have been identified in different cancer patient populations (e.g., pediatric vs. adult patients, patients with solid vs. hematological malignancies, patients with metastatic vs. nonmetastatic disease), the use of CPR has largely been indiscriminate (3,4). More efforts are needed to identify the specific cancer patient populations that would benefit in terms of survival to hospital discharge. In our view, there is a need to systematically assess whether the available CPR measures are futile, to avoid potential painful and costly interventions that do not benefit the patient. To help understand this topic, we sought to identify cancer patients with a poor prognosis who might benefit from an early discussion of end-of-life measures and further treatment goals before the occurrence of sudden, unanticipated cardiac arrest. We conducted retrospective analyses of 650 patients (>18 years of age) who experienced in-hospital cardiac arrest between
Journal of the Advanced Practitioner in Oncology, 2021
Purpose: The objective of this study is to describe characteristics and short- and long-term outcomes of patients with hematologic malignancies who received cardiopulmonary resuscitation (CPR). Methods: A retrospective review was conducted of all Code Blues at a large comprehensive cancer center. Demographic, clinical, and outcome variables were analyzed for patients with a hematologic malignancy who underwent CPR. Results: Of 258 patients, 60.1% had leukemia. Outcomes included return of spontaneous circulation (70.2%), hospital survival (12%), and 90-day, 6-month, and 1-year survival rates of 9.8%, 8.2%, and 5.9%, respectively. Factors associated with hospital mortality included establishing a do not resuscitate order after CPR (p < .0001), location of CPR (p = .0004), cause of arrest (p = .0019), requiring vasopressors (p = .0130), mechanical ventilation (p = .0423), and acute renal failure post CPR (p = .0006). Although no difference in hospital survival between leukemia and n...
Predictors of cardiopulmonary arrest outcome in a comprehensive cancer center intensive care unit
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 2013
Background: Some comprehensive cancer centers in industrialized countries have reported improved outcomes in their cardiopulmonary arrest (CPA) patients. Little is known about the outcomes and predictors of CPA in cancer centers in other parts of the world. The objective of this study was to examine the predictors of CPA outcome in a comprehensive cancer center closed medical-surgical intensive care unit (ICU) located in Amman, Jordan. Methods: In this retrospective single-center cohort study, we identified 104 patients who had a CPA during their stay in the ICU between 1/1/2008 and 6/30/2009. Demographic data and CPA-related variables and outcome were extracted from medical records. Comparisons between different variables and CPA outcome were conducted using logistic regression. Results: The mean age of the group was 49.7 ± 15.3 years. The mean APACHE II score was 23.7 ± 8.0. Thirty six patients (34.6%) were resuscitated successfully but 8 of them (7.7% of the cohort) left the ICU alive and only 6 out of the 8 (5.8% of the cohort) left the hospital alive. The following variables predict resuscitation failure: acute kidney injury (OR 1.7, CI: 1.1 -2.6), being on mechanical ventilation (OR 3.8, CI: 1.3 -11), refractory shock (OR 4.7, CI: 1.8 -12) and CPR duration (OR 1.1, CI: 1.1 -1.2). Conclusion: Survival among cancer patients who develop CPA in the ICU continues to be poor. Once cancer patients suffered a CPA in the ICU multiple factors predicted resuscitation failure but CPR duration was the only factor that predicted resuscitation failure and ICU as well as hospital mortality.
Cureus, 2018
Despite cancer being the second most common cause of death in the United States, more people are living longer after the diagnosis of cancer than before. Healthcare workers will be treating an increasing number of patients with cancer. Various studies have identified predictors of cardiac arrest in the general population, however, none have been done to identify such factors in cancer patients who form a more vulnerable group with lower survival rate following cardiac arrest. We retrospectively analysed charts of all patients with active cancer who experienced in-hospital cardiac arrest (IHCA) and underwent cardio-pulmonary resuscitation (CPR) from January 2015 to December 2017 at our hospital (n=44, group A). We compared this group to 44 consecutive patients with active cancer admitted to the oncology unit who did not experience cardiac arrest (n=44, group B). We excluded patients in remission. Both the groups were comparable in terms of age (69 ± 14 vs 68 ± 15, p=0.776) and gender...
European heart journal. Acute cardiovascular care, 2020
Objective: As the prevalence of malignancies in the general population increases, the odds of an out-of-hospital cardiac arrest (OHCA) patient having a history of cancer likewise increases, and the impact on post-cardiac arrest care and mortality is not well known. We aimed to investigate 30-day and 1-year mortality after successful resuscitation in patients with cancer prior to OHCA compared with OHCA patients without a previous cancer diagnosis. Methods: A cohort of 993 consecutive OHCA patients with successful resuscitation during 2007-2011 was included. Vital status was obtained from the Danish Civil Register, and cancer diagnoses from the Danish National Patient Register dating back to 1994. Primary endpoints were 30-day, 1-year and long-term mortality (no cancer: mean 811 days; cancer: mean 406 days), analysed by Cox regression. Functional status assessed by cerebral performance category at discharge and use of post-resuscitation care were secondary endpoints. Results: A total of 119 patients (12%) were diagnosed with cancer prior to OHCA. Mortality was higher in patients with cancer (30-day 69% vs. 58%, P=0.01); however, after adjustment for prognostic factors cancer was no longer associated with higher mortality (hazard ratio (HR) 30 days 0.98, 95% confidence interval (CI) 0.76-1.27, P=0.88; HR 1 year 0.99, 95% CI 0.78-1.27, P=0.96 HR end of follow-up 0.95, 95% CI 0.75-1.20, P=0.67). Favourable cerebral performance category scores in patients alive at discharge did not differ (cerebral performance category 1 or 2 n=310 (84%) vs. n=31 (84%), P=1). Conclusion: Cancer prior to OHCA was not associated with higher mortality in patients successfully resuscitated from OHCA when adjusting for confounders. Cancer prior to OHCA should be used with caution when performing prognostication after OHCA.
Contemporary impacts of a cancer diagnosis on survival following in-hospital cardiac arrest
Resuscitation, 2019
Aim: The objective of this study was to determine whether survival and post-arrest procedural utilization following in-hospital cardiac arrest (IHCA) differ in patients with and without comorbid cancer. Methods: We retrospectively reviewed all adult (age ≥18 years old) hospital admissions complicated by IHCA from 2003-2014 using the National Inpatient Sample (NIS) dataset. Utilizing propensity score matching using age, gender, race, insurance, all hospital level variables, HCUP mortality score, diabetes, hypertension and cardiopulmonary resuscitation use, rates of survival to hospital discharge and post-arrest procedural utilization were compared. Results: From 2003-2014, there were a total of 1,893,768 hospitalizations complicated by IHCA, of which 112,926 occurred in patients with history of cancer. In a propensity matched cohort from 2012 to 2014, those with cancer were less likely to survive the hospitalization (31% vs. 46%, p<0.0001). Following an IHCA, rates of procedural utilization in patients with cancer were significantly less when compared to those without a concurrent malignancy: coronary angiography (4.0% vs. 13.0%), percutaneous coronary intervention (2.2% and 8.0%), targeted temperature management (0.8% vs. 6.0%); p<0.0001 for all comparisons. This patient population was less likely to have acute coronary syndrome (12.6% vs. 27.0%) or congestive heart failure (24.5% vs. 38.2%); p<0.0001 for both comparisons. Survival improved in both groups over the study period (p<0.0001). Conclusions: Patients with a history of cancer who sustain IHCA are less likely to receive postarrest procedures and survive to hospital discharge. Given the expected rise in the rates of cancer survivorship, these findings highlight the need for broader application of potentially life-saving interventions to lower risk cancer patients who have sustained a cardiac arrest.
Out-of-hospital cardiopulmonary resuscitation in cancer patients: An observational cohort study
Resuscitation, 2013
Objective: To evaluate the effectiveness, the safety, and the practicability of the new automated load-distributing band resuscitation device AutoPulse TM in out-ofhospital cardiac arrest in the midsized urban emergency service of Bonn city. Study design: Prospective, observational study. Methods: Measurements of effectiveness were the proportion of patients with a return of spontaneous circulation (ROSC) and end-tidal carbon-dioxide (etCO 2 ) values during cardiopulmonary resuscitation (CPR). The indications of safety was the proportion of injuries caused by the device, and practicability was assessed by the measurement of the time taken to setup the AutoPulse TM . Results: Forty-six patients were resuscitated with the device from September 2004 to May 2005. In 25 patients (54.3%) ROSC was achieved, 18 patients (39.1%) were admitted to intensive care unit (ICU), and 10 patients (21.8%) were discharged from ICU. End-tidal capnography showed significantly higher etCO 2 values in patients with ROSC than in patients without ROSC. The mean time to setup the AutoPulse TM was 4.7 ± 5.9 min, but activation of the device after arrival at the scene in 2 min or less was possible in 67.4%. No injuries were detected after use of the AutoPulse TM -CPR. Conclusion: The AutoPulse TM system is an effective and safe mechanical CPR device useful in out-of-hospital cardiac arrest CPR. Automated CPR devices may play an increasingly important role in CPR in the future because they assure continuous chest compressions of a constant quality.
Views of cancer patients regarding cardiopulmonary resuscitation in Greece
European Journal of Cancer Care, 2018
Cancer is a major cause of death worldwide accounting for about 8.8 million deaths in 2015 according to the World Health Organization (World Health Organization, 2017). Although modern oncology treatments have greatly increased survival, a lot of patients with cancer still reach a palliative phase of their disease. Physicians commonly face ethical dilemmas concerning end-of-life (EOL) decisions in patients with cancer; one of these is whether these patients are candidates for cardiopulmonary resuscitation (CPR) or not in case of cardiac arrest. Survival of patients with cancer after CPR has not changed in recent years and current data indicate that patients with cancer undergoing in-hospital CPR have poorer chances to survive to hospital discharge than non-cancer patients (Ebell & Afonso, 2011;