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Resuscitation outcomes in patients with cancer: experience in a large urban cancer centre

Issues de la réanimation chez la patientèle atteinte de cancer : expérience dans un grand centre urbain de cancérologie

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Canadian Journal of Anesthesia/Journal canadien d'anesthésie Aims and scope Submit manuscript

Abstract

Purpose

Hospitalized patients with cancer who experience cardiopulmonary arrest have historically low survival rates. This retrospective cohort study describes outcomes of patients at a large Canadian cancer centre who had a “code medical emergency” activated, and the use of pragmatic criteria to identify patients with poor survival following resuscitation.

Methods

We included hospitalized patients with cancer who had a “code blue” activated between January 2007 and December 2018. Our primary outcome was intensive care unit (ICU) mortality. We developed pragmatic criteria to identify patients with “poor prognosis” for survival from cardiopulmonary resuscitation (CPR) based on disease status and candidacy for further cancer treatment. We used descriptive statistics to analyze the outcomes of poor prognosis patients.

Results

Two hundred and twenty-five patients had a code blue activated. The median age was 61 yr, 52% were male, and 48% had a solid tumour. Overall, 173/225 (77%) patients survived the code blue; 164 were admitted to the ICU, where 49% (81/164) died; 31% survived to hospital discharge; and 16% (n = 27) were alive at one year. One hundred and twenty out of 225 (53%) required chest compressions; spontaneous circulation returned in 61% (73/120), and 12% (14/120) survived to hospital discharge. Patients meeting “poor prognosis” criteria (114, 51%) were more likely to die in the ICU (64% vs 35%; P < 0.001) or in hospital (86% vs 59%; P < 0.001), and more often had goals-of-care discussions prior to the code blue (46% vs 7%; P < 0.001). At one year, only 2% of poor prognosis patients were alive, compared with 24% of patients who did not meet any poor prognosis criteria.

Conclusion

Hospitalized patients with cancer requiring CPR have poor hospital and long-term outcomes. The proposed set of pragmatic criteria may be useful to identify patients unlikely to benefit from CPR and life support, to trigger early goals of care discussions, and to avoid potentially goal-discordant interventions.

Résumé

Objectif

Les patient·es hospitalisé·es atteint·es d’un cancer qui subissent un arrêt cardiorespiratoire ont des taux de survie historiquement bas. Cette étude de cohorte rétrospective décrit les issues des patient·es d’un grand centre canadien de cancérologie pour qui un « code d’urgence médicale » a été activé et l’utilisation de critères pragmatiques pour identifier les patient·es ayant une faible survie après réanimation.

Méthode

Nous avons inclus les personnes hospitalisées atteintes d’un cancer pour qui un « code bleu » avait été activé entre janvier 2007 et décembre 2018. Notre critère d’évaluation principal était la mortalité à l’unité de soins intensifs (USI). Nous avons développé des critères pragmatiques pour identifier les personnes ayant un « mauvais pronostic » de survie à la réanimation cardiorespiratoire (RCR) en fonction de l’état de la maladie et de leur éligibilité à un traitement ultérieur contre le cancer. Nous avons utilisé des statistiques descriptives pour analyser les issues des patient·es ayant un mauvais pronostic.

Résultats

Un code bleu a été activé pour deux cent vingt-cinq patient·es. L’âge médian était de 61 ans, 52 % étaient des hommes et 48 % avaient une tumeur solide. Dans l’ensemble, 173/225 (77 %) patient·es ont survécu au code bleu; 164 ont été admis·es aux soins intensifs, où 49 % (81/164) sont décédé·es; 31 % ont survécu jusqu’à leur congé de l’hôpital; et 16 % (n = 27) étaient en vie après un an. Cent vingt sur 225 (53 %) ont nécessité des compressions thoraciques; la circulation spontanée est revenue chez 61 % (73/120), et 12 % (14/120) ont survécu jusqu’à leur congé de l’hôpital. Les patient·es répondant aux critères de « mauvais pronostic » (114, 51 %) étaient plus susceptibles de mourir à l’USI (64 % vs 35 %; P < 0,001) ou à l’hôpital (86 % vs 59 %; P < 0,001) et avaient plus souvent eu des discussions sur les objectifs de soins avant l’activation du code bleu (46 % vs 7 %; P < 0,001). À un an, seulement 2 % des patient·es ayant un mauvais pronostic étaient en vie, contre 24 % des patient·es qui ne présentaient aucun critère de mauvais pronostic.

Conclusion

Les personnes hospitalisées atteintes d’un cancer nécessitant une RCR ont de mauvaises issues intra-hospitalières et à plus long terme. L’ensemble de critères pragmatiques proposé peut être utile pour identifier la patientèle peu susceptible de bénéficier de la RCR et du maintien des fonctions vitales, pour amorcer rapidement des discussions sur les objectifs de soins et pour éviter les interventions potentiellement discordantes par rapport à ces objectifs.

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Author contributions

Sangeeta Mehta, Laveena Munshi, and Santhosh Thyagu contributed to the study conception and design. Material was prepared by Sumesh Shah. Data were collected and analyzed by Sabrina H. M. Yeung and Ramy Boles. Data were collected by Sarah Seedon and Mobolaji Moore. The first draft of the manuscript was written by Sabrina H. M. Yeung and Ramy Boles and all authors commented on previous versions of the manuscript.

Disclosures

None.

Funding statement

No funding received.

Prior conference presentations

Critical Care Canada Forum 2019 (Toronto, ON, Canada; 10–13 November 2019); Can J Anesth 2020; 67: S135–6; https://doi.org/10.1007/s12630-019-01552-z

Editorial responsibility

This submission was handled by Dr. Patricia S. Fontela, Associate Editor, Canadian Journal of Anesthesia/Journal canadien d’anesthésie.

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Author notes

  1. Sabrina H. M. Yeung and Ramy Boles contributed equally to this study and are co-first authors.

Authors and Affiliations

  1. Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada

    Sabrina H. M. Yeung MD & Ramy Boles MD

  2. Department of Medicine, Sinai Health System, Interdepartmental Division of Critical Care Medicine, University of Toronto, 600 University Avenue Suite 18-216, Toronto, ON, M5G 1X5, Canada

    Laveena Munshi MD, Mobolaji Moore BDS, Sarah Seedon MBBS, Sumesh Shah CCRP & Sangeeta Mehta MD, FRCPC

  3. Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada

    Santhosh Thyagu MD

  4. Department of Medicine, University of Toronto, Toronto, ON, Canada

    Santhosh Thyagu MD

Authors
  1. Sabrina H. M. Yeung MD
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Correspondence to Sangeeta Mehta MD, FRCPC.

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Yeung, S.H.M., Boles, R., Munshi, L. et al. Resuscitation outcomes in patients with cancer: experience in a large urban cancer centre. Can J Anesth/J Can Anesth 70, 1234–1243 (2023). https://doi.org/10.1007/s12630-023-02505-3

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