Abstract
Background
The survival of cancer patients who undergo cardiopulmonary resuscitation (CPR) after in-hospital cardiac arrest is poor. The survival of cancer patients who undergo CPR after out-of-hospital cardiac arrest is unknown. We sought to determine survival rates in such patients and to identify phrases in patient charts that might have prompted end-of-life discussions.
Methods
We performed a retrospective review of patients who had CPR in our Emergency Center after out-of-hospital cardiac arrest in 2000–2002, including an in-depth chart review of outpatient clinic visits by these patients in the 3 months preceding cardiac arrest.
Results
Of the 41 patients who had CPR in the Emergency Center, 18 (43%) had return of spontaneous circulation and were admitted to the intensive care unit (ICU). Seven patients were subsequently discharged alive to another facility. Only two (4.9%) of the 41 patients in our series were discharged alive to their home. More than half of the study patients had at least one clinic note that mentioned “disease progression” (n = 23), 44% mentioned “poor prognosis” (n = 18), and 27% mentioned “poor response” (n = 11).
Conclusions
Survival of cancer patients who underwent CPR after out-of-hospital cardiac arrest was poor. Medical providers should consider discussing end-of-life issues, including out-of-hospital do-not-resuscitate orders, in the outpatient clinic setting with cancer patients nearing the end of life.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Anonymous AC (1999) Medical futility in end-of-life care: report of the council on ethical and judicial affairs. JAMA 281:937–941. doi:10.1001/jama.281.10.937 see comment
Carew HT, Zhang W, Rea TD, Carew HT, Zhang W, Rea TD (2007) Chronic health conditions and survival after out-of-hospital ventricular fibrillation cardiac arrest. Heart 93:728–731. doi:10.1136/hrt.2006.103895
City of Houston (access date August 2008) Houston Fire Department Emergency Medical Services. http://www.houstontx.gov/fire/divisions/ems.html
Cummins RO, Chamberlain DA, Abramson NS, Allen M, Baskett PJ, Leo Bossaert LB, Delooz HH, Dick WF, Eisenberg MS, Evans TR, Holmberg S, Kerber R, Mullie A, Ornato JP, Sandoe E, Skulberg A, Tunstall-Pedoe H, Ra S, Thies WH (1991) Recommended guidelines for uniform reporting of data from out-of-hospital cardiac arrest: the Utstein style. A statement for health professionals from a task force of the American Heart Association, the European Resuscitation Council, the Heart and Stroke Foundation of Canada, and the Australian Resuscitation Council. Circulation 84:960–975
Ebell MH, Becker LA, Barry HC, Hagen M (1998) Survival after in-hospital cardiopulmonary resuscitation. A meta-analysis. J Gen Intern Med 13:805–816. doi:10.1046/j.1525-1497.1998.00244.x
Eliott J, Olver I, Eliott J, Olver I (2008) Choosing between life and death: patient and family perceptions of the decision not to resuscitate the terminally ill cancer patient. Bioethics 22:179–189. doi:10.1111/j.1467-8519.2007.00620.x
Eliott JA, Olver IN, Eliott JA, Olver IN (2003) Legitimating do-not-resuscitate orders: a discursive study of cancer patients' speech. J Palliat Care 19:100–106
Ewer MS, Kish SK, Martin CG, Price KJ, Feeley TW (2001) Characteristics of cardiac arrest in cancer patients as a predictor of survival after cardiopulmonary resuscitation. Cancer 92:1905–1912. doi:10.1002/1097-0142(20011001) 92:7<1905::AID-CNCR1708>3.0.CO;2-6
Gates RA, Weaver MJ, Gates RH (1993) Patient acceptance of an information sheet about cardiopulmonary resuscitation options. J Gen Intern Med 8:679–682. doi:10.1007/BF02598286
Groeger JS, Lemeshow S, Price K, Nierman DM, White P Jr, Klar J, Granovsky S, Horak D, Kish SK, Groeger JS, Lemeshow S, Price K, Nierman DM, White P Jr, Klar J, Granovsky S, Horak D, Kish SK (1998) Multicenter outcome study of cancer patients admitted to the intensive care unit: a probability of mortality model. J Clin Oncol 16:761–770
Haidet P, Hamel MB, Davis RB, Wenger N, Reding D, Kussin PS, Connors AF Jr, Lynn J, Weeks JC, Phillips RS (1998) Outcomes, preferences for resuscitation, and physician–patient communication among patients with metastatic colorectal cancer. Support Investigators. Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments. Am J Med 105:222–229. doi:10.1016/S0002-9343(98)00242-3
Heyland DK, Frank C, Groll D, Pichora D, Dodek P, Rocker G, Gafni A, Heyland DK, Frank C, Groll D, Pichora D, Dodek P, Rocker G, Gafni A (2006) Understanding cardiopulmonary resuscitation decision making: perspectives of seriously ill hospitalized patients and family members. Chest 130:419–428. doi:10.1378/chest.130.2.419
Holler NG, Mantoni T, Nielsen SL, Lippert F, Rasmussen LS, Holler NG, Mantoni T, Nielsen SL, Lippert F, Rasmussen LS (2007) Long-term survival after out-of-hospital cardiac arrest. Resuscitation 75:23–28. doi:10.1016/j.resuscitation.2007.03.015
Hwang JP, Smith ML, Flamm AL, Hwang JP, Smith ML, Flamm AL (2004) Challenges in outpatient end-of-life care: wishes to avoid resuscitation. J Clin Oncol 22:4643–4645. doi:10.1200/JCO.2004.01.043
Lombardi G, Gallagher J, Gennis P (1994) Outcome of out-of-hospital cardiac arrest in New York City. The Pre-Hospital Arrest Survival Evaluation (PHASE) Study. JAMA 271:678–683. doi:10.1001/jama.271.9.678 see comment
Murphy DJ, Murray AM, Robinson BE, Campion EW (1989) Outcomes of cardiopulmonary resuscitation in the elderly. Ann Intern Med 111:199–205 see comment
Olver IN, Eliott JA, Blake-Mortimer J (2002) Cancer patients' perceptions of do not resuscitate orders. Psychooncology 11:181–187. doi:10.1002/pon.558
Pentz RD, Lenzi R, Holmes F, Khan MM, Verschraegen C, Pentz RD, Lenzi R, Holmes F, Khan MM, Verschraegen C (2002) Discussion of the do-not-resuscitate order: a pilot study of perceptions of patients with refractory cancer. Support Care Cancer 10:573–578. doi:10.1007/s00520-002-0374-z
Reichner CA, Thompson JA, O'Brien S, Kuru T, Anderson ED, Reichner CA, Thompson JA, O'Brien S, Kuru T, Anderson ED (2006) Outcome and code status of lung cancer patients admitted to the medical ICU. Chest 130:719–723. doi:10.1378/chest.130.3.719
Reisfield GM, Wallace SK, Munsell MF, Webb FJ, Alvarez ER, Wilson GR (2006) Survival in cancer patients undergoing in-hospital cardiopulmonary resuscitation: a meta-analysis. Resuscitation 71:152–160. doi:10.1016/j.resuscitation.2006.02.022
Varon J, Marik PE, Varon J, Marik PE (2007) Cardiopulmonary resuscitation in patients with cancer. Am J Hosp Palliat Care 24:224–229. doi:10.1177/1049909107301485
Vitelli CE, Cooper K, Rogatko A, Brennan MF, Vitelli CE, Cooper K, Rogatko A, Brennan MF (1991) Cardiopulmonary resuscitation and the patient with cancer. J Clin Oncol 9:111–115
Acknowledgements
The authors thank Gary Deng MD, PhD for initiating this project, Sijin Wen and Tongyao Liu for data management, Sunay Ravindra and Peyton Moon for data entry, and Stephanie Deming for editorial assistance.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Hwang, J.P., Patlan, J., de Achaval, S. et al. Survival in cancer patients after out-of-hospital cardiac arrest. Support Care Cancer 18, 51–55 (2010). https://doi.org/10.1007/s00520-009-0629-z
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00520-009-0629-z