Jessica P Hwang1, John Patlan, Sofia de Achaval, Carmen P Escalante. 1. Department of General Internal Medicine, Ambulatory Treatment and Emergency Care, The University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Boulevard, P.O. Box 301402, Houston, TX 77030-1402, USA. jphwang@mdanderson.org
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.
BACKGROUND: The survival of cancerpatients who undergo cardiopulmonary resuscitation (CPR) after in-hospital cardiac arrest is poor. The survival of cancerpatients 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 cancerpatients 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 cancerpatients nearing the end of life.
Authors: Gary M Reisfield; Susannah Kish Wallace; Mark F Munsell; Fern J Webb; Edgar R Alvarez; George R Wilson Journal: Resuscitation Date: 2006-09-20 Impact factor: 5.262
Authors: R O Cummins; D A Chamberlain; N S Abramson; M Allen; P J Baskett; L Becker; L Bossaert; H H Delooz; W F Dick; M S Eisenberg Journal: Circulation Date: 1991-08 Impact factor: 29.690
Authors: N Sikich; S Baidobonsoo; V Costa; C Hulobowich; K Kaulback; I Nevis; S Sehatzadeh; N Sikich; L Levin; B Pham; M Krahn Journal: Ont Health Technol Assess Ser Date: 2014-12-01