Characteristics of cardiac arrest in cancer patients as a predictor of survival after cardiopulmonary resuscitation.
BACKGROUND
Despite advances in cardiopulmonary resuscitation and the education of its providers, survival remains dismal for cancer patients suffering in-hospital cardiac arrest. In an effort to determine if characteristics of cardiac arrest would represent a useful parameter for prognostication and recommendations regarding the suitability of ongoing resuscitation for various groups, this review was undertaken for patients who experienced in-hospital cardiac arrest.


METHODS
A retrospective study of data gathered between January 1993 and December 1997 was undertaken in a 518-bed comprehensive cancer center. The records of 243 inpatients who experienced cardiac arrest and received cardiopulmonary resuscitation were reviewed, and their course observed until hospital discharge or death.


RESULTS
Sixteen of 73 patients (22%) who had sudden, unanticipated cardiac arrests survived to be discharged from the hospital; however, none (0 of 171) of the patients who experienced an anticipated cardiac arrest survived (P < 0.001). Logistic regression analysis revealed that anticipated cardiac arrest associated with metabolic derangement was an independent predictor of hospital mortality.


CONCLUSIONS
Patients experiencing an anticipated cardiac arrest, the course of which could not be interrupted through aggressive management in an intensive care unit, have an extremely poor prognosis. Ongoing resuscitative measures in these patients need not be routinely provided. The authors suggest an algorithm for resuscitation that evaluates the characteristics of the arrest as a prognostic factor. This algorithm should be implemented once progressive deterioration spirals toward cardiac arrest that cannot be prevented. Such an approach should avoid painful and costly interventions that are futile with the present techniques of cardiopulmonary resuscitation.
Ewer
M S
MS
Department of Cardiology, The University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX 77030, USA. mewer@mdanderson.org
Kish
S K
SK
Martin
C G
CG
Price
K J
KJ
Feeley
T W
TW
D000465:Algorithms; D016887:Cardiopulmonary Resuscitation; D006323:Heart Arrest / Q000150:complications* / Q000628:therapy*; D017052:Hospital Mortality; D006801:Humans; D007297:Inpatients; D016015:Logistic Models; D018447:Medical Futility; D009369:Neoplasms / Q000150:complications* / Q000401:mortality*; D011379:Prognosis; D016414:Resuscitation Orders; D012189:Retrospective Studies; D016019:Survival Analysis; D013727:Terminal Care