Outcome and cost implications of cardiopulmonary resuscitation in the medical intensive care unit of a comprehensive cancer center.
Intensive care unit (ICU) resources are frequently utilized in the supportive care of hospitalized patients with cancer. Patients with cancer reportedly have poor outcomes from cardiopulmonary resuscitation (CPR). The goal of this study was to evaluate the effectiveness and patient care costs of CPR applied to patients already receiving life support in an ICU. The medical records of patients who developed cardiac arrest and underwent CPR in the ICU of a comprehensive cancer center between 1993 and 2000 were reviewed. ICU charges after the first episode of CPR were analyzed. There were 5,196 admissions to the ICU during this time; 406 (8%) of the patients underwent CPR; 67% had hematologic malignancies or had undergone hematopoietic stem cell transplantation: 256 patients (63%) died at the time of the arrest, and in 150 (37%) spontaneous circulation was restored. There were 104 patients (26%) who survived more than 24 hours but ultimately died during their hospitalization; their mean time to death was 4.3 days (95% confidence interval [CI] 2.9-5.6), and mean ICU charges were $45,877 (95% CI $24,802-$66,952). Seven patients (2%) survived to be discharged. Patients who survived after CPR and were discharged from the hospital were those who had acute ventricular dysrhythmias and were resuscitated promptly. The application of CPR to cancer patients receiving life support is costly and typically does not lead to long-term survival. Cancer patients requiring admission to an ICU should receive full supportive care short of resuscitation. Providing assurances that care will remain appropriate, aggressive, and in accordance with the patient's and family's wishes can optimize compassionate care while avoiding futile life-sustaining interventions.
Department of Medical Informatics, The University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Boulevard, Box 214, Houston, TX 77030, USA. skishwall@mdanderson.org
Susannah  K
S
Wallace
Michael S
MS
Ewer
Kristen J
KJ
Price
Thomas W
TW
Feeley
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016887:Cardiopulmonary Resuscitation / Q000191:economics*; D016009:Chi-Square Distribution; D002648:Child; D016638:Critical Illness; D005260:Female; D017048:Health Care Costs; D006323:Heart Arrest / Q000209:etiology* / Q000401:mortality / Q000628:therapy*; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications* / Q000401:mortality; D017063:Outcome Assessment, Health Care; D016019:Survival Analysis