Survival in cancer patients after out-of-hospital cardiac arrest.
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.
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
Jessica P
JP
Hwang
John
J
Patlan
Sofia
S
de Achaval
Carmen P
CP
Escalante
D000328:Adult; D032722:Advance Care Planning; D000368:Aged; D000369:Aged, 80 and over; D016887:Cardiopulmonary Resuscitation / Q000401:mortality*; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications / Q000401:mortality*; D058687:Out-of-Hospital Cardiac Arrest / Q000209:etiology / Q000401:mortality*; D016414:Resuscitation Orders; D012189:Retrospective Studies; D015996:Survival Rate; D013781:Texas