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.
Hwang
Jessica P
JP
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
Patlan
John
J
de Achaval
Sofia
S
Escalante
Carmen P
CP
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