What is the outcome of cancer patients admitted to the ICU after cardiac arrest? Results from a multicenter study.
OBJECTIVE
Low survival rate was previously described after cardiac arrest in cancer patients and may challenge the appropriateness of intensive care unit (ICU) admission after return of spontaneous circulation (ROSC). Objectives of this study were to report outcome and characteristics of cancer patients admitted to the ICU after cardiac arrest.


METHODS
A retrospective chart review in seven medical ICUs in France, in 2002-2012. We studied consecutive patients with malignancies admitted after out-of-hospital cardiac arrest (OHCA) or in-hospital cardiac arrest (IHCA).


RESULTS
Of 133 included patients of whom 61% had solid tumors, 48 (36%) experienced OHCA and 85 (64%) IHCA. Cardiac arrest was related to the malignancy or its treatment in 47% of patients. Therapeutic hypothermia was used in 51 (41%) patients. The ICU mortality rate was 98/133 (74%). Main causes of ICU death were refractory shock or multiple organ failure (n = 64, 48%) and neurological injury (n = 27, 20%); 42 (32%) patients died in ICU after treatment-limitation decisions. Twenty-four (18%) patients were discharged alive from the hospital. Overall 6-month survival rate was 14% (18/133, 95% confidence interval, 8-21%). Survival rates at ICU discharge and after 6 months did not differ significantly across type of malignancy or between the OHCA and IHCA groups, and neither were they significantly different from those in matched controls who had cardiac arrest but no malignancy.


CONCLUSIONS
Even if low, the 6-month survival rate of 14% observed in cancer patients admitted to the ICU after cardiac arrest and ROSC may support the admission of these patients to the ICU and may warrant an initial full-code ICU management.
Medical Intensive Care Unit (ICU), Cochin University Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France; Paris Descartes University, Sorbonne Paris Cité, Paris, France. Electronic address: benoit.champigneulle@cch.aphp.fr.
B
B
Champigneulle
ICU, Mignot Hospital, Versailles, France.
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S
Merceron
Medical ICU, Saint Louis University Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France.
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V
Lemiale
Medical Intensive Care Unit (ICU), Cochin University Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France; Paris Descartes University, Sorbonne Paris Cité, Paris, France; INSERM U970 Sudden Death expertise Center, Paris Cardiovascular Research Center, Paris, France.
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G
Geri
Medical ICU, Paoli Calmette Institute, Marseille, France.
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D
Mokart
ICU, Mignot Hospital, Versailles, France.
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F
Bruneel
Medical ICU, Avicenne University Hospital, Assistance Publique - Hôpitaux de Paris, Bobigny, France.
F
F
Vincent
Medical ICU, Nancy University Hospital, Nancy, France.
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P
Perez
Medical ICU, La Pitié-Salpêtrière University Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France.
J
J
Mayaux
Medical Intensive Care Unit (ICU), Cochin University Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France; Paris Descartes University, Sorbonne Paris Cité, Paris, France; INSERM U970 Sudden Death expertise Center, Paris Cardiovascular Research Center, Paris, France.
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A
Cariou
Medical ICU, Saint Louis University Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France; Paris 7 University, Paris, France.
E
E
Azoulay
D000368:Aged; D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D005260:Female; D005602:France / Q000453:epidemiology; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D007036:Hypothermia, Induced / Q000379:methods; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications* / Q000401:mortality; D058687:Out-of-Hospital Cardiac Arrest / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome
Cancer; Cardiac arrest; Malignancy; Prognosis