title: Outcomes of In-Hospital Cardiopulmonary Resuscitation Among Patients With Cancer.
abstract: OBJECTIVE
  To review all episodes where an emergency code was called in a cancer-specialized hospital in Pakistan and to assess survival to discharge among patients who received a cardiopulmonary resuscitation (CPR).
  
  
  METHODS
  We reviewed demographic and clinical data related to all "code blue" calls over 3 years. Multivariate logistic regression analyses were used to test the association of clinical characteristics with the primary outcome of survival to discharge.
  
  
  RESULTS
  A total of 646 code blue calls were included in the analysis. The CPR was performed in 388 (60%) of these calls. For every 20 episodes of CPR among patients with cancer of all ages, only 1 resulted in a patient's survival to discharge, even though in 52.2% episodes there was a return of spontaneous circulation. No association was found between the type of rhythm at initiation of CPR and likelihood of survival to discharge.
  
  
  CONCLUSIONS
  The proportion of patients with advanced cancer surviving to discharge after in-hospital CPR in a low-income country was in line with the reported international experience. Most patients with cancer who received in-hospital CPR did not survive to discharge and did not appear to benefit from resuscitation. Advance directives by patients with cancer limiting aggressive interventions at end of life and proper documentation of these directives will help in provision of care that is humane and consonant with patients' wishes for a dignified death. Patients' early appreciation of the limited benefits of CPR in advanced cancer is likely to help them formulate such advance directives.
authors.affiliation: 1 Department of Cancer Registry and Clinical Data Management, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan.
authors.forename: Waleed
authors.initials: W
authors.lastname: Zafar
authors.affiliation: 2 Department of Internal Medicine, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan.
authors.forename: Irum
authors.initials: I
authors.lastname: Ghafoor
authors.affiliation: 3 Department of Radiation Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan.
authors.forename: Arif
authors.initials: A
authors.lastname: Jamshed
authors.affiliation: 2 Department of Internal Medicine, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan.
authors.forename: Sabika
authors.initials: S
authors.lastname: Gul
authors.affiliation: 2 Department of Internal Medicine, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan.
authors.forename: Haroon
authors.initials: H
authors.lastname: Hafeez
mesh_terms: D002173:Cancer Care Facilities / Q000706:statistics & numerical data*; D016887:Cardiopulmonary Resuscitation / Q000706:statistics & numerical data*; D003906:Developing Countries; D005260:Female; D006323:Heart Arrest / Q000401:mortality*; D006801:Humans; D007297:Inpatients / Q000706:statistics & numerical data*; D008297:Male; D009369:Neoplasms / Q000401:mortality*; D010154:Pakistan; D016414:Resuscitation Orders; D012959:Socioeconomic Factors; D013727:Terminal Care
keywords: Pakistan; advance directive; cancer; cardiopulmonary resuscitation; code blue; end-of-life care; survival to discharge