Source
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.
Abstract
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.