Should a cancer patient be resuscitated following an in-hospital cardiac arrest?

Varon, Joseph; Walsh, Garrett L; E. Marik, Paul; Fromm, Robert E

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Volume 36, Issue 3 , Pages 165-168, March 1998

Should a cancer patient be resuscitated following an in-hospital cardiac arrest?

Joseph Varon
- Pulmonary and Critical Care Section, Baylor College of Medicine, Department of Emergency Services, The Methodist Hospital, 6565 Fannin M 196, Houston, TX 77030, USA
- Corresponding author. Tel.: +1 713 7931912; fax: +1 713 7931851; e-mail: jvaron@bcm.tmc.edu
Garrett L Walsh
- Department of Thoracic and Cardiovascular Surgery, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
Paul E. Marik
- Department of Medicine, University of Massachusetts, Medical Intensive Care Unit, St. Vincent Hospital, Worcester, MA 01640, USA
Robert E Fromm
- Pulmonary and Critical Care Section, Baylor College of Medicine, Department of Emergency Services, The Methodist Hospital, 6565 Fannin M 196, Houston, TX 77030, USA
- Cardiology Section, Baylor College of Medicine, Department of Emergency Services, The Methodist Hospital, 6565 Fannin M 196, Houston, TX 77030, USA

Received 17 August 1997; received in revised form 5 December 1997; accepted 5 December 1997.

Abstract

Objective: Previous reports from general hospitals and cancer centers have identified the presence of malignancy as a poor prognostic indicator for successful cardiopulmonary resuscitation (CPR) for an in-hospital cardiac arrest. The purpose of this study was to evaluate the initial success of CPR as determined by return of spontaneous circulation (ROSC), patient survival to hospital discharge, and 1-year survival of this group as compared to previous studies in non-oncological centers. In addition, the charges incurred in caring for these patients were analyzed. Materials and methods: All cardiac arrests occurring between 1 January 1993 and 31 December 1994 were identified from a centralized morbidity and mortality database and reviewed retrospectively. Cardiac arrest was defined as the absence of a palpable pulse and initiation of CPR. Patients suffering pure respiratory arrest or shock without loss of pulse were excluded. Age, gender, primary site of malignancy, initial and ultimate outcome, including Zubrod's functional status (ZFS), and total hospital charges following cardiac arrest were recorded. Computerized billing records were used to tabulate total charges. Results: 83 cardiac arrests occurred during the study period (42 women, 41 men). Mean age was 56.2 years. Forty-two percent of the patients had hematologic malignancies, 19% lung, 15% gastrointestinal, 5% head and neck cancers and 19% other malignancies. Sixty-six percent of the patients had ROSC. Only eight (9.6%) patients survived to hospital discharge: three died within 6 weeks under hospice care, two died within 6 months of discharge and only three (3.6%) patients survived to 1 year. Functional status follow-up of these three patients revealed two with ZFS 1 and one with ZFS 2. Total hospital charges for these 83 patients were US$ 2 959 740. Conclusions: Although ROSC after cardiac arrest in our patients was better than that reported for most series in general hospitals, their ultimate survival and hospital discharge was extremely poor.

Keywords: Cardiopulmonary resuscitation, Cancer, CPR, Health care resources, Outcome