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Inhospital cardiopulmonary resuscitation of cancer patients: is it worthwhile?
Critical Care volume 8, Article number: P299 (2004)
To determine whether inhospital cardiopulmonary resuscitation (CPR) of cancer patients is worthwhile.
Data of all inhospital cardiac/respiratory arrests from December 2002 to September 2003, in a 550-bed tertiary cancer care center, were prospectively recorded using the Utstein template. A panel of three expert oncologists independently reviewed the medical records of these patients and grouped them according to their disease status by a majority view as follows: group I, patients whose disease status was being assessed; group II, patients who received treatment to achieve cure or disease control; group III, no treatment options offered except palliative care. These data were retrospectively analysed with respect to the following outcomes: return of spontaneous circulation (ROSC), survival on hospital discharge (SOHD), cerebral performance criteria (CPC) (scale 1–5: 1, good and 5, coma) and survival after arrest (recorded on 1 December 2003).
There were 85 arrests, 71(84%) cardiac and 14 (16%) respiratory arrests: 11 patients (13%) in Group I, 45 (53%) in group II and 29 (34%) in group III. There was a difference of opinion in grouping 15 patients (18%), in whom a majority opinion was taken. Sixty-five patients (77%) were male and 20 (23%) female with a mean age of 46.6 ± 18.9 (2–85) years. Eighty-four patients were resuscitated, 33 (39%) patients had sustained ROSC. Twenty-four (28%) of these patients had SOHD (three [3.52%] in group I, 21 [24.7%] in group II, 0 in group III; P < 0.001). Twenty-one (24.7%) patients, two (2.4%) patients and one (1.2%) patient had good, moderate and poor CPC, respectively. On 1 December 2003, eight patients (9.4%) (one [1.2%] in group I and seven [8.2%] in group II) were alive. The mean survival after discharge was 23.4 ± 68.4 (0–356) in those who died and 206.8 ± 101.2 (82–351) in survivors. Nineteen patients (22.4%) had a 1-month survival, eight patients (9.4%) had a 6-month survival. None of the patients labeled by even one expert as group III had SOHD.
Resuscitation of cancer patients is worthwhile. However, outcome in advanced cases (group III) is poor. Although oncologists are not always unanimous in grouping, those patients labeled even once as group III will not benefit from CPR
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Myatra, S., Divatia, J. & Pathan, H. Inhospital cardiopulmonary resuscitation of cancer patients: is it worthwhile?. Crit Care 8 (Suppl 1), P299 (2004). https://doi.org/10.1186/cc2766