Relevance of a cardiac arrest team in an Indian cancer hospital ICU

Introduction

Cardiopulmonary resuscitation (CPR) after cardiac arrest in cancer patients is often discouraged as it is associated with very poor outcomes. In our 560-bed tertiary cancer hospital in Mumbai, India, the ICU runs a cardiac arrest team (CAT). We reviewed our data to determine outcomes in our patients and whether it is justified to continue the CAT.

Methods

All inhospital patients from June 2005 to July 2007 with unanticipated cardiorespiratory arrests and other emergencies for whom the CAT was called were included. Data were recorded using the Utstein template. Patients with anticipated progression towards arrest, and those with seizures, hypotension without dysarrythmias or dysarrythmias without hypotension, were excluded. The outcome studied was survival on hospital discharge (SOHD). Binary logistic regression analysis was performed to determine factors associated with SOHD.

Results

Three hundred and sixty patients (227 males, 133 females, mean age 45.2 ± 18.3 years) were studied. The mean time interval between collapse and onset of resuscitation was 2.3 ± 2.1 minutes. The overall SOHD was 25.3%. Sixteen out of 244 patients (6.6%) with cardiac arrest and 75/116 (64.7%) patients with respiratory arrest or other emergencies had SOHD. The initial rhythm recorded during CPR was asystole in 189 patients, pulseless electrical activity in 31 patients and ventricular fibrillation/tachycardia in 24 patients, while 116 patients had other rhythms. SOHD for these rhythms was 1.6%, 3.2%, 54% and 65.6%, respectively. Cardiac arrest in medical oncology patients was associated with significantly worse SOHD than in other patients (3/117, 2.6% vs 13/127, 10.1%, P = 0.02). On univariate analysis, the age, medical oncology admission and monitored arrest were not associated with SOHD. On multivariate analysis, only asystole (OR = 97.5, 95% CI = 29.0–327.5) and time to resuscitation (OR = 1.4, 95% CI = 1.17–1.67) were significantly associated with mortality (P < 0.000), while witnessed arrest and cardiac arrest were not.

Conclusion

The overall survival was 25.3%. Nearly one-third of patients suffer from respiratory arrest or other emergencies with good (64.7%) SOHD. A reduced response time is associated with improved SOHD. These considerations justify the presence of a CAT in our cancer hospital. Asystolic patients should not be resuscitated.