Work

Impact of Cardiopulmonary Resuscitation on Survival in Cancer Patients

Year: 2020

Type: editorial

Abstract: C ancer patients have particularly low rates of return of spontaneous circulation (ROSC) and survival to hospital discharge following cardiopulmonary resuscitation (CPR) compared with non-cancer patients (1).The quality of life at discharge of those who survive after CPR is often diminished, and a significant percentage survive for only a short time following discharge (2).Among survivors, there is a high likelihood of changing their code status to do not resuscitate (DNR) post-cardiac arrest.Although variations in the rates of survival to hospital discharge have been identified in different cancer patient populations (e.g., pediatric vs. adult patients, patients with solid vs. hematological malignancies, patients with metastatic vs. nonmetastatic disease), the use of CPR has largely been indiscriminate (3,4).More efforts are needed to identify the specific cancer patient populations that would benefit in terms of survival to hospital discharge.In our view, there is a need to systematically assess whether the available CPR measures are futile, to avoid potential painful and costly interventions that do not benefit the patient.To help understand this topic, we sought to identify cancer patients with a poor prognosis who might benefit from an early discussion of end-of-life measures and further treatment goals before the occurrence of sudden, unanticipated cardiac arrest.We conducted retrospective analyses of 650 patients (>18 years of age) who experienced in-hospital cardiac arrest between January 2011 and December 2015 at The University of Texas MD Anderson Cancer Center, Houston, Texas.Cardiac arrest was defined by the presence of hemodynamically unstable cardiac rhythm (ventricular tachycardia, ventricular fibrillation, cardiac asystole, or pulseless electrical activity).The patients were identified by using a CPR database provided by ZOLL Medical Corporation (Chelmsford, Massachusetts).The study protocol was approved by the local institutional review board.Patients were excluded from the study if they did not have a cancer diagnosis or if they did not experience cardiac arrest.The patients' pre-cardiac arrest clinical characteristics (age, sex, type of malignancy, and cardiovascular risk factors such as history of smoking, hypertension, hyperlipidemia, and cardiovascular disease) were reviewed.CPR was considered effective if it met the 2015 American Heart Association recommendations for compression rate (100 to 120 compressions/min), depth (2.0 to 2.4 cm), and fraction (60% to 80%).All CPR team members were trained and certified in advanced cardiac life support techniques.Real-time measurements of the average

Source: JACC CardioOncology

DOI: 10.1016/j.jaccao.2020.03.003