SHOULD A CANCER-PATIENT BE RESUSCITATED FOLLOWING AN IN-HOSPITAL CARDIAC-ARREST

Objective: Previous reports from general hospitals and cancer centers have identified the presence of malignancy as a poor prognostic indica tor for successful cardiopulmonary resuscitation (CPR) for an in-hospi tal cardiac arrest. The purpose of this study was to evaluate the init ial success of CPR as determined by return of spontaneous circulation (ROSC), patient survival to hospital discharge, and I-pear 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 centralize d morbidity and mortality database and reviewed retrospectively. Cardi ac arrest was defined as the absence of a palpable pulse and initiatio n 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 (ZF S), and total hospital charges following cardiac al rest were recorded . Computerized billing records were used to tabulate total charges. Re sults: 83 cardiac arrests occurred during the study period (42 women, 41 men). Mean age was 56.2 years. Forty-two percent of the patients ha d hematologic malignancies, 19% lung, 15% gastrointestinal, 5% head an d neck cancers and 19% other malignancies. Sixty-six percent of the pa tients had ROSC. Only eight (9.6%) patients survived to hospital disch arge: 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 patient s were US$ 2959740, 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 extreme ly poor. (C) 1998 Elsevier Science Ireland Ltd. All rights reserved.