Characteristics of cardiac arrest in cancer patients as a predictor of survival after cardiopulmonary resuscitation

BACKGROUND. Despite advances in cardiopulmonary resuscitation and the educa tion of its providers, survival remains dismal for cancer patients sufferin g in-hospital cardiac arrest. In an effort to determine if characteristics of cardiac arrest would represent a useful parameter for prognostication an d recommendations regarding the suitability of ongoing resuscitation for va rious groups, this review was undertaken for patients who experienced in-ho spital cardiac arrest. METHODS. A retrospective study of data gathered between January 1993 and De cember 1997 was undertaken in a 518-bed comprehensive cancer center. The re cords of 243 inpatients who experienced cardiac arrest and received cardiop ulmonary resuscitation were reviewed, and their course observed until hospi tal discharge or death. RESULTS. Sixteen of 73 patients (22%) who had sudden, unanticipated cardiac arrests survived to be discharged from the hospital; however, none (0 of 1 71) of the patients who experienced an anticipated cardiac arrest survived (P < 0.001). Logistic regression analysis revealed that anticipated cardiac arrest associated with metabolic derangement was an independent predictor of hospital mortality. CONCLUSIONS. Patients experiencing an anticipated cardiac arrest, the cours e of which could not be interrupted through aggressive management in an int ensive care unit, have an extremely poor prognosis. Ongoing resuscitative m easures in these patients need not be routinely provided. The authors sugge st an algorithm for resuscitation that evaluates the characteristics of the arrest as a prognostic factor. This algorithm should be implemented once p rogressive deterioration spirals toward cardiac arrest that cannot be preve nted. Such an approach should avoid painful and costly interventions that a re futile with the present techniques of cardiopulmonary resuscitation. (C) 2001 American Cancer Society.