Abstract
BackgroundIn-hospital cardiopulmonary resuscitation (CPR) is one of undesirable situations. We tried to identify and characterize a potentially avoidable CPR in cancer patients who were hospitalized in hematology and oncology wards.MethodsA potentially avoidable CPR was determined based on chemotherapy setting, disease status and clinical situation at the time when a cardiopulmonary arrest occurred, by using a consensus-driven medical records review of two physicians.ResultsOne hundred thirty-seven patients among 12,437 patients hospitalized at hematology and oncology wards between March 2003 and June 2015 (1.1%) underwent a CPR. Eighty-eight patients (64.2%) were men. The majority of patients with a CPR had lung cancer (41, 29.9%), hematologic malignancy (24, 17.5%), stomach cancer (23, 16.8%) or lymphoma (20, 14.6%). A potentially avoidable CPR was identified in 51 patients (37.2%). In a multivariate analysis, advanced diseases and certain tumor types (e.g., lung cancer, lymphoma) were significant risk factors for a potentially avoidable CPR. Of patients who received a potentially avoidable CPR, 29 patients (56.9%) did not have a do-not-resuscitate documentation. A first return of spontaneous circulation rate (ROSC) and in-hospital survival rate (IHSR) were much lower in patients with a potentially avoidable CPR than those with a CPR that was not avoidable (ROSC: 39.2% vs 53.5%, P = 0.106; IHSR: 2.0% vs 12.8%, P = 0.032, respectively).ConclusionsA potentially avoidable CPR was common at hematology and oncology wards. A potentially avoidable CPR frequently occurred in advanced diseases and certain tumor types. Furthermore, cancer patients who received a potentially avoidable CPR showed the worse prognosis.
Highlights
In-hospital cardiopulmonary resuscitation (CPR) is one of undesirable situations
Patients’ characteristics There were 12,437 cancer patients hospitalized in the hematology and oncology wards at Seoul National
CPR cardiopulmonary resuscitation, DNR do-not-resuscitate aOf patients with the potentially avoidable CPR, bOf patients who provided. In this present study, 137 patients (1.1%) of all hospitalized patients during the study period received a CPR. Among these 137 patients, a potentially avoidable CPR was identified in 37.2% patients
Summary
In-hospital cardiopulmonary resuscitation (CPR) is one of undesirable situations. We tried to identify and characterize a potentially avoidable CPR in cancer patients who were hospitalized in hematology and oncology wards. In-hospital cardiopulmonary arrest is one of the most undesirable events in caring for patients. Patients who underwent an early palliative care including advanced care planning for do-not-resuscitate (DNR) showed an improved survival outcome compared with those who experienced a standard care [6]. End-of-life and advanced care planning may have contributed to improved outcomes of a CPR in the general population by allowing terminally ill patients to choose a DNR, which were effectively decreasing the number of patients that would have worse outcomes [10]. Through a focus on palliative care for cancer patients and an incorporation of patient goals of care in deciding therapeutic interventions, CPR might be applied more selectively, resulting in higher rates of ROSC and longer survival after CPR. The identification of a potentially avoidable CPR is an important issue in the palliative care of the cancer
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