The feasibility of extracorporeal cardiopulmonary resuscitation for patients with active cancer who undergo in-hospital cardiac arrest

Yo Sep Shin,Seung Mok Ryoo,Sung-Ho Jung,Sang-Bum Hong,Won Young Kim,Youn-Jung Kim,Pil-Je Kang

doi:10.1038/s41598-022-05786-8

Yo Sep Shin, Seung Mok Ryoo + Show 5 more

Open Access

https://doi.org/10.1038/s41598-022-05786-8

Copy DOI

Abstract

Indications of extracorporeal cardiopulmonary resuscitation (ECPR) are still debatable, particularly in patients with cancer. Prediction of the prognosis of in-hospital cardiac arrest (IHCA) in patients with cancer receiving ECPR is important given the increasing prevalence and survival rate of cancer. We compared the neurologic outcomes and survival rates of IHCA patients with and without cancer receiving ECPR. Data from the extracorporeal membrane oxygenation registry between 2015 and 2019 were used in a retrospective manner. The primary outcome was 6-month good neurologic outcome, defined as a Cerebral performance category score of 1 or 2. The secondary outcomes were 1- and 3-month good neurologic outcome, and 6-month survival. Among 247 IHCA patients with ECPR, 43 had active cancer. The 6-month good neurologic outcome rate was 27.9% and 32.4% in patients with and without active cancer, respectively (P > 0.05). Good neurologic outcomes at 1-month (30.2% vs. 20.6%) and 3-month (30.2% vs. 28.4%), and the survival rate at 6-month (39.5% vs. 36.5%) were not significantly different (all P > 0.05) Active cancer was not associated with 6-month good neurologic outcome by logistic regression analyses. Therefore, patients with IHCA should not be excluded from ECPR solely for the presence of cancer itself.

Highlights

Indications of extracorporeal cardiopulmonary resuscitation (ECPR) are still debatable, in patients with cancer
With the implementation of extracorporeal cardiopulmonary resuscitation (ECPR) as a rescue therapy for patients with refractory cardiac arrest becoming widespread, both the survival rate and neurologic outcome have steadily increased over the last decades[1,2,3,4]
As the survival rate of patients with cancer has increased, so has the rate of admission due to the intensive and continued care of patients, and some eventually suffer from in-hospital cardiac arrest (IHCA)[9,10,11]

Summary

Introduction

Indications of extracorporeal cardiopulmonary resuscitation (ECPR) are still debatable, in patients with cancer. Prediction of the prognosis of in-hospital cardiac arrest (IHCA) in patients with cancer receiving ECPR is important given the increasing prevalence and survival rate of cancer. With the implementation of extracorporeal cardiopulmonary resuscitation (ECPR) as a rescue therapy for patients with refractory cardiac arrest becoming widespread, both the survival rate and neurologic outcome have steadily increased over the last decades[1,2,3,4]. Cancer is traditionally considered as one of the contraindications for extracorporeal membrane oxygenation (ECMO)[16], considering the increasing survival rate and the fact that patients with cancer represent a considerable portion of IHCA cases, it is reasonable to consider implementing ECPR in these cases, based on advance directives and anticipated life expectancy. We investigated the neurologic outcomes and survival rates of adult patients with cancer who underwent IHCA and who received ECPR; the outcomes of these patients were compared with those of adults without cancer who suffered IHCA and received ECPR

Objectives

Methods

Results

Conclusion