Outcome and cost implications of cardiopulmonary resuscitation in the medical intensive care unit of a comprehensive cancer center

Abstract

Intensive care unit (ICU) resources are frequently utilized in the supportive care of hospitalized patients with cancer. Patients with cancer reportedly have poor outcomes from cardiopulmonary resuscitation (CPR). The goal of this study was to evaluate the effectiveness and patient care costs of CPR applied to patients already receiving life support in an ICU. The medical records of patients who developed cardiac arrest and underwent CPR in the ICU of a comprehensive cancer center between 1993 and 2000 were reviewed. ICU charges after the first episode of CPR were analyzed. There were 5,196 admissions to the ICU during this time; 406 (8%) of the patients underwent CPR; 67% had hematologic malignancies or had undergone hematopoietic stem cell transplantation: 256 patients (63%) died at the time of the arrest, and in 150 (37%) spontaneous circulation was restored. There were 104 patients (26%) who survived more than 24 hours but ultimately died during their hospitalization; their mean time to death was 4.3 days (95% confidence interval [CI] 2.9-5.6), and mean ICU charges were $45,877 (95% CI $24,802-$66,952). Seven patients (2%) survived to be discharged. Patients who survived after CPR and were discharged from the hospital were those who had acute ventricular dysrhythmias and were resuscitated promptly. The application of CPR to cancer patients receiving life support is costly and typically does not lead to long-term survival. Cancer patients requiring admission to an ICU should receive full supportive care short of resuscitation. Providing assurances that care will remain appropriate, aggressive, and in accordance with the patient's and family's wishes can optimize compassionate care while avoiding futile life-sustaining interventions.

Admitting lung cancer patients to intensive care for organ dysfunction: a complex decision process

“…Along with the overall improvement in the prognosis of ICU cancer patients, the same trend was observed for lung cancer [5], with hospital mortality ranging from 24% to 65% [6,7]. It is also important to consider that the prognosis of lung cancer patients surviving to the ICU stay is relatively poor, with a 6-month mortality rate of 73%, and only two-thirds of those receiving further anticancer treatment survive [8].…”

“…However, after recovery, the prognosis is again determined by the characteristics of the underlying oncological disease. These conclusions are of value in unselected oncology populations [2] and in specific groups of cancer patients requiring invasive mechanical ventilation [3], noninvasive ventilation [4] or renal replacement therapy [1,5].…”

“…However, after recovery, the prognosis is again determined by the characteristics of the underlying oncological disease. These conclusions are of value in unselected oncology populations [2] and in specific groups of cancer patients requiring invasive mechanical ventilation[3], noninvasive ventilation [4] or renal replacement therapy [1,5].Along with the overall improvement in the prognosis of ICU cancer patients, the same trend was observed for lung cancer [5], with hospital mortality ranging from 24% to 65% [6,7]. It is also important to consider that the prognosis of lung cancer patients surviving to the ICU stay is relatively poor, with a 6-month mortality rate of 73%, and only two-thirds of those receiving further anticancer treatment survive [8].…”

Amyotrophic lateral sclerosis and palliative care: Where we are, and the road ahead

“…81 On the other hand, if their disease does not respond to treatment, cardiopulmonary resuscitation (CPR) and mechanical ventilation (MV) are usually ineffective to prevent death from progression of their underlying malignancy, and the nature of the disease is such that long-term survival on MV is rarely an option. 82 ALS patients have far fewer choices for treatment of the underlying illness. However, when they develop lifethreatening respiratory failure, LTMV can prolong life for more than 10 years.…”

Wide variation in content of inpatient do-not-resuscitate order forms used at National Cancer Institute-designated cancer centers in the United States

“…Multiple studies have documented the poor outcome of cardiopulmonary resuscitation (CPR) in hospitalized patients with advanced cancer, with survival to discharge rates typically ranging from 0% to 7% [3,8,10,13,18,19]. Numerous medical societies have upheld that CPR is not appropriate for all patients, such as those who are in the terminal stages of incurable illnesses, or whose death is expected or imminent, or who have made an informed refusal of CPR [5,17].…”