Department of Hematology and Oncology, Ascension St. John Hospital and Medical Center, Detroit, Michigan.
Department of Hematology and Oncology, Henry Ford Health System, Detroit, Michigan.
Cancer. 2021 Jun 15;127(12):2148-2157. doi: 10.1002/cncr.33451. Epub 2021 Mar 9.
Cardiopulmonary arrest is known to have a poor prognosis, further worsened by preexisting comorbidities. With improved treatment, the prevalence of metastatic cancers is rapidly increasing; however, the outcomes of in-hospital cardiopulmonary resuscitation (ICPR) remain to be well described. This study examines the epidemiology, associations, and outcomes of ICPR in these patients.
This is a retrospective cohort analysis of the Nationwide Inpatient Sample database (2012-2014) including patients aged ≥18 years with metastatic cancers. Primary outcome was inpatient mortality following ICPR. Factors associated with the primary outcome were analyzed using univariate/multivariate logistic regression analysis.
Among all admissions with metastatic cancers (n = 5,500,684), 0.47% (n = 26,070) received ICPR. Inpatient mortality was 81.77% (n = 8905) versus 68.90% among those without metastatic solid cancers and receiving ICPR. Inpatient palliative care encounter was documented in 18.95% of patients with metastatic cancer who received ICPR. On multivariate logistic regression, some of the notable factors associated with higher mortality included being of African American or Hispanic race and hospital admission over the weekend. Factors associated with lower mortality included female sex, elective admission, and head and neck as the primary site. Admissions with ICPR were associated with higher mean total charge of hospitalization (by $48,670) compared with admissions without ICPR. Of those who survived ICPR, 43.82% were transferred to another facility after discharge.
Among adult patients with metastatic solid cancers having ICPR, 81.8% died within the same hospital admission. Race and admission type predicted mortality. Despite known poor prognosis, only a minority had palliative care.
Cardiopulmonary resuscitation during hospitalization for patients who have metastatic cancer has a very poor outcome with a mortality rate of 81.77%. Inpatient cardiopulmonary resuscitation in these patients is also associated with a significantly higher cost of care, longer length of stay, and high rate of transfer to a different health care facility upon discharge. Knowledge of these outcomes is helpful in discussing the pros and cons of pursuing aggressive resuscitative interventions with patients and families.
众所周知，心肺骤停预后不良，合并先前存在的合并症则进一步恶化。随着治疗的改善，转移性癌症的患病率迅速增加；然而，院内心肺复苏（ICPR）的结果仍有待很好地描述。本研究检查了这些患者的 ICPR 的流行病学、相关性和结果。
这是对全国住院患者样本数据库（2012-2014 年）的回顾性队列分析，包括年龄≥18 岁的转移性癌症患者。主要结果是 ICPR 后住院死亡率。使用单变量/多变量逻辑回归分析分析与主要结果相关的因素。
在所有患有转移性癌症的住院患者中（n=5500684），有 0.47%（n=26070）接受了 ICPR。接受 ICPR 的转移性癌症患者的住院死亡率为 81.77%（n=8905），而非转移性实体癌症患者的住院死亡率为 68.90%。接受 ICPR 的转移性癌症患者中有 18.95%记录了住院姑息治疗。多变量逻辑回归分析显示，与死亡率较高相关的一些显著因素包括非裔美国人和西班牙裔以及周末住院。与死亡率较低相关的因素包括女性、择期入院和头颈部作为主要部位。接受 ICPR 的入院与无 ICPR 入院相比，住院总费用平均增加了 48670 美元。在 ICPR 后存活的患者中，有 43.82%在出院后被转往其他医疗机构。
在接受 ICPR 的成年转移性实体癌症患者中，有 81.8%在同一住院期间死亡。种族和入院类型预测死亡率。尽管预后已知较差，但只有少数患者接受了姑息治疗。
对于患有转移性癌症并接受住院心肺复苏的患者，死亡率非常高，为 81.77%。这些患者的 ICPR 还与护理成本显著增加、住院时间延长以及出院后转移到不同医疗机构的比率高有关。了解这些结果有助于与患者及其家属讨论是否采用积极复苏干预措施的利弊。
