Wechsler Adriana H, Sandoval Marcelo, Viets-Upchurch Jayne, Cruz Carreras Maria, Page Valda D, Elsayem Ahmed, Qdaisat Aiham, Yeung Sai-Ching J
Department of Emergency Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
Cancers (Basel). 2024 Aug 13;16(16):2835. doi: 10.3390/cancers16162835.
Cardiopulmonary resuscitation (CPR) outcomes vary for patients with cancer. Here, we characterized cancer patients who underwent CPR in the emergency department (ED), their outcomes, and the effects of advanced care planning (ACP). The hospital databases and electronic medical records of cancer patients at a comprehensive cancer center who underwent CPR in the ED from 6 March 2016 to 31 December 2022 were reviewed for patient characteristics, return of spontaneous circulation (ROSC), conversion to do-not-resuscitate (DNR) status afterward, hospital and intensive care unit (ICU) length of stay, mortality, cost of hospitalization, and prior GOC discussions. CPR occurred in 0.05% of all ED visits. Of the 100 included patients, 67 patients achieved ROSC, with 15% surviving to hospital discharge. The median survival was 26 h, and the 30-day mortality rate was 89%. Patients with and without prior ACP had no significant differences in demographics, metastatic involvement, achievement of ROSC, or in-hospital mortality, but patients with ACP were more likely to change their code status to DNR and had shorter stays in the ICU or hospital. In conclusion, few cancer patients undergo CPR in the ED. Whether this results from an increase in terminally ill patients choosing DNR status requires further study. ACP was associated with increased conversion to DNR after resuscitation and decreased hospital or ICU stays without an increase in overall mortality.
癌症患者心肺复苏（CPR）的结果各不相同。在此，我们对在急诊科（ED）接受CPR的癌症患者、他们的结局以及高级护理计划（ACP）的影响进行了特征描述。回顾了一家综合癌症中心2016年3月6日至2022年12月31日在ED接受CPR的癌症患者的医院数据库和电子病历，以了解患者特征、自主循环恢复（ROSC）情况、之后转为不进行心肺复苏（DNR）状态的情况、住院和重症监护病房（ICU）的住院时长、死亡率、住院费用以及之前关于临终关怀目标（GOC）的讨论。CPR发生在所有ED就诊患者的0.05%中。在纳入的10例患者中，67例实现了ROSC，15%存活至出院。中位生存期为26小时，30天死亡率为89%。有无ACP的患者在人口统计学、转移灶累及情况、ROSC的实现或院内死亡率方面无显著差异，但有ACP的患者更有可能将其抢救状态改为DNR，并且在ICU或医院的住院时间更短。总之，很少有癌症患者在ED接受CPR。这是否是由于晚期患者选择DNR状态的增加所致，需要进一步研究。ACP与复苏后转为DNR的比例增加以及住院或ICU住院时间缩短相关，而总体死亡率并未增加。
