1. Prior Advanced Care Planning and Outcomes of Cardiopulmonary Resuscitation in the Emergency Department of a Comprehensive Cancer Center.
- Author
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Wechsler, Adriana H., Sandoval, Marcelo, Viets-Upchurch, Jayne, Cruz Carreras, Maria, Page, Valda D., Elsayem, Ahmed, Qdaisat, Aiham, and Yeung, Sai-Ching J.
- Subjects
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CANCER treatment , *MORTALITY , *RESEARCH funding , *DO-not-resuscitate orders , *SCIENTIFIC observation , *TREATMENT effectiveness , *HOSPITAL emergency services , *RETROSPECTIVE studies , *DESCRIPTIVE statistics , *ELECTRONIC health records , *INTENSIVE care units , *MEDICAL records , *ACQUISITION of data , *CARDIOPULMONARY resuscitation , *CANCER patient psychology , *LENGTH of stay in hospitals , *ADVANCE directives (Medical care) , *SPECIALTY hospitals , *MEDICAL care costs - Abstract
Simple Summary: As more cancer patients with advanced disease present to the emergency department (ED), data on outcomes of cardiopulmonary resuscitation (CPR) are needed to help counsel patients before and during an acute event. We investigated the characteristics of cancer patients who required CPR, their outcomes, and how prior advanced care planning (ACP) influenced these outcomes. Few studies have specifically looked at these data in an emergency department, where medical history is limited and the need for acute intervention often precludes discussion of therapeutic limitations. We found cardiopulmonary resuscitation of cancer patients to be rare in the ED. Although the return of spontaneous circulation (ROSC) is often attained, very few patients survive to discharge. Patient characteristics, resuscitation success, overall mortality, and the cost of care did not differ between patients with and without ACP. However, patients with ACP had shorter hospital and intensive care unit (ICU) stays and higher rates of conversion to do-not-resuscitate (DNR) status post-resuscitation. 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. [ABSTRACT FROM AUTHOR]
- Published
- 2024
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