Outcomes of in-hospital cardiopulmonary resuscitation for cardiac arrests in adult patients with cancers

Cardiac page or code blue is an intensive care service, which once activated, mobilizes a dedicated team to the site of cardiac arrest with all the equipment required for resuscitation. Successful resuscitation requires early recognition, immediate action by the parent team till ICU team arrives, high quality ACLS and CPR, efficient transport to the ICU.

The underlying pathology plays the most important role in determining the outcome of the oncology patient. This is the reason that many times revival at site does not translate into survival at hospital discharge. This may be a reflection of ill-sustained organ function and irreversible damage setting in before, during or post cardiac arrest.

Survival to in-hospital cardiac arrest is reported at 46 percent at discharge as per a recent systematic review. The National Registry of Cardiopulmonary Resuscitation in the United States suggests 27 percent survival to discharge, but only 15.7 percent with good neurological outcome.

Unique to cancer setting. Cancer patients often travel from distant places causing delay in presentation. Acute respiratory failure and sepsis are common causes of ICU admissions in these immunocompromised patients. Lack of do not resuscitate DNR orders may allow CPR in unwarranted situations.

Important clarification. This study will have no direct contact with patients. Data will only be collected from existing code blue forms and electronic medical records EMR.

Definitions. Cardiac arrest. 1 No palpable pulse, 2 No detectable blood pressure, 3 No effective respiration, 4 Loss of consciousness. ROSC. Maintenance of spontaneous circulation for at least 1 hour following resuscitation effort.