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）的临床结局存在差异。本研究旨在分析急诊科（ED）接受CPR的癌症患者特征、预后及预先医疗计划（ACP）的影响。通过回顾一家综合性癌症中心2016年3月6日至2022年12月31日期间在急诊科接受CPR的癌症患者医院数据库及电子病历，收集患者特征、自主循环恢复（ROSC）情况、复苏后转为拒绝复苏（DNR）状态、住院及重症监护病房（ICU）停留时间、死亡率、住院费用及前期治疗目标讨论记录。结果显示，CPR实施率占急诊就诊总人次的0.05%。在纳入的100例患者中，67例实现ROSC，其中15%存活至出院。中位生存时间为26小时，30天死亡率为89%。有无ACP的患者在人口学特征、转移情况、ROSC达成率及院内死亡率方面均无显著差异，但ACP患者更倾向于转为DNR状态，且ICU或住院时间更短。综上，癌症患者在急诊科接受CPR的比例较低，这是否与终末期患者更多选择DNR状态有关需进一步研究。ACP与复苏后DNR转化率升高及住院/ICU时间缩短相关，且未增加总体死亡率。
肿瘤(癌症)患者之家