Survival outcomes of cancer patients who experience a code blue.
CCCF ePoster library. Yeung S. 11/11/19; 283459; EP28
Sabrina Yeung
Sabrina Yeung
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Abstract
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ePoster
Topic: Retrospective or Prospective Cohort Study or Case Series

Yeung, Sabrina*1; Boles, Ramy*1; Moore, Mobolaji2; Seedon, Sarah2; Munshi, Laveena2,3, Shah, Sumesh2, Mehta, Sangeeta2,3
1 MD Program University of Toronto, Toronto, Canada.
2 Mount Sinai Hospital, Intensive Care Unit, Toronto, Canada; 3Department of Medicine, University of Toronto, Toronto, Canada.

*co-first author


Introduction
In patients with cancer, goals of care (GOC) conversations including code status and life‐sustaining interventions such as cardiopulmonary resuscitation (CPR) often do not occur at all or occur late in the illness trajectory (1). Cancer patients have a poor prognosis after CPR, and GOC discussions play a large role in educating patients and their family members on options at the end of life (EOL) and suitability of resuscitation (2). To our knowledge, no study has focused on “code blue” events in cancer patients.
This study aims to describe the population of cancer patients experiencing a code blue and their outcomes at a large Canadian cancer centre. Despite medical advances, outcomes after CPR in cancer patients have not improved over the past decade (3). This lack of improvement emphasizes the profound impact GOC discussions may have in eliminating futile efforts.
Objectives
To describe survival outcomes of cancer patients who experienced a code blue.
Methods
We conducted a retrospective chart review of cancer patients at Princess Margaret Hospital who had a “code blue” initiated between January 2007 to December 2017. Variables were collected from the patient record using a standardized case report form.
Results
There were 183 patients who met the study criteria; median age was 60.5 years (range 18-91 years), 52% male, 51% hematological cancers, 49% had solid cancers, and of the solid cancers 63% had metastatic disease. Reasons for code blue being called was cardiac/arrythmia (N=56, 36%), respiratory arrest/failure (N=39, 26%), and other (N=57, 38%). Of the 174 cases with documentation 97 (56%) had CPR, and overall 44 (24%) died at the code. Of 139 (76%) patients who survived, 129 (93%) were admitted to the ICU; and 3 remained at PMH. Of the 129 patients admitted to ICU, 75% received mechanical ventilation, 69% vasopressors, 6% CRRT, 8% therapeutic hypothermia, and 8% had a tracheostomy; 34% had withdrawal of care, and 47% died in the ICU. Of the 68 patients who were discharged alive from ICU, 24% were DNR at ICU discharge.
Of the 183 patients, resuscitation was considered to be “inappropriate” in 92 (50%), with 21 (23%) having a DNR recommended, 12 (13%) with GOC documenting wishes for no CPR/resuscitation, 17 (18%) with no further therapeutic options for cancer treatment, 2 (2%) with no therapeutic options for ICU care, 30 (33%) having palliative medicine involved for EOL care, and 10 (11%) with other reasons.
When comparing characteristics of the appropriate and inappropriate resuscitation groups, the inappropriate group was more likely to have a solid cancer (70% vs 29%) and metastatic disease (78% vs 27%). The inappropriate resuscitation group was also more likely to have a code status discussion before the code (47% vs 2%). In terms of code blue outcomes they were also more likely to die in ICU (64 vs 32%) or in hospital (88 vs 60%), and be dead 12 (99% vs 74%) months.
Conclusion
Of cancer patients who experienced a code blue, 26% survived to hospital discharge. 50% of patients were deemed to be inappropriate resuscitation candidates because they were palliative or had no treatment options; these patients had worse outcomes compared to appropriate resuscitations. The poor prognosis was recognized by physicians, as GOC discussions had occurred more frequently in cases of inappropriate resuscitations. Our study highlights the need for more GOC discussions in patients with no treatment options.
 


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[1] Bestvina CM, Polite BN. Implementation of Advance Care Planning in Oncology : A Review of the Literature. J Oncol Pract. 2017;13(10):657-662. doi:10.1200/JOP.2017.021246.
[2] Varon J, Marik PE. Cardiopulmonary Resuscitation in Patients With Cancer. Am J Hosp Palliat Med. 2007;24(3):224-229.
[3] Miller AH, Sandoval M, Wattana M, Page VD, Todd KH. Cardiopulmonary resuscitation outcomes in a cancer center emergency department. SpringerPlus [Internet]. 2015 Dec [cited 2019 Jul 25];4(1). Available from: https://springerplus.springeropen.com/articles/10.1186/s40064-015-0884-z
 

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