Initial experience with a "code-no code" resuscitation system in cancer patients

A "code-no code" resuscitation classification was recently instituted at Memorial Sloan Kettering Cancer Center. Physician compliance was voluntary. Of 48 subsequent cardiopulmonary arrests, 7 patients (14.6%) were discharged from hospital. They included 4 of 17 patients (23.5%) previously assigned "code" status and 1 of 27 patients (3%) whose resuscitation status had not been designated. Reluctance on the part of the primary physician to withhold resuscitation was clearly evident in this group, of whom more than half had widespread malignancy. Stage of disease did not influence the 50% rate of successful resuscitations but no patient with metastatic or uncontrolled cancer left hospital. The discharge rate among arrest patients with recently diagnosed or localized cancer was 32%. These observations justify continued efforts to restrict cardiopulmonary resuscitation (CPR) to those with a reasonable prognosis for worthwhile palliation or cure.