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

F P Arena, M Perlin, A D Turnbull

    Critical Care Medicine
    |December 1, 1980
    PubMed
    Summary
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    A voluntary "code-no code" policy for cardiopulmonary resuscitation (CPR) showed low discharge rates, especially for patients with advanced cancer. This suggests CPR should be reserved for those with a realistic chance of meaningful recovery.

    Area of Science:

    • Oncology
    • Critical Care Medicine
    • Medical Ethics

    Background:

    • A voluntary "code-no code" resuscitation classification system was implemented at Memorial Sloan Kettering Cancer Center.
    • Physician compliance with this classification was not mandatory.

    Purpose of the Study:

    • To evaluate the effectiveness of the "code-no code" resuscitation classification system.
    • To assess the outcomes of cardiopulmonary resuscitation (CPR) in cancer patients based on their resuscitation status.

    Main Methods:

    • Retrospective analysis of 48 cardiopulmonary arrests following the implementation of the classification system.
    • Categorization of patients into "code" status, "no code" status, or unassigned resuscitation status.
    • Analysis of hospital discharge rates based on resuscitation status and cancer stage.

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    Main Results:

    • Overall, 7 out of 48 patients (14.6%) were discharged from the hospital after cardiopulmonary arrest.
    • Patients with "code" status had a higher discharge rate (4/17, 23.5%) compared to those with unassigned status (1/27, 3%).
    • No patients with metastatic or uncontrolled cancer were discharged; discharge rate for localized or recently diagnosed cancer was 32%.

    Conclusions:

    • Physician reluctance to withhold resuscitation was observed, particularly in patients with widespread malignancy.
    • The study supports continued efforts to judiciously apply cardiopulmonary resuscitation (CPR) to patients with a reasonable prognosis for palliation or cure.
    • Resuscitation status designation and cancer stage are critical factors influencing patient outcomes after cardiopulmonary arrest.