As the global burden of cancer increases, number of out-of-hospital cardiac arrest (OHCA) patients with malignancies also increases. Recent studies show effect of percutaneous coronary intervention (PCI) is similar between cancer patients and non-cancer patients. The objective of this study is to investigate to evaluate the influence of cancer history on post-resuscitation therapies among OHCA patients with ROSC. We hypothesize that OHCA patients with cancer history receive lower post-resuscitation treatments compared with those without cancer history.
All adults OHCA patients with presumed cardiac etiology and sustained return of spontaneous circulation (ROSC) from 2009 to 2016 were included in this study. Main exposure was history of cancer which was obtained from medical record review process in the national OHCA registry database. The type and stage of malignancy was not classified. The primary outcome was accessibility of post-resuscitation treatment including PCI and therapeutic targeted temperature management (TTM). The secondary outcomes were survival to discharge and good neurological recovery. Multivariable logistic regression was used to determine the association between cancer and post-resuscitation treatments, PCI and TTM, respectively, Adjusted odds ratios (AORs) and 95% confidence intervals (CIs) were calculated with adjusting for potential confounders such as demographics, Utstein, EMS, and hospital factors.
Total 33,760 patients were included for final analysis. Of these, OHCAs with cancer history was 3,453 (10.2%) and OHCAs received PCI and TTM were 2,714 (8.0%) and 3,331 (9.9%), respectively. Multivariable logistic regression analysis showed that cancer patients were significantly less likely to receive PCI and TTM compared to who did not have cancer history. AOR (95% CI) 0.29 (0.24-0.37) was for PCI and 0.66 (0.58-0.77) for TTM. The AORs (95% CIs) for survival to discharge and good neurological recovery of the cancer patients were 0.47 (0.42-0.53) and 0.39 (0.33-0.46), respectively.
OHCAs with cancer history were significantly less likely to undergo PCI and TTM than non-cancer patients. The results of this study are expected to provide a better understanding of post-resuscitation treatments given to OHCA patients with cancer history. Further studies on post-resuscitation care for OHCAs with cancer history considering type and stage are needed.