Frailty, multimorbidity and in-hospital cardiopulmonary resuscitation: predictable markers of outcome?

Abstract

BackgroundThis study's aim was to investigate an association between outcome from in-hospital cardiopulmonary resuscitation (CPR) and increasing burden of comorbidities and frailty. Methods Retrospective analysis of prospectively collected data from contemporaneous patient notes and electronic records of all patients who suffered an in-hospital cardiac arrest between 1 April 2017 and 31 March 2018 in a hospital that includes a tertiary cardiology department. Results A total of 113 patient records were assessed. Patient frailty was assessed based on calculation of Rockwood clinical frailty score (CFS) and comorbidity assessment based on Charlson comorbidity index (CCI). A linear correlation has been identified between increasing CCI and reduced survival(ANOVA = p<0.001) and rates of return of spontaneous circulation (ROSC) (ANOVA = 0.013). No patients with a CFS above 6 survived to 1 year. A linear correlation was identified between increasing CFS and reduced probability of ROSC (ANOVA p=0.002), survival to discharge (ANOVA p=0.003) and 1 year (ANOVA p=0.001). ConclusionOur findings suggest an association between increasing patient multimorbidity and frailty and poorer outcome post cardiac arrest.

Outcomes in adults living with frailty receiving cardiopulmonary resuscitation: A systematic review and meta-analysis

“…Eight studies comparing the outcomes in frail versus non-frail individuals receiving CPR for cardiac arrest were included in a narrative synthesis ( Table 1 ). 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 Of these, seven studies presented sufficient data for inclusion in quantitative synthesis. All studies included in meta-analysis were of a retrospective observational design and considered to be of high methodological quality ( Table 2 ).…”

“…visitors, patients in emergency department) Tertiary referral hospital, Australia • Readmission to hospital within 30 days from discharge • Chest compressions and/or electrical defibrillation performed • Cardiac arrest in subacute units (e.g. palliative care, geriatric medicine) Ibitoye, 19 2020 Retrospective observational CFS (≥5) • Survival to discharge • IHCA in patients (>60) who received CPR • Repeat cardiac arrests Tertiary referral hospital, UK • Discharge location • Cases where CPR was discontinued due to presence of DNACPR • One year survival • CFS score non-determinable • Non-true cardiac arrest Xu, 20 2020 Retrospective observational CFS (≥5) • In-hospital mortality • Adult (≥18) IHCA • None Zigong fourth people’s hospital, China Sulzgruber, 21 2016 Prospective observational N/A • ROSC • OHCA with resuscitation attempt by emergency medical service • No professional resuscitation attempt Out-of-hospital, Austria • 30 day survival • DNACPR decision present • Favourable cerebral performance category Thomas, 23 2021 Retrospective observational CFS (≥5) • ROSC • Adult (>16) IHCA • DNACPR decision present Tertiary hospital, UK • 30 day survival • OHCA • Survival to discharge • One year survival Hu, 22 2021 ...…”

“…One study presented a moderate risk of bias (overall score 4–6). Study Selection Comparability of cohorts Outcome Overall score (/9) Exposed cohort Non-exposed cohort Exposure ascertainment Outcome not present at start Assessment of outcome Follow-up length Follow-up adequacy Wharton, 16 2019 * * * * ** * * * 9 Sulzgruber, 21 2016 * * * ** * 6 Fernando, 17 2019 * * * * *** * * * 9+ Smith, 18 2018 * * * * *** * * * 9+ Ibitoye, 19 2020 * * * * *** * * * 9+ Xu, 20 2020 * * * * *** * * * 9+ Thomas, 23 2021 * * * * * * * 7 Hu, 22 ...…”

“… 16 A further study showed that after one-year no patient with a CFS ≥ 6 survived. 23 Three studies analysed for an association between increasing CFS and mortality following receipt of CPR. All three studies demonstrated that greater severity of frailty was associated with reduced odds of survival.…”

“…All three studies demonstrated that greater severity of frailty was associated with reduced odds of survival. 20 , 22 , 23 …”