Outcome of Cardiopulmonary Resuscitation In Frail Patients

Abstract

The concept of frailty is one which is gaining increasing attention due to its multifactorial constituents, and its impact on geriatric patient care. This retrospective analysis of cardiopulmonary resuscitation (CPR) in Maltese Hospitals aims to determine the significance of frailty in relation to CPR outcome in one calendar year. In this study, we analysed the outcome of cardiopulmonary resuscitation (CPR) in Maltese Hospitals for the year 2019 in relation to frailty status using the Charlson Comorbidity Index (CCI). 185 eligible patients were obtained from the CPR register after excluding patients <18years of age, peri-arrest cases, a test case, double-recorded CPR documents and patients with insufficient data recorded. From these 185 patients, the statistics were of 123 males and 62 females, with an age range of 26 years to 99 years. The median age was 78 years whilst mean age was 76.2 years. The majority of patients fell within CCI of 4-8 (143 patients), with the largest cohort obtaining a score of 6 (39 patients). The results highlight a low rate of ROSC (4.32%) irrespective of CCI score. However, when ROSC was achieved, survival to discharge was noted to be greater with lower CCI scores. Only 5 patients survived one year post discharge.This data is in keeping with other studies regarding CPR in frail patients, despite the use of other scores such as the Clinical Frailty Score. Smith et al’s study in Australian tertiary centres between 2008 and 2017 used the CCI, and points out a lower rate of discharge home in frail patients who survive an in-hospital cardiac arrest [1]. Limitations of our study include the small population, although exhaustive of the CPRs performed on the Maltese Islands in 2019.