Clinical

Bedside frailty assessment can determine when CPR will be nonbeneficial


 

Background: Although average survival after in-hospital cardiac arrest is 17%-20%, many clinicians feel that survival is lower in older patients or patients with multiple comorbidities. The Clinical Frailty Scale (CFS) is a simple bedside visual tool that encapsulates patients’ mobility and functional status, with a score greater than 4 indicating frailty. How this measure of frailty correlates with outcomes after in-hospital cardiac arrest is unknown.

Dr. Krishna A. Chokshi, division of hospital medicine, Mount Sinai Health System, New York

Dr. Krishna A. Chokshi

Study design: Retrospective review.

Setting: Tertiary referral center in England.

Synopsis: The study included patients over 60 years old who received CPR between May 2017 and December 2018. CFS was retroactively applied based on available chart data. The patients’ median age was 77 years old, and 71% were male. The initial cardiac rhythm was nonshockable in 82% of cases, and overall in-hospital mortality was 86%. Frailty was independently associated with increased mortality when controlling for age, comorbidities, and rhythm. No frail patients survived to hospital discharge, while 26% of patients with CFS greater than 4 survived. Although patients with a shockable rhythm had a better chance of survival overall, compared with those with a nonshockable rhythm (92% vs. 23%, P less than .001), 15% of frail patients had a shockable rhythm, and none survived to discharge. Limitations of the study include relatively small sample size and the possibility of confounding variables, such as comorbid conditions.

Bottom line: When adjusted for age and rhythm, no frail patients older than 60 who received CPR for cardiac arrest survived to hospital discharge. Clinicians should discuss the limited chance of survival and potential burdens of resuscitation with frail patients and their families to avoid inappropriate CPR at the end of life.

Citation: Ibitoye SE et al. Frailty status predicts futility of cardiopulmonary resuscitation in older adults. Age Ageing. 2020 Jun 5;[e-pub]. doi: doi.org/10.1093/ageing/afaa104.

Dr. Chokshi is a hospitalist in the Division of Hospital Medicine, Mount Sinai Health System, New York.

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