The following is a summary of “Frailty and Neurologic Outcomes of Patients Resuscitated From Nontraumatic Out-of-Hospital Cardiac Arrest: A Prospective Observational Study,” published in the July 2023 issue of Emergency Medicine by Yamamoto et al.

To elucidate the clinical utility of the Clinical Frailty Scale score for predicting poor neurologic functions in patients who have undergone resuscitation following an out-of-hospital cardiac arrest (OHCA). This prospective, multicenter, observational study was conducted within the medical field between 2019 and 2021. The research encompassed individuals who experienced nontraumatic out-of-hospital cardiac arrest (OHCA) and were subsequently admitted to the intensive care unit (ICU) following the restoration of spontaneous circulation (ROSC). A pre-arrest high Clinical Frailty Scale score was determined to be 5 or greater.  Favorable neurologic outcomes, characterized by a Cerebral Performance Category score of 2 or lower within 30 days of admission, were compared between patients with and without elevated Clinical Frailty Scale scores.

Multivariable logistic regression analyses were conducted using generalized estimating equations to account for patient characteristics, out-of-hospital information, and resuscitation content. Additionally, within-institution clustering was taken into consideration. Out of 9,909 individuals who experienced out-of-hospital cardiac arrest (OHCA) within the designated timeframe of the investigation, 1,216 patients were deemed eligible for inclusion in the study. Among these participants, 317 scored highly on the Clinical Frailty Scale before experiencing the cardiac arrest event. Fewer patients with high Clinical Frailty Scale scores showed favorable neurologic outcomes. The group with a high Clinical Frailty Scale score showed a decreased percentage of good neurologic outcomes following OHCA compared to the group with a low Clinical Frailty Scale score (6.1% vs. 24.4%; adjusted odds ratio, 0.45 [95% CI 0.22 to 0.93]).

This association persisted in subgroups characterized by cardiogenic out-of-hospital cardiac arrest (OHCA), return of spontaneous circulation (ROSC) after arrival at the hospital, and absence of a high mortality risk (Clinical Frailty Scale score of 7 or lower). Conversely, the neurological outcomes were similar regardless of pre-arrest frailty in individuals experiencing noncardiogenic OHCA and achieving ROSC before hospital admission. A pre-arrest high Clinical Frailty Scale score was found to be correlated with unfavorable neurologic outcomes in patients who were resuscitated from out-of-hospital cardiac arrest (OHCA). Utilizing the Clinical Frailty Scale score would aid in prognosticating clinical outcomes after intensive care in the aftermath of spontaneous circulation (ROSC) return.

Source: sciencedirect.com/science/article/abs/pii/S0196064423001178