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Research

Can the Clinical Frailty Scale predict futility in out-of-hospital cardiac arrest?

02 March 2024
Research
02 February 2024
Volume 16 · Issue 3

Abstract

Background:

Cardiopulmonary resuscitation (CPR) is considered an essential intervention in unanticipated cardiac arrest, but in the out-of-hospital setting it is often the default treatment for many patients dying of chronic and incurable disease who experience this. The Clinical Frailty Scale (CFS) can predict an individual's vulnerability to adverse health outcomes and might be a useful tool in prognostication in the prehospital setting.

Aims:

The primary aim was to assess if the CFS can be used for prognostication in cardiac arrest and whether UK paramedics would be able to use the CFS in the context of an out-of-hospital cardiac arrest.

Methods:

A rapid review of the literature was undertaken to identify research relating to frailty's influence on cardiac arrest outcomes. Five primary research articles were identified and were included.

Findings:

All the primary research focused on in-hospital cardiac arrest and demonstrated that an higher clinical frailty score was associated with increased mortality following cardiac arrest, with a significant reduction in survival at CFS ≥6.

Conclusion:

Research could assess whether these findings would be replicated in the out-of-hospital cardiac arrest context and whether paramedics could use the CFS to aid in prognostication in this situation.

Cardiopulmonary resuscitation (CPR) is a critical intervention in the management of cardiac arrest and early intervention is associated with improved survival. Multiple studies have demonstrated the critical importance of bystander CPR in extending the time frame during which defibrillation is likely to be effective in those presenting in shockable rhythms.

However, there is significant heterogeneity among individuals who experience a cardiac arrest, and the chance of survival depends upon a multitude of factors including the aetiology of the cardiac arrest, the initial presenting rhythm, initiation of bystander CPR and access to early defibrillation (Perkins et al, 2015). Furthermore, the duration of time in cardiac arrest, the patient's age and the presence of comorbidities are factors considered in prognostication (Wissenberg et al, 2015; Goto et al, 2016; Hirlekar et al, 2018). Despite this, in emergency medical services (EMS) systems around the world, CPR continues to be undertaken irrespective of prognosis (Druwé et al, 2020).

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Clinical Frailty Scale
Frailty
Futility
Out-of-hospital cardiac arrest
Prognostication
Resuscitation outcomes