• Ryo Yamamoto, Tomoyoshi Tamura, Akina Haiden, Jo Yoshizawa, Koichiro Homma, Nobuya Kitamura, Kazuhiro Sugiyama, Takashi Tagami, Hideo Yasunaga, Shotaro Aso, Munekazu Takeda, Junichi Sasaki, and SOS-KANTO 2017 Study Group.
• Department of Emergency and Critical Care Medicine, Keio University School of Medicine, Tokyo, Japan. Electronic address: ryo.yamamoto@gmail.com.
• Ann Emerg Med. 2023 Jul 1; 82 (1): 849384-93.

Study ObjectiveTo elucidate the clinical utility of the Clinical Frailty Scale score for predicting poor neurologic functions in patients resuscitated from out-of-hospital cardiac arrest (OHCA).MethodsThis was a prospective, multicenter, observational study conducted between 2019 and 2021. The study included adults with nontraumatic OHCA admitted to the intensive care unit after return of spontaneous circulation (ROSC). Pre-arrest high Clinical Frailty Scale score was defined as 5 or more. Favorable neurologic outcomes defined as a Cerebral Performance Category score of 2 or less at 30 days after admission were compared between patients with and without high Clinical Frailty Scale scores. Multivariable logistic regression analyses fitted with generalized estimating equations were performed to adjust for patient characteristics, out-of-hospital information, and resuscitation content and account for within-institution clustering.ResultsOf 9,909 patients with OHCA during the study period, 1,216 were included, and 317 had a pre-arrest high Clinical Frailty Scale score. Favorable neurologic outcomes were fewer among patients with high Clinical Frailty Scale scores. The high Clinical Frailty Scale score group showed a lower percentage of favorable neurologic outcomes after OHCA than the low Clinical Frailty Scale score group (6.1% vs 24.4%; adjusted odds ratio, 0.45 [95% confidence interval 0.22 to 0.93]). This relationship remained in subgroups with cardiogenic OHCA, with ROSC after hospital arrival, and without a high risk of dying (Clinical Frailty Scale score of 7 or less), whereas the neurologic outcomes were comparable regardless of pre-arrest frailty in those with noncardiogenic OHCA and with ROSC before hospital arrival.ConclusionsPre-arrest high Clinical Frailty Scale score was associated with unfavorable neurologic functions among patients resuscitated from OHCA. The Clinical Frailty Scale score would help predict clinical consequences following intensive care after ROSC.Copyright © 2023 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

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