Impact of Frailty on Survival and Neurological Outcomes After Cardiac Arrest: A Systematic Review and Meta-Analysis

To synthesize the evidence on the associations of frailty with the risk of mortality and neurological outcomes in patients with cardiac arrest undergoing cardiopulmonary resuscitation. We conducted a literature search on PubMed, EMBASE, and Scopus. We included observational studies on adult participants (18 years or older) with cardiac arrest. The eligible studies reported frailty assessments using standard tools, and the comparator group comprised nonfrail participants. We used random-effects models for all analyses and expressed pooled effect sizes as odds ratios (ORs) with 95% confidence intervals (CIs). We included data from 12 studies in our analysis. Individuals with frailty exhibited a significantly higher risk of in-hospital mortality (OR, 2.18; 95% CI, 1.62-2.94), and increased 30-day mortality (OR, 1.43; 95% CI, 1.12-1.84) and 12-month mortality (OR, 4.16; 95% CI, 2.32-7.47) than the nonfrail individuals. Frail individuals also displayed lower odds of achieving favorable neurological outcomes upon hospital discharge (OR, 0.32; 95% CI, 0.20-0.50) and at the 30-day follow-up (OR, 0.42; 95% CI, 0.23-0.78). Additionally, they had lower odds of return of successful spontaneous circulation (OR, 0.49; 95% CI, 0.34-0.72). The observed associations between frailty and a higher risk of mortality reduced odds of favorable neurological outcomes, and lower odds of return of successful spontaneous circulation underscore the value of identifying frailty in individuals to achieve more accurate prognoses. Our findings highlight the importance of including frailty assessments as a component of the management plan for patients experiencing cardiac arrest.