9 Cardio pulmonary resuscitation (CPR) in the frail and multimorbid; outcomes before and during the COVID pandemic

Résumé fourni par la source

Introduction SARS-COV2 placed greater emphasis on identifying frail or comorbid patients early and limiting treatment where appropriate. Resuscitation guidelines changed as cardiopulmonary resuscitation (CPR) was classified an aerosol generating procedure (AGP). We assessed the impact of these changes in our tertiary centre focusing on frail and/or comorbid patients. Methods Retrospective analysis of prospectively collected data from contemporaneous clinical and electronic records for all patients with a recorded cardiac arrest between June 2020 and June 2021. Data collected on features of the cardiac arrest, clinical frailty scale (CFS), Charlson comorbidity index (CCI), survival at discharge, 30 days and 12 months. The comparator was our previously published cohort between April 2017 to March 2018. Results 62 patients studied compared to 113 in 2017–18. 20 patients survived to discharge, 30 days and 1 year. This 32.2% survival rate is higher than the 23.8% observed in 2017–18 but not statistically significant (p=0.235). Rates of ROSC similar in both studies (61.3% v 60.2% p=0.960). Median CFS was significantly lower (3.4 v 4.2, p=0.006) as was median CCI (4.1 v 5.7, p001 more patients received CPR in the cardiology department (64.5% v 38.9% p=‘0.002).’ Conclusion There was a dramatic reduction in cardiac arrest events on medical and surgical wards with little change in arrests within the cardiology department. The improvement in survival rate observed in this study is multifactorial but likely includes a less frail and comorbid population and a higher proportion of cardiac arrests in a shockable rhythm. CPR outcomes improved due to better patient selection. No evidence to show COVID ALS guidelines affect outcomes.

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