3584 Too frail to fail: frailty and the limits of resuscitation

Abstract Background Hundreds of cardiac arrest calls occur annually in hospitals, with a significant proportion involving patients aged 65 and above. Previous research has shown that survival to discharge in this population remains poor. Frailty is increasingly recognised as a predictor of adverse outcomes, but its relationship with CPR outcomes in older adults remains underexplored. Objectives: This audit aimed to: Identify which older inpatients are most likely to die following cardiac arrest. Explore the association between frailty and CPR outcomes. Provide guidance for DNACPR (Do Not Attempt CPR) conversations with patients and families. Methods We conducted a retrospective review of electronic health records for all inpatients aged ≥65 who received CPR between 1 January 2022 and 31 December 2024 at our institution. Clinical Frailty Scale (CFS) scores were extracted where available, and patient outcomes were analysed with respect to survival to discharge. Results A total of 71 patients over the age of 65 underwent CPR during the audit period. Of these, 62 (87%) died in hospital. Frailty was strongly associated with poorer outcomes. Among patients with a CFS score of ≥5 (mild frailty or worse), only one survived to discharge. This sole survivor had a witnessed arrest in the cardiac catheterisation lab during a percutaneous coronary intervention, with a downtime of less than 10 seconds. Conclusions Survival following inpatient cardiac arrest in older adults is rare, particularly among those living with frailty. Our findings support the use of the Clinical Frailty Scale as a valuable tool in guiding CPR discussions and decision-making. We recommend incorporating frailty assessment into routine care and resuscitation planning to facilitate more appropriate and patient-centred DNACPR decisions.