Examining the Prognostic Utility of Frailty for Post-arrest Outcomes Following the Provision of Cardiopulmonary Resuscitation: A Systematic Review and Meta-Analysis Protocol

Abstract BackgroundAdvanced knowledge of patient prognosis following a cardiac arrest is necessary to determine if resuscitation efforts are futile and ensure value-congruent care. Prior reviews have identified the prognostic factors associated with survival and recovery following cardiac arrest. However, few studies to date have examined the prognostic value of frailty in predicting post-arrest outcomes. The objective of this systematic review is to synthesize the available evidence reporting the association between frailty and patient outcomes following the provision of CPR in-hospital or out-of-hospital MethodsWe searched the following electronic databases from inception until August 2020: Medline Epub Ahead of Print, In-Process and Other Non-Index citations, Pubmed exclusive of Medline citations, EMBASE, CINAHL and Web of Science. We plan to include observational studies that examine the association between frailty and any of the following outcomes: survival to hospital discharge, survival at one, three and twelve months post-arrest, return of spontaneous circulation, functional status at hospital discharge and one-month post-discharge, health-related quality of life at 90 days and one-year post-arrest, and discharge to continuing or long-term care. We plan to conduct a random-effects meta-analysis that pools the effect estimates from all eligible studies to obtain a summary estimate and confidence interval. DiscussionThe findings of this review can be used to determine if the evidence supports the consideration of frailty when discussing advanced directives and care planning with patients, families and caregivers. The findings of this review can also be used to inform future prognostic and clinical prediction models aiming to predict post-resuscitation outcomes. Systematic Review RegistrationThis review has been submitted to the PROSPERO registry (submission ID: 212922)