The Impact of Frailty on Cardiopulmonary Resuscitation Adverse Outcomes in Patients Requiring Code Blue Activation

Out-of-hospital cardiac arrest remains an important cause of death in developed countries with an average adult survival rate of 5.6% . In contrast, in-hospital cardiac arrests have been reported to have a survival rate between 4.1% and 40% and several factors have been shown to affect survival rates. These factors include patient and physiologic factors such as age, initial rhythm disturbance and duration of cardiopulmonary resuscitation (CPR), as well as hospital and logistic factors such as location and timing of the arrest.Code blue (CC) is the emergency call and management systems for respiratory or cardiac arrest. CC is used worldwide for the same emergency and the same color. The CC is the organization that initiates certain systems to initiate, perform and terminate the intervention of the designated responsible team. CC is given by a doctor (emergency, anesthesia and reanimation, internal medicine, pediatrics, intensive care specialist), anesthesia technician, nurse. The CC team is a team that prevents clinical death quickly, effectively and safely to provide life-saving support to patients. The CC team provides immediate intervention to patients, their relatives and all hospital staff. While the prevalence of frailty is 10-25% in the elderly aged 65 years and over, it increases to 30-45% in those aged 85 years and over. There are no definitive data on the prevalence of frail elderly in Turkey. The definition of frail elderly syndrome emerged as a concept in geriatrics and gerontology in the 1980s in response to the growing need for a unifying diagnosis among seemingly disparate and nonspecific disease presentations in older adults. The main symptoms are weight loss, weakness, fatigue and immobility, while the main findings are sarcopenia, osteopenia, malnutrition, impaired balance and gait, and slow walking. The importance of the definition of frailty comes from the fact that it is an alarm table used to indicate the susceptibility of the elderly to conditions such as clinical deterioration, falls and mortality over time. Frailty is a syndrome that can be prevented or at least postponed if diagnosed at an early stage. In fact, the frail elderly constitute a group vulnerable to adverse events with poor prognosis Mortality and complication rates are higher in elderly surgical patients than in younger surgical patients. Surgical risk is even higher in frail elderly patients. Regardless of the type of surgery and whatever assessment tool is used, the presence of frailty is associated with an approximately two- to threefold increased risk of adverse surgical outcome. Numerous studies have shown that frailty is a risk factor for postoperative complications, longer hospital stay and loss of functional independence at discharge. Therefore, identifying older patients with frailty offers opportunities to provide improved risk stratification and targeted interventions to improve outcomes The Edmonton Frailty Scale, a performance-based multidimensional frailty assessment tool, was designed by non-geriatricians in the west to help assess and screen frail older patients in primary care and at the bedside. It consists of 11 questions relating to nine different domains such as awareness, social support, mood, nutrition and functional performance. The result correlates well with the clinical impression of geriatricians through detailed history and physical examination.