Intensive Care Medicine Published: 10 November 2025
Purpose
To explore the
association of frailty with mortality, functional outcome, and health status
after out-of-hospital cardiac arrest.
Methods
This is a
cohort-based secondary analysis of the Targeted Hypothermia versus Targeted
Normothermia after out-of-hospital cardiac arrest (TTM2) trial, an
international, prospective, multicentre study. Frailty was assessed using the
Clinical Frailty Scale (1–9): fit (1–3), prefrail (4), frail (5), and severely
frail (6–9). Main outcomes were mortality and poor functional outcome (modified
Rankin Scale 4–6) at 6 and 24 months. Additional outcomes included
neuroprognostication, withdrawal-of-life-sustaining-therapies (WLST),
functional decline (retrospectively reported pre-arrest versus 6 month
Glasgow Outcome Scale Extended score), health status (EQ-5D-5L, EQ-VAS), and
life satisfaction at 6 and 24 months.
Results
Of 1861
participants, 240 (13%) were prefrail, and 188 (10%) were frail or severely
frail. Mortality and poor functional outcome increased significantly with
greater frailty. Compared to fit participants, adjusted ORs (95% CI) for
6 month mortality were: prefrail 2.7 (1.8–3.8), frail 3.7 (1.9–7.1), and
severely frail 8.9 (4.2–18.7); and poor functional outcome: prefrail 2.9
(1.9–4.2), frail 3.9 (1.9–8.1), and severely frail 35.4 (8.4–148.8). Severely
frail participants underwent neuroprognostication less often (p < 0.001),
while WLST was more common in the prefrail, frail and severely frail (p < 0.001).
Prefrail and frail survivors tended to report more frequent functional decline
and lower health status, though with individual variation.
Conclusion
Frailty was
associated with a significantly increased risk of mortality and poor functional
outcome after out-of-hospital cardiac arrest. Findings suggest more frequent
functional decline and lower overall health status in frail survivors.
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