Abstract
Abstract: Audit of Cardiac Arrests at Nevill Hall Hospital (October 2022 - February 2025)
Introduction
This comprehensive audit examined cardiac arrests at Nevill Hall Hospital, part of Aneurin Bevan University Health Board (ABUHB), over a 28-month period. The study investigated relationships between patient frailty, comorbidities, resuscitation appropriateness, and clinical outcomes in a unique step-down hospital setting. Following health board restructuring, Nevill Hall operates without on-site specialties, anaesthetics, or intensive treatment unit facilities, comprising multiple Care of the Elderly wards and a medical assessment unit.
Method
A retrospective analysis of cardiac arrest events from October 2022 to February 2025 was performed. Data were extracted from hospital records encompassing 2222 emergency calls during this timeframe. Detailed analysis included patient demographics, clinical frailty scores, comorbidity burden, and resuscitation outcomes. The hospital's operational constraints as a step-down facility were considered throughout the analysis.
Results
Twenty-one cardiac arrests were identified during the study period. Return of spontaneous circulation (ROSC) was achieved in seven cases (33%). Patient ages ranged from 25 to 93 years, with a mean clinical frailty score of 5. Sixty-seven percent of patients presented with significant comorbidity burden. Critical findings revealed that ROSC and survival beyond 24 hours occurred exclusively in patients under 65 years and in patients with clinical frailty scores below 5. Comparative analysis demonstrated suboptimal ROSC rates and survival to discharge rates when benchmarked against other UK hospitals.
Conclusions
Strong associations were demonstrated between patient frailty, comorbidity burden, and cardiac arrest outcomes. Clinical frailty scores above 5 correlated with poor resuscitation success. Age alone proved inadequate for predicting outcomes, while comorbidity burden significantly impacted immediate and long-term post-arrest survival. The findings support evidence-based DNACPR decision-making using objective frailty assessments, potentially reducing futile resuscitation attempts while ensuring appropriate intervention for patients with favourable prognostic indicators in step-down hospital settings.