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Predicting unsuccessful cardiopulmonary resuscitation (CPR): a comparison of three morbidity scores
Insights
Assessing morbidity scores for predicting resuscitation outcomes, this study found that while Pre-Arrest Morbidity (PAM), Prognosis After Resuscitation (PAR), and Modified PAM Index (MPI) scores showed potential, further refinement is needed for bedside use in predicting CPR success.
Area of Science:
- Emergency Medicine
- Critical Care Medicine
- Clinical Outcomes Research
Background:
- Cardiopulmonary resuscitation (CPR) success rates vary widely.
- Predictive tools are needed to estimate resuscitation outcomes and guide clinical decisions.
- Existing morbidity scores require evaluation for their utility in predicting CPR success.
Purpose of the Study:
- To evaluate the effectiveness of three distinct morbidity scores in predicting unsuccessful CPR.
- To assess the Pre-Arrest Morbidity (PAM) score, Prognosis After Resuscitation (PAR) score, and Modified PAM Index (MPI) in a real-world clinical setting.
- To determine if these scores can reliably identify patients unlikely to benefit from CPR.
Main Methods:
- Retrospective review of adult patients undergoing CPR between September 1994 and June 1996.
- Collection of demographic and clinical data to calculate PAM, PAR, and MPI scores.
- Analysis of score values in relation to patient survival to hospital discharge.
Main Results:
- A total of 264 adult patients underwent inpatient CPR, with an 11% survival rate to discharge.
- Patients who did not survive CPR had significantly higher morbidity scores than survivors.
- Specific score thresholds (PAM > 6/25, PAR > 7/28, MPI > 6/24) indicated non-survival, with sensitivities ranging from 20% (PAM) to 29% (PAR).
- Combined use of all three scores identified 42% of unsuccessful CPR attempts.
Conclusions:
- Morbidity scores like PAM, PAR, and MPI show promise in predicting CPR outcomes.
- No single score accurately identified all unsuccessful resuscitation attempts.
- Further refinement of these morbidity scoring systems is necessary to develop a reliable bedside tool for predicting individual resuscitation success.
Abstract:
The aim of the study was to assess the usefulness of three different morbidity scores in predicting unsuccessful resuscitation. We reviewed the records of adult patients who underwent CPR between September 1994 and June 1996 in The Royal Hampshire County Hospital, Winchester. Demographic data and enough clinical data to calculate the Pre-Arrest Morbidity score (PAM), the Prognosis After Resuscitation score (PAR) and the Modified PAM Index (MPI) were collected. During the study period 264 consecutive adult patients underwent inpatient CPR. Twenty-eight (11%) of the patients survived to discharge from hospital. Patients who died had significantly higher morbidity scores than those who survived. No patient with a PAM score greater than 6/25, PAR greater than 7/28 or MPI greater than 6/24 survived. There were 47/264 patients who scored above this threshold for the PAM score giving a sensitivity for predicting unsuccessful CPR of 20%. The sensitivity of the PAR was 29% and MPI was 22%. Each score identified a different group of patients for whom CPR was unsuccessful. Using all three scores in combination identified 42% of the unsuccessful CPR attempts. Morbidity scores are likely to need further refinement in order to be a useful bedside tool for predicting success for individual patient resuscitation attempts.