Does concurrent or previous illness accurately predict cardiac arrest survival?

Abstract

Various investigators have looked at the difficult problem of how to predict survival after cardiac arrest and three scoring systems have been developed. These are the pre-arrest morbidity score (PAM) [1–3] developed by George and colleagues, the prognosis after resuscitation score (PAR) [1–3] developed by Ebell, and the modified PAM score developed by Dautzenberg [1–3]. These scores are time consuming to apply and require the user to be able to identify such signs as heart failure and gallop rhythm. They also lack accuracy as none of them produced a sensitivity of greater than 30%. We set out to develop an improved scoring system which would be simple to apply, have a high reproducibility and no potential for observer error. Our hypothesis was that pre-arrest morbidity alone is by far the most important predictor of survivability of cardiac arrest. The scoring system we devised does not involve clinical signs and may be assessed in a few minutes and be used by doctors and nurses alike. The study was based upon the pre-hospital morbidity and established in-hospital diagnosis of patients. This removes the potential for observer error and means that frequent re-calculation becomes unnecessary. A final decision not to resuscitate is of course multi-factorial and we would never expect to make CPR decisions based on a scoring system alone. Any decisions would need to be made in the context of the guidelines already issued by the British Medical Association, the Royal College of Nursing, the European Resuscitation Council and the Resuscitation Council (UK).