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The Mainz Emergency Evaluation Score with Capnometry (MEESc) for Patients with Cardiopulmonary Resuscitation in a Prehospital Setting

Purpose: To use the Mainz emergency evaluation score combined with capnometry (MEESc) to evaluate prehospital cardiopulmonary resuscitation.

Description

The Mainz Emergency Evaluation Score (MEES) was developed for evaluation of patients receiving prehospital emergency medical services. Grmec and Kupnik used the basic score together with endotracheal capnometry to evaluate patients receiving cardiopulmonary resuscitation in a prehospital setting. The authors are from Maribor, Slovenia.


Parameters:

(1) Glasgow coma scale

(2) heart rate

(3) respiratory rate

(4) cardiac rhythm

(5) pain

(6) systolic blood pressure

(7) oxygen saturation

(8) initial endotracheal pCO2

(9) final endotracheal pCO2 after 20 minutes CPR

 

Differences from the MEES:

(1) Only the systolic blood pressure is used (the original MEES using both systolic and diastolic).

(2) Pain does not include the "entfallt" category.

(3) Comparison of previous values does not appear to be emphasized.

(4) The patient is intubated with measurement of pCO2 in the endotracheal tube.

 

Degree of Change in Parameter

Scoring (Below)

physiologic, normal

4

mild deviation

3

considerable deviation

2

life-threatening

1

 

Patient selection: The MEESc is not applicable to children.

 

Parameter

Finding

Points

Glasgow coma scale

15

4

 

12 - 14

3

 

8 - 11

2

 

<= 7

1

heart rate

<= 39 beats per minute

1

 

40 - 49

2

 

50 - 59

3

 

60 - 100

4

 

101 - 130

3

 

131 - 160

2

 

>= 161

1

respiratory rate

<= 4 breaths per minute

1

 

5 - 7

2

 

8 - 11

3

 

12 - 18

4

 

19 - 24

3

 

25 - 30

2

 

>= 31

1

cardiac rhythm

sinus rhythm

4

 

supraventricular extrasystole (SVES)

isolated ventricular extrasystole

3

 

multiple ventricular extrasystole

ABSARRH

2

 

ventricular tachycardia

ventricular fibrillation

asystole

1

pain

none

4

 

mild

3

 

strong

2

systolic blood pressure

<= 79

1

 

80 - 99

2

 

100 - 119

3

 

120 - 140

4

 

141 - 159

3

 

160 - 229

2

 

>= 230

1

oxygen saturation

96 - 100%

4

 

91 - 95%

3

 

86 - 90%

2

 

<= 85%

1

initial endotracheal pCO2

< 1.99 kPa (< 15 mm Hg)

0

 

1.99 - 2.66 kPa (15-20 mm Hg)

1

 

> 2.66 kPa (> 20 mm Hg)

2

final endotracheal pCO2

< 3.33 kPa (< 25 mm Hg)

0

 

3.33 - 3.99 kPa (25-30 mm Hg)

1

 

> 3.99 kPa (> 30 mm Hg)

2

 

where:

• I am not sure what ABSARRH means. It appears to mean "absolute arrhythmia".

 

MEESc =

= SUM(points for the 9 parameters)

 

Interpretation:

• minimum score: 8 (the titlebar to Table 1 says the minimum score is 10, but 8 is all I see)

• maximum score: 32

• The higher the score, the better the patient's condition.

• The cutoff score selected was > 21 for good prognosis and <= 21 for poor.

 

Performance:

• The sensitivity was 82.8% and specificity 76.3%.

• The correct prediction of outcome was seen in 82.8%.

• The Youden index was 0.65 and the area under the ROC was 0.84.

• These numbers are not stellar.


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Specialty

Objective

ICD-10