The Early Prediction Score (EPS) of Delooz et al for Cardiopulmonary Resuscitation

 

Outcomes following cardiopulmonary arrest:

(1) Class 1: unsuccessful CPR, with failure to restore spontaneous circulation

(2) Class 2: spontaneous circulation restored but the patient died within 14 days or was in a vegetative state

(3) Class 3: alive and conscious at 14 days after CPR

 

Parameters:

(1) type of cardiac arrest

(2) type of respiratory arrest

(3) pupillary reaction

(4) swallowing activity

(5) arrest detection

Parameter	Finding	Points
type of cardiac arrest	ventricular fibrillation	1
	other	0
type of respiratory arrest	gasping	1
	other	0
pupillary reaction	present (normal, slow or unequal)	1
	absent	0
swallowing activity	present	1
	absent	0
arrest detection	witnessed	1
	not witnessed	0

 

EPS =

= SUM(points for all 5 parameters)

 

Interpretation:

• minimum score: 0

• maximum score: 5

• The higher the score, the more likely a successful outcome (Class 3) can be achieved.

• Determining the score during resuscitation was of limited use in deciding whether to continue or discontinue resuscitation.

• Determining the score 10 minutes after an initially successful outcome could be used to discuss the chances for survival vs nonsurvival with the patient's relatives.

 

Score at 10 minutes	Probability of Class 3 Outcome
0	41%
1	42%
2	47%
3	54%
4	59%
5	61%

see Table III, page S152, and Figure 1, page S153, solid black dots

 

where:

• Outcomes for scores of 0 or 1 and of 4 or 5 look pretty close.

• I am not sure how much the score would change at 10 minutes after vs during resuscitation. The type of cardiac and pulmonary arrest should be the same, as would be the manner the detecting the arrest. Waiting would exclude those who did not obtain spontaneous circulation.

 

Limitation:

• Stopping at 14 days and ignoring late outcomes seems to be somewhat biased.

• After reading the discussion, I am not sure just how useful the score is for discussing the patient's chances with relatives, as claimed on page S154. The outcome looks pretty guarded across the spectrum of scores.