Does the Mainz Emergency Evaluation Scoring (MEES) in combination with capnometry (MEESc) help in the prognosis of outcome from cardiopulmonary resuscitation in a prehospital setting?

We present an improved Mainz Emergency Evaluation Scoring (MEES) combined with capnometry. MEES combined with capnometry in a new scoring system MEESc compared with MEES is significantly better and has greater value in predicting survival after cardiopulmonary resuscitation (CPR) in patients with normothermic nontraumatic cardiac arrest. We show that higher pre-CPR and final post-CPR values of partial end-tidal CO(2) pressure (p(et) CO(2)) at the time of the return of spontaneous circulation (ROSC) are connected with improved rate of survival. In our prospective clinical study we observed 246 patients 18 years of age and over who were found in nontraumatic normothermic cardiac arrest from February 1998 to February 2001. 128 (52%) were men. Initial and final (post-CPR) values of p(et) CO(2) were significantly higher in the group of patients with ROSC and in those who survived than in the group of patients without ROSC and those who died. All the patients with ROSC and those who survived had initial values of p(et) CO(2) higher than 1.33 kPa (10 mmHg). The mean of all the initial values of pet CO2 in patients without ROSC was 2.12 kPa+/-0.68 and the mean of all the final values in patients with ROSC was 3.11 kPa+/-0.55 kPa. Our study shows that the initial and final values of p(et) CO(2) of less than 2.13 kPa are connected with higher mortality rate and the values of less than 1.33 kPa incompatible with survival in normothermic nontraumatic cardiac arrest. We also must not forget the fact that prehospital use of the improved MEESc system enabled more efficient communication between the prehospital and hospital setting.