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Am J Med. 2017 Dec;130(12):1464.e13-1464.e21. doi: 10.1016/j.amjmed.2017.05.035. Epub 2017 Jun 21.

External Validation of the Simple NULL-PLEASE Clinical Score in Predicting Outcome of Out-of-Hospital Cardiac Arrest.

Author information

1
Cardiology Clinic, Clinical Centre of Serbia, Belgrade, Serbia; School of Medicine, Belgrade University, Belgrade, Serbia.
2
School of Medicine, Belgrade University, Belgrade, Serbia.
3
Emergency Centre, Clinical Centre of Serbia, Belgrade, Serbia.
4
School of Medicine, Belgrade University, Belgrade, Serbia; Emergency Centre, Clinical Centre of Serbia, Belgrade, Serbia.
5
Cardiology Department, City Hospital, Birmingham, United Kingdom.
6
School of Medicine, Belgrade University, Belgrade, Serbia; Institute of Cardiovascular Sciences, University of Birmingham, United Kingdom. Electronic address: g.y.h.lip@bham.ac.uk.

Abstract

BACKGROUND:

Rapid clinical decision-making on further management of patients with out-of-hospital cardiac arrest may be challenging. Recently, a "futility" score (NULL-PLEASE) incorporating multiple adverse resuscitation features (Nonshockable rhythm, Unwitnessed arrest, Long no-flow or Long low-flow period, blood PH <7.2, Lactate >7.0 mmol/L, End-stage chronic kidney disease on dialysis, Age ≥85 years, Still resuscitation, and Extracardiac cause) has been proposed to help identify patients with out-of-hospital cardiac arrest unlikely to survive; however, external independent score validation is lacking.

METHODS:

We retrospectively validated the NULL-PLEASE predictive ability for early in-hospital outcome of out-of-hospital cardiac arrest in a single-center cohort of 547 consecutive patients with out-of-hospital cardiac arrest who were admitted from April 2013 to October 2016 (mean age, 66.3 ± 13.2 years); 227 patients (41.5%) died. Because pH and lactate were inconsistently measured, a modified NULL-PLEASE score excluding both variables was calculated as the principal analysis. A sensitivity analysis included the subgroup with pH data available (n = 177).

RESULTS:

Long low-flow period and age ≥85 years were independently associated with fatal outcome (both P < .001). Patients with a modified NULL-PLEASE score of ≥5 had a 3.3-fold greater risk of fatal outcome compared with a score of 0 to 4 (odds ratio, 3.34; 95% confidence interval [CI], 2.29-4.89; P < .001); 77% of nonsurvivors had a score ≥5; NULL-PLEASE showed a modest predictive ability for fatal outcome (c-statistic 0.658; 95% CI, 0.613-0.704; P < .001). Sensitivity analysis yielded similar results, with 88% of nonsurvivors having a score ≥5.

CONCLUSIONS:

The NULL-PLEASE score was predictive for early in-hospital outcome of out-of-hospital cardiac arrest, with a 3.3-fold greater odds for fatal outcome at the score values of ≥5.

KEYWORDS:

In-hospital mortality; NULL-PLEASE score; Out-of-hospital cardiac arrest; Outcome; Prediction; Resuscitation

PMID:
28647407
DOI:
10.1016/j.amjmed.2017.05.035
[Indexed for MEDLINE]

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