Usefulness of the NULL-PLEASE Score to Predict Survival in Out-of-Hospital Cardiac Arrest

Out-of-hospital cardiac arrest (OHCA) carries a very high mortality rate even after successful cardiopulmonary resuscitation. Currently, information given to relatives about prognosis following resuscitation is often emotive and subjective, and varies with clinician experience. We aimed to validate...

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Bibliographic Details
Published in:	The American journal of medicine Vol. 133; no. 11; pp. 1328 - 1335
Main Authors:	Gue, Ying X., Sayers, Max, Whitby, Benjamin T., Kanji, Rahim, Adatia, Krishma, Smith, Robert, Davies, William R., Perperoglou, Aris, Potpara, Tatjana S., Lip, Gregory Y.H., Gorog, Diana A.
Format:	Journal Article
Language:	English
Published:	United States Elsevier Inc 01-11-2020
Subjects:	Age Factors Aged Aged, 80 and over Cardiac arrest Cardiopulmonary Resuscitation Electric Countershock Female Hemorrhage - complications Hospital Mortality Humans Hydrogen-Ion Concentration Kidney Failure, Chronic - epidemiology Kidney Failure, Chronic - therapy Lactic Acid - blood Length of Stay - statistics & numerical data Logistic Models Male Middle Aged Myocardial Infarction - complications Out-of-Hospital Cardiac Arrest - blood Out-of-Hospital Cardiac Arrest - etiology Out-of-Hospital Cardiac Arrest - mortality Out-of-Hospital Cardiac Arrest - therapy Outcome Prognosis Prospective Studies Pulmonary Embolism - complications Reproducibility of Results Retrospective Studies Return of Spontaneous Circulation Risk Assessment Risk-score Stroke - complications Survival Survival Rate Time Factors Wounds and Injuries - complications Prognosis Risk-score Survival Outcome Cardiac arrest
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Summary:	Out-of-hospital cardiac arrest (OHCA) carries a very high mortality rate even after successful cardiopulmonary resuscitation. Currently, information given to relatives about prognosis following resuscitation is often emotive and subjective, and varies with clinician experience. We aimed to validate the NULL-PLEASE score to predict survival following OHCA. A multicenter cohort study was conducted, with retrospective and prospective validation in consecutive unselected patients presenting with OHCA. The NULL-PLEASE score was calculated by attributing points to the following variables: Nonshockable initial rhythm, Unwitnessed arrest, Long low-flow period, Long no-flow period, pH <7.2, Lactate >7.0 mmol/L, End-stage renal failure, Age ≥85 years, Still resuscitation, and Extracardiac cause. The primary outcome was in-hospital death. We assessed 700 patients admitted with OHCA, of whom 47% survived to discharge. In 300 patients we performed a retrospective validation, followed by prospective validation in 400 patients. The NULL-PLEASE score was lower in patients who survived compared with those who died (0 [interquartile range 0-1] vs 4 [interquartile range 2-4], P < .0005) and strongly predictive of in-hospital death (C-statistic 0.874; 95% confidence interval, 0.848-0.899). Patients with a score ≥3 had a 24-fold increased risk of death (odds ratio 23.6; 95% confidence interval, 14.840-37.5; P < .0005) compared with those with lower scores. A score ≥3 has a 91% positive predictive value for in-hospital death, while a score <3 predicts a 71% chance of survival. The easy-to-use NULL-PLEASE score predicts in-hospital mortality with high specificity and can help clinicians explain the prognosis to relatives in an easy-to-understand, objective fashion, to realistically prepare them for the future.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0002-9343 1555-7162
DOI:	10.1016/j.amjmed.2020.03.046