• Tatjana S Potpara, Miroslav Mihajlovic, Sanja Stankovic, Tanja Jozic, Irena Jozic, Milika R Asanin, Rajai Ahmad, and LipGregory Y HGYHSchool of Medicine, Belgrade University, Belgrade, Serbia; Institute of Cardiovascular Sciences, University of Birmingham, United Kingdom. Electronic address: g.y.h.lip@bham.ac.uk..
• Cardiology Clinic, Clinical Centre of Serbia, Belgrade, Serbia; School of Medicine, Belgrade University, Belgrade, Serbia.
• Am. J. Med. 2017 Dec 1; 130 (12): 1464.e13-1464.e21.

BackgroundRapid 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.MethodsWe 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).ResultsLong 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.ConclusionsThe 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.Copyright © 2017 Elsevier Inc. All rights reserved.

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