• Christina Byrne, Carlo A Barcella, KrogagerMaria LukacsMLDepartment of Cardiology, Aalborg University Hospital, Aalborg, Denmark., Manan Pareek, RinggrenKristian BundgaardKBDepartment of Cardiology, Aalborg University Hospital, Aalborg, Denmark., Mikkel Porsborg Andersen, Elisabeth Helen Anna Mills, Mads Wissenberg, Fredrik Folke, Gunnar Gislason, Lars Køber, Freddy Lippert, Jesper Kjærgaard, Christian Hassager, Christian Torp-Pedersen, Kristian Kragholm, and LipGregory Y HGYHLiverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark..
• Department of Cardiology, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark; Department of Cardiology, Gentofte University Hospital, Hellerup, Denmark. Electronic address: christina.aagaard@sund.ku.dk.
• Resuscitation. 2022 Nov 1; 180: 128136128-136.

AimThe NULL-PLEASE score (Nonshockable rhythm, Unwitnessed arrest, Long no-flow or Long low-flow period, blood pH < 7.2, Lactate > 7.0 mmol/L, End-stage renal disease on dialysis, Age ≥85 years, Still resuscitation, and Extracardiac cause) may identify patients with out-of-hospital cardiac arrest (OHCA) unlikely to survive. We aimed to validate the NULL-PLEASE score in a nationwide setting.MethodsWe used Danish nationwide registry data from 2001 to 2019 and identified OHCA survivors with return of spontaneous circulation (ROSC) or ongoing cardiopulmonary resuscitation at hospital arrival. The primary outcome was 1-day mortality. Secondary outcomes were 30-day mortality and the combined outcome of 1-year mortality or anoxic brain damage. The risks of outcomes were estimated using logistic regression with a NULL-PLEASE score of 0 as reference (range 0-14). The predictive ability of the score was examined using the area under the receiver operating characteristics (AUCROC) curve.ResultsA total of 3,881 patients were included in the analyses. One-day mortality was 35%, 30-day mortality was 61%, and 68% experienced the combined outcome. For a NULL-PLEASE score ≥9 (n = 244) the absolute risks were: 1-day mortality: 80.7% (95% confidence interval [CI]: 75.8-85.7%); 30-day mortality: 98.0% (95% CI: 96.2-99.7%); and the combined outcome: 98.4% (95% CI: 96.8-100.0%). Corresponding AUCROC values were 0.800 (95% CI: 0.786-0.814) for 1-day mortality, 0.827 (95% CI: 0.814-0.840) for 30-day mortality, and 0.828 (95% CI: 0.815-0.841) for the combined outcome.ConclusionsIn a nationwide OHCA-cohort, AUCROC values for the predictive ability of NULL-PLEASE were high for all outcomes. However, some survived even with high NULL-PLEASE scores.Copyright © 2022. Published by Elsevier B.V.

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