Ahmad et al reported the NULL-PLEASE score for evaluating a patient who has had an out-of-hospital cardiac arrest. This can help to identify a patient for whom management may be futile. The authors are from City Hospital in Birmingham, England.
NULL-PLEASE is an acronym for the parameters.
Patient selection: out-of-hospital cardiac arrest
Parameters:
(1) non-shockable rhythm (N)
(2) unwitnessed arrest (U)
(3) long no-flow period (L), indicated by no bystander CPR prior to arrival of EMS)
(4) long low-flow period (L)
(5) pH (P)
(6) serum lactate (L) in mmol/L
(7) end-stage renal failure (E)
(8) age (A)
(9) still on-going CPR (S), suggesting delayed return of spontaneous circulation (ROSC)
(10) extra-cardiac cause (E), such as trauma
|
Parameter
|
Finding
|
Points
|
|
non-shockable rhythm
|
no
|
0
|
|
|
yes
|
2
|
|
unwitnessed arrest
|
no
|
0
|
|
|
yes
|
2
|
|
long no-flow period
|
no
|
0
|
|
|
yes
|
2
|
|
low-flow period
|
<= 30 minutes
|
0
|
|
|
> 30 minutes
|
2
|
|
arterial pH
|
< 7.2
|
1
|
|
|
>= 7.2
|
0
|
|
serum lactate
|
<= 7 mmol/L
|
0
|
|
|
> 7 mmol/L
|
1
|
|
ESRD
|
no
|
0
|
|
|
yes, on dialysis
|
1
|
|
age
|
<= 85 years
|
0
|
|
|
> 85 years
|
1
|
|
still on-going CPR
|
no
|
0
|
|
|
yes
|
1
|
|
extra-cardiac cause
|
no
|
0
|
|
|
yes
|
1
|
total score =
= SUM(points for all of the pararmeters)
Interpretation:
• minimum score: 0
• maximum score: 14
• All patients with a score > 6 did not survive.
• The lower the score the better the survival.
