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Validation of the NUE Rule to Predict Futile Resuscitation of Out-of-Hospital Cardiac Arrest

Nancy K Glober, Thomas Lardaro, Shawn Christopher

    Prehospital Emergency Care
    |October 7, 2020
    PubMed

    Insights

    The NUE rule, identifying patients with non-shockable rhythm, unwitnessed arrest, and age 80+, accurately predicted futile resuscitation in out-of-hospital cardiac arrest (OHCA) cases. This tool can guide emergency medical services (EMS) in withholding aggressive interventions when survival is unlikely.

    Area of Science:

    • Emergency Medicine
    • Cardiology
    • Public Health

    Background:

    • Out-of-hospital cardiac arrest (OHCA) presents significant resuscitation challenges.
    • Predicting futile resuscitation is crucial for optimizing emergency medical services (EMS) resource allocation.
    • The NUE rule (Non-shockable rhythm, Unwitnessed arrest, Eighty years or older) was developed to identify OHCA patients with extremely low survival probability.

    Purpose of the Study:

    • To validate the predictive performance of the NUE rule in an independent cohort of OHCA patients.
    • To assess the NUE rule's utility in identifying patients unlikely to survive to hospital discharge.

    Main Methods:

    • Retrospective cohort analysis of OHCA cases in Marion County, Indiana (2014-2019).
    • Inclusion of patient demographics, arrest characteristics, and EMS response data.
    • Evaluation of the NUE rule's accuracy in predicting survival outcomes.

    Main Results:

    • The study analyzed 4370 OHCA cases, with 329 excluded due to incomplete data.
    • The NUE rule identified 290 cases (7.2%) as unlikely to survive.
    • None of the patients identified by the NUE rule survived to hospital discharge.

    Conclusions:

    • The NUE rule demonstrated strong performance in external validation, accurately identifying OHCA patients with negligible survival chances.
    • The findings support the integration of the NUE rule into EMS protocols to guide decisions regarding aggressive resuscitation efforts.
    • Utilizing the NUE rule can help ensure resources are directed towards patients with a higher likelihood of positive outcomes.
    Abstract

    Keywords:
    emergency medical servicesout-of-hospital cardiac arrestresuscitation

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