Resuscitation · 2026
Pre-hospital neurological risk stratification at return of spontaneous circulation (ROSC) after out-of-hospital cardiac arrest - the Pre-MIRACLE2 score.
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Razak Muhamad Abd, Hodsoll John, Jeyaprakash Prajith, McGarvey Michael, Hamilton Garry, Roy Roman, Ansell Evan, Kalra Sundeep, Kordis Peter, Cannata Antonio, Simpson Rupert, Sajjad Uzma, Curzen Nick, Rakar Serena, Appleby Clare, Mozid Abdul, Arri Satpal, Rathod Krishnaraj, Palczynski Piotr, Sieminski Mariusz, Yeoh Julian, Johnson Thomas W, Rees Paul, Keeble Thomas, Dworakowski Rafal, Fothergill Rachael, Noc Marko, MacCarthy Philip, Byrne Jonathan, Stahl Daniel, Pareek Nilesh
Аннотация
BACKGROUND: Out-of-hospital cardiac arrest (OHCA) remains a global health burden where neurological injury sustained is a key predictor of mortality but there are challenges in early risk stratification. This study aims to derive the Pre-MIRACLE2 score, which excludes pH as a component from the MIRACLE2 score, as a means of stratifying neurological risk in a pre-hospital setting.
METHODS: To validate the Pre-MIRACLE2 score, we used (i) the EUCAR Registry retrospectively analysed from 1 May 2012 to 31 December 2021, and (ii) the GLOBAL-MIRACLE Registry, a prospective cohort analysed from 1 January 2022 to 31 May 2023. The primary outcome was poor neurological outcome (defined as Cerebral Performance Category 3-5) at hospital discharge.
RESULTS: From 1 May 2012 until 31 May 2023, 2149 patients were resuscitated from OHCA with sustained return of spontaneous circulation. After excluding patients who remained non-comatose following return of spontaneous circulation and those with incomplete scores, 1402 patients from EUCAR and 747 from GLOBAL-MIRACLE were included in the final analysis. The primary endpoint occurred in 54.4% of the study cohort. The performance of the Pre-MIRACLE2 score for the primary endpoint was excellent, with an area under the receiver operating curve (AUROC) of 0.85 (95% CI 0.83, 0.87). From the prospective validation cohort (GLOBAL-MIRACLE), the AUROC was 0.85 (95% CI 0.82-0.88) with a calibration slope of 1.11 (95% CI 0.95-1.29).
CONCLUSION: The Pre-MIRACLE2 score has the potential to be an effective and pragmatic risk stratification tool for prediction of poor neurological outcome in patients with resuscitated OHCA of suspected cardiac aetiology in a pre-hospital environment or where pH cannot be measured.
METHODS: To validate the Pre-MIRACLE2 score, we used (i) the EUCAR Registry retrospectively analysed from 1 May 2012 to 31 December 2021, and (ii) the GLOBAL-MIRACLE Registry, a prospective cohort analysed from 1 January 2022 to 31 May 2023. The primary outcome was poor neurological outcome (defined as Cerebral Performance Category 3-5) at hospital discharge.
RESULTS: From 1 May 2012 until 31 May 2023, 2149 patients were resuscitated from OHCA with sustained return of spontaneous circulation. After excluding patients who remained non-comatose following return of spontaneous circulation and those with incomplete scores, 1402 patients from EUCAR and 747 from GLOBAL-MIRACLE were included in the final analysis. The primary endpoint occurred in 54.4% of the study cohort. The performance of the Pre-MIRACLE2 score for the primary endpoint was excellent, with an area under the receiver operating curve (AUROC) of 0.85 (95% CI 0.83, 0.87). From the prospective validation cohort (GLOBAL-MIRACLE), the AUROC was 0.85 (95% CI 0.82-0.88) with a calibration slope of 1.11 (95% CI 0.95-1.29).
CONCLUSION: The Pre-MIRACLE2 score has the potential to be an effective and pragmatic risk stratification tool for prediction of poor neurological outcome in patients with resuscitated OHCA of suspected cardiac aetiology in a pre-hospital environment or where pH cannot be measured.