MIRACLE2 score validation for neuroprognostication after out-of-hospital cardiac arrest: a district general hospital experience.

Abstract

Introduction and objectives: Decision-making regarding prognosticating out-of-hospital cardiac arrest (OHCA) remains challenging at the front door. The MIRACLE2 score provides a simple and practical tool for early neuroprognostication to aid decision-making. The study aims to validate the MIRACLE2 score in a district general hospital (DGH).

Material and methods: This is a retrospective analysis of the patients with OHCA and return of spontaneous circulation (ROSC) in the community who attended the cardiac catheter laboratory in a DGH between 1 September 2021 and 25 September 2023. Patients with a Glasgow Coma Scale of 15/15 after ROSC were excluded. Medical notes were examined, and the MIRACLE2 score was calculated and correlated with the Cerebral Performance Category (CPC) on discharge and compared with other neuroprognostication risk scores. The primary outcome was poor neurological recovery at hospital discharge, and the secondary outcome included poor neurological recovery at 6 months.

Results: A total of 46 patients satisfied the study criteria, of which 43 (93%) were males. The median age was 64; half had a CPC of 0-2 on discharge and at 6 months. The MIRACLE2 score was low (0-2) in 14 patients (30%), intermediate (3-4) in 16 patients (35%) and high (≥5) in 16 patients (35%). The MIRACLE2 score performed well in neuroprognostication as a MIRACLE2 score ≥5 had a positive predictive value of 91%, while a MIRACLE2 score ≤2 had a negative predictive value of 92% for poor neurological outcomes at discharge.

Conclusions: The MIRACLE2 score provides an accurate and practical neuroprognostication tool in patients with OHCA of cardiac origin presenting to this DGH.