This study derived and validated the Pre-MIRACLE2 score — a modified version of the MIRACLE2 score that omits pH — for pre-hospital prediction of poor neurological outcome (Cerebral Performance Category 3–5 at hospital discharge) in comatose survivors of out-of-hospital cardiac arrest (OHCA) of suspected cardiac aetiology. Two registries were used: EUCAR (retrospective, May 2012–Dec 2021) and GLOBAL-MIRACLE (prospective, Jan 2022–May 2023).
Across 2,149 resuscitated OHCA patients, 1,402 (EUCAR) and 747 (GLOBAL-MIRACLE) were analysed after exclusions; 54.4% reached the primary endpoint of poor neurological outcome. The Pre-MIRACLE2 score achieved an AUROC of 0.85 (95% CI 0.83–0.87) in the derivation cohort and 0.85 (95% CI 0.82–0.88) in prospective validation, with a calibration slope of 1.11 (95% CI 0.95–1.29).
- Full text was not available; details on score components, cut-off thresholds, and individual variable contributions cannot be assessed. - Patients with incomplete scores or who were non-comatose at ROSC were excluded, which may limit generalisability to real-world pre-hospital populations. - The score is restricted to suspected cardiac aetiology OHCA, so applicability to non-cardiac arrests is unclear.
The Pre-MIRACLE2 score may enable reliable neurological risk stratification at the scene or in settings where arterial blood gas is unavailable — consider its use to guide early triage and family communication after OHCA when pH cannot be measured.
Explore related topics
