Pareek et al reported the MIRACLE2 score for early prediction of the neurological outcome following an out-of-hospital cardiac arrest (OOHCA). This can help to identify patients with a worse prognosis. The authors are from multiple institutions in England and Slovenia.
MIRACLE2 is an acronym for missed, initial rhythm, reactivity of pupils, age, changing rhythms, low pH and epinephrine (given 2 points).
Outcome: cerebral performance category 3 to 5 at 6 months after OOHCA
Parameters:
(1) unwitnessed arrest (missed)
(2) non-shockable rhythm (initial rhythm)
(3) pupil reactivity on return of spontaneous circulation (ROSC)
(4) age in years
(5) intra-arrest rhythms
(6) arterial pH
(7) epinephrine therapy (any)
Parameter
Finding
Points
arrest
witnessed
0
unwitnessed
1
initial rhythm
shockable
0
non-shockable
1
pupil reactivity
none
1
any
0
age in years
< 60 years
0
60 to 80 years
1
> 80 years
3
cardiac rhythm
any 2 of ventricular fibrillation, pulseless electrical activity and asystole
1
other
0
arterial pH
< 7.2
1
>= 7.2
0
epinephrine therapy
any
2
none
0
total score =
= SUM(points for all of the parameters)
Interpretation:
• minimum score: 0
• maximum score: 10
Total Score
Poor Neurological Outcome at 6 Months
0
3%
1
8%
2
19%
3
40%
4
63%
5
82%
6
92%
7
97%
8
99%
9 or 10
> 99%
Performance:
• The area under the ROC curve is 0.90.
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