Comparison of MIRACLE2, Cardiac Arrest Hospital Prognosis, Target Temperature Management, and General Severity Scores for Predicting Poor Neurological Outcomes and Mortality after Out-of-hospital Cardiac Arrest

Background and aims: The comparative performance of cardiac arrest-specific prognostic models, MIRACLE 2 , Cardiac Arrest Hospital Prognosis (CAHP), and target temperature management (TTM), vs general intensive care unit (ICU) severity scores, Acute Physiology and Chronic Health Evaluation (APACHE) II, Simplified Acute Physiology Score (SAPS) II, and SAPS-3 in predicting post-arrest outcomes is not fully established.This study compared these scores in predicting neurological outcomes and in-hospital mortality for out-of-hospital cardiac arrest (OHCA) patients of cardiac origin. Patients and methods:We retrospectively analyzed 158 consecutive adult OHCA patients of cardiac origin admitted to the ICU after achieving return of spontaneous circulation (ROSC).The primary outcome was unfavorable neurological status at discharge.Results: Overall, hospital mortality was 53.2%, and 73.4% of patients experienced unfavorable neurological outcomes.All scores demonstrated good discriminative ability with areas under the receiver operating characteristic curve (AUROC) >0.80 for both outcomes.However, the TTM score achieved the highest discriminative performance for predicting poor neurological outcomes [AUROC: 0.899; 95% confidence interval (CI): 0.852-0.946]and mortality (AUROC: 0.854; 95% CI: 0.796-0.912).The TTM score showed significantly better predictive accuracy than MIRACLE 2 (p = 0.005), APACHE II (p < 0.001), SAPS II (p < 0.001), and SAPS-3 (p < 0.001).Conclusion: The MIRACLE 2 , CAHP, TTM, and general ICU scores can be used as part of the outcome assessment in OHCA from cardiac etiologies.The TTM score may be preferable, as it has superior discriminatory performance to the MIRACLE 2 and general ICU scores.However, a notable limitation of the TTM score is more clinical granularity compared with MIRACLE 2 , which may render it less practical in time-sensitive emergency settings.