Point-of-care testing for pre-hospital stratification after out-of-hospital cardiac arrest: the RAPID-MIRACLE study

Area of Science:

• Emergency Medicine
• Cardiology
• Critical Care

Background:

• Out-of-hospital cardiac arrest (OHCA) has a high mortality rate, with outcomes varying significantly.
• Current guidelines recommend transport to cardiac arrest centers, but early pre-hospital risk stratification could optimize patient selection.
• The utility of the MIRACLE2 score in the pre-hospital setting is not well-established.

Purpose of the Study:

• To evaluate the feasibility of rapid point-of-care testing for calculating the MIRACLE2 score after return of spontaneous circulation (ROSC).
• To assess the prognostic accuracy of pre-hospital MIRACLE2 scores for neurological outcomes in OHCA patients.

Main Methods:

• A prospective, multi-center observational study (RAPID-MIRACLE) involving adult OHCA patients with suspected cardiac etiology and sustained ROSC.
• Pre-hospital point-of-care venous blood-gas sampling was performed.
• Evaluated ROSC-MIRACLE2 (including post-ROSC pH), pre-MIRACLE2 (excluding pH), and admission MIRACLE2 scores.

Main Results:

• Among 292 patients, 48% experienced poor neurological outcome (Cerebral Performance Category 3-5).
• ROSC-MIRACLE2 demonstrated excellent discrimination (AUC 0.89), comparable to pre-MIRACLE2 (AUC 0.88) and admission MIRACLE2 (AUC 0.89).
• Post-ROSC pH <7.00 was independently associated with poor neurological outcome, with only 3% achieving good outcomes.

Conclusions:

• Pre-hospital application of ROSC-MIRACLE2 enables early neurological risk stratification for resuscitated OHCA patients.
• Point-of-care pH measurement enhances prognostic precision but faces feasibility challenges; the simplified pre-MIRACLE2 score is more practical with similar performance.
• Further studies are needed to integrate these scores into OHCA care pathways for improved patient stratification and resource utilization.