• Simon Schmidbauer, Christian Rylander, Alain Cariou, Matt P Wise, Matthew Thomas, Thomas R Keeble, David Erlinge, Matthias Haenggi, Pedro D Wendel-Garcia, Jan Bělohlávek, Anders Morten Grejs, Niklas Nielsen, Hans Friberg, and Josef Dankiewicz.
• Department of Clinical Sciences, Anaesthesia and Intensive Care, Lund University, Skåne University Hospital, Malmö, Sweden. Electronic address: simon.schmidbauer@med.lu.se.
• Resuscitation. 2023 Oct 1; 191: 109949109949.

Background And AimsSeveral different scoring systems for early risk stratification after out-of-hospital cardiac arrest have been developed, but few have been validated in large datasets. The aim of the present study was to compare the well-validated Out-of-hospital Cardiac Arrest (OHCA) and Cardiac Arrest Hospital Prognosis (CAHP)-scores to the less complex MIRACLE2- and Target Temperature Management (TTM)-scores.MethodsThis was a post-hoc analysis of the Targeted Hypothermia versus Targeted Normothermia after Out-of-Hospital Cardiac Arrest (TTM2) trial. Missing data were handled by multiple imputation. The primary outcome was discriminatory performance assessed as the area under the receiver operating characteristics-curve (AUROC), with the outcome of interest being poor functional outcome or death (modified Rankin Scale 4-6) at 6 months after OHCA.ResultsData on functional outcome at 6 months were available for 1829 cases, which constituted the study population. The pooled AUROC for the MIRACLE2-score was 0.810 (95% CI 0.790-0.828), 0.835 (95% CI 0.816-0.852) for the TTM-score, 0.820 (95% CI 0.800-0.839) for the CAHP-score and 0.770 (95% CI 0.748-0.791) for the OHCA-score. At the cut-offs needed to achieve specificities >95%, sensitivities were <40% for all four scoring systems.ConclusionsThe TTM-, MIRACLE2- and CAHP-scores are all capable of providing objective risk estimates accurate enough to be used as part of a holistic patient assessment after OHCA of a suspected cardiac origin. Due to its simplicity, the MIRACLE2-score could be a practical solution for both clinical application and risk stratification within trials.Copyright © 2023 The Author(s). Published by Elsevier B.V. All rights reserved.

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