Acute cardiac care & resuscitation
Point-of-care testing for pre-hospital stratification after out-of-hospital cardiac arrest: the RAPID-MIRACLE study
Authors' conclusion
In this study, pre-hospital application of ROSC-MIRACLE2 enables early neurological risk stratification following resuscitated OHCA. Point-of-care pH improves prognostic precision, but is constrained by feasibility, whilst the simplified pre-MIRACLE2 score is more practical with comparable performance. Integration into OHCA care pathways may improve patient stratification and resource utilization but requires further study.
Study context
- Population
- Adult patients with suspected cardiac aetiology out-of-hospital cardiac arrest (OHCA) achieving sustained return of spontaneous circulation (ROSC)
- Participants
- 292 patients
- Exposure
- ROSC-MIRACLE2 incorporating post-ROSC pH, compared with a modified MIRACLE2 excluding pH (pre-MIRACLE2) and standard MIRACLE2 calculated on hospital admission
- Outcome
- Poor neurological outcome (cerebral performance category (CPC) 3-5)
- Follow-up
- 30 days
Methodological detailsconducted across London with the London Ambulance Service, results blinded to receiving hospitals
- Conducted across London with the London Ambulance Service
- Results blinded to receiving hospitals
Main finding
As reported in the abstract
| Group | AUC |
|---|---|
| ROSC-MIRACLE2 | 0.89 (95% CI 0.85-0.92) |
| pre-MIRACLE2 | 0.88 (95% CI 0.84-0.92) |
| Admission MIRACLE2 | 0.89 (95% CI 0.85-0.92) |
AUC
ROSC-MIRACLE20.89 (95% CI 0.85-0.92)
pre-MIRACLE20.88 (95% CI 0.84-0.92)
Admission MIRACLE20.89 (95% CI 0.85-0.92)
- Patients with poor neurological outcome
- 48%
Observational data: associations, not effects.
Further findings
ROSC-MIRACLE2 predictive values
- Threshold 0-2, negative predictive value for good outcome
- 0.89 (0.82-0.94)
- Threshold ≥5, positive predictive value
- 0.88 (0.82-0.94)
Post-ROSC pH
- Patients with a ROSC pH <7.00 who had good neurological outcome
- less than 3%
- Independently associated with poor neurological outcome in a multi-variable regression model
Original publication
Point-of-care testing for pre-hospital stratification after out-of-hospital cardiac arrest: the RAPID-MIRACLE study. Eur Heart J Acute Cardiovasc Care. Published 30 March 2026. doi:10.
Summarised from the published abstract; every number is checked against it