The MIRACLE2 risk score is associated with cognitive function, referral burden and discharge outcome

Abstract

Abstract Background Out-of-hospital cardiac arrest (OOHCA) can lead to poor neurological outcome. The MIRACLE2 score was devised to predict that risk, whilst supplementing clinical assessment and decision-making processes. However, the score has not previously been shown to correlate with cognitive and functional scoring assessment. Purpose To investigate the relationship between the MIRACLE2 risk score and cognitive and functional scoring assessments 1-3 months after hospital discharge. Methods We carried out a 1-year pilot evaluation of the cardiac arrest survivors’ clinic in a cardiac tertiary centre in London. From 46 patients, 12 had died, 6 did not attend, 7 were referred to their local hospital or rehabilitation facility, and 21 patients attended. The attending patients were tasked to complete the following questionnaires: Montreal Cognitive Assessment (MOCA), Hospital Anxiety and Depression Scale (HADS), Post-traumatic stress disorder (PTSD) checklist (PCL-5) and EQ-5D-5L score. Results Of the 21 patients (median age was 62; 90% were male), 3 had a MIRACLE2 score ≥ 5 (high risk), 6 had scored 3-4 (intermediate risk), whilst 12 had scored 0-2 (low risk). The median MOCA score was 85% (median self-assessed EQ-5D-5L: 65%; median HADS: anxiety 31%, depression 29%; median PCL-5: 14%). We found that patients with a low risk of poor neurological outcome (MIRACLE2 ≤ 2), had scored higher for MOCA (median: 92%) and self-assessed EQ-5D-5L (75%), and lower for HADS (anxiety: 29%, depression: 14%) and PCL-5 (7%). In comparison, patients with a high risk of poor neurological outcome (MIRACLE2 ≥ 5) had scored much lower for MOCA (58%) and self-assessed EQ-5D-5L (50%), and higher for HADS (anxiety: 67%, depression: 38%) and PCL-5 (40%). On average, patients with an intermediate risk of poor neurological outcome (MIRACLE2 3-4) had scored between both extremes. Of all 21 patients, 6 were referred to neurorehabilitation and/or neuropsychology (67% of those who scored ≥5, 33% who scored 3-4, and 17% who scored 0-2 were referred). Conclusion After hospital discharge, the MIRACLE2 score can predict the risk of cognitive impairment, anxiety, depression, PTSD and overall health in OOHCA patients. As such, the MIRACLE2 score can support the role for expedited access to neurorehabilitation and neuropsychology for affected patients – especially as recovery is time-sensitive.Assessment results in risk categories