A retrospective study published in the Indian Journal of Critical Care Medicine in September 2026 found that the TTM score predicted neurological recovery and hospital death after out-of-hospital cardiac arrest more accurately than conventional cardiac and intensive care scoring systems. The TTM score reached an area under the receiver operating characteristic curve, or AUROC, of 0.899 for poor neurological recovery and 0.854 for in-hospital mortality, the highest figures among the six tools tested.
The study, by Natthaka Sathaporn and Bodin Khwannimit of the Division of Critical Care Medicine at Prince of Songkla University in Thailand, looked at 158 adult patients admitted to a Thai academic intensive care unit after resuscitated cardiac-origin out-of-hospital cardiac arrest. The researchers compared three cardiac arrest tools, MIRACLE2, Cardiac Arrest Hospital Prognosis (CAHP) and the TTM score, against three general intensive care models, APACHE II, SAPS II and SAPS-3, for forecasting neurological recovery and hospital mortality after resuscitation.
Out-of-hospital cardiac arrest remains a major global mortality challenge, and prompt post-resuscitation evaluation shapes what happens next for survivors. Families and clinicians need an early, honest estimate of whether a patient is likely to recover brain function or face severe impairment, since that estimate guides intensive care decisions and planning for rehabilitation. Comparative evidence on post-arrest scoring tools in cardiac-origin cases has been scarce, which is the gap the study set out to address.
How the TTM score compared with the other tools
All six scores performed well in the study, each reaching AUROC values above 0.80 for both outcomes. An AUROC of 1.0 would mean perfect discrimination between patients who recover and those who do not, while 0.5 would mean no better than chance, so figures above 0.80 show real predictive power across the board. The TTM score still came out ahead, with 0.899 for poor neurological status and 0.854 for mortality, and it outperformed MIRACLE2, APACHE II, SAPS II and SAPS-3 by margins the researchers reported as statistically significant.
The overall figures from the 158 patients show how serious the condition is. Hospital mortality stood at 53.2 percent, and 73.4 percent of post-arrest patients had unfavourable neurological status at discharge. That is why an accurate early TTM score carries weight for clinicians and families.
The study also tested cut-off thresholds for bedside use. Thresholds of TTM 16 or above, MIRACLE2 5 or above and CAHP 200 or above each gave a specificity of 90.5 percent for poor neurological recovery, with sensitivities of 74.1 percent, 69.0 percent and 66.4 percent respectively. At the extremes, no patient with a TTM score below 5, a MIRACLE2 score below 2 or a CAHP score below 120 had a poor outcome, while scores of TTM 19 or above, MIRACLE2 7 or above and CAHP 290 or above each predicted poor neurological status in every case.
What separated patients with good TTM score outcomes
Patients who recovered well differed from the rest in several measurable ways. They were younger, at an average of 56.5 years against 61 years for the others. They more often had a shockable heart rhythm at presentation, 76.2 percent against 29.3 percent. Their no-flow times, the minutes without blood circulation before resuscitation began, were shorter, at 4 minutes against 10 minutes. Their lactate levels, a blood marker of tissue oxygen starvation, were lower, at 5.4 against 8.9 millimoles per litre. Each of those differences was reported as statistically significant.
Those patterns fit what intensive care teams already know about cardiac arrest. A shockable rhythm can often be corrected with defibrillation, a short no-flow time limits brain injury, and lower lactate points to less severe oxygen deprivation across the body. The TTM score pulls such factors together into a single number, which is why the researchers suggest it may help clinicians weigh prognosis more consistently than juggling separate observations during a busy intensive care admission.
Limits of the study
The study has limits the authors stated plainly. It was a single-centre retrospective study, so its results reflect the practice patterns of one Thai academic intensive care unit rather than a mix of hospitals. Its evaluations were short term, restricted to hospital discharge, so the findings say nothing about longer term functional recovery months after the event. Prospective multicentre studies that track long-term recovery would be needed to confirm the findings across different settings.
That caution matters for hospitals thinking about adopting the tool. A score that performs well in one unit, with one case mix and one set of treatment routines, may behave differently elsewhere. The study still gives intensive care teams a concrete comparison of six tools on the same patients, and the TTM score’s lead on both outcomes, 0.899 and 0.854, gives it a clear case for further testing rather than immediate universal adoption.