Comparison of two sedation regimens during targeted temperature management after cardiac arrest

Claudio Sandroni, Marine Paul, Wulfran Bougouin, Florence Dumas, Guillaume Geri, Benoit Champigneulle, Lucie Guillemet, Omar Ben Hadj Salem, Stéphane Legriel, Jean-Daniel Chiche, Julien Charpentier, Jean-Paul Mira, Alain Cariou

Risultato della ricerca: Contributo in rivistaArticolo in rivista

27 Citazioni (Scopus)

Abstract

Purpose: Although guidelines on post-resuscitation care recommend the use of short-acting agents for sedation during targeted temperature management (TTM) after cardiac arrest (CA), the potential advantages of this strategy have not been clinically demonstrated. Methods: We compared two sedation regimens (propofol-remifentanil, period P2, vs midazolam-fentanyl, period P1) among comatose TTM-treated CA survivors. Management protocol, apart from sedation and neuromuscular blockers use, did not change between the two periods. Baseline severity was assessed with Cardiac-Arrest-Hospital-Prognosis (CAHP) score. Time to awakening was measured starting from discontinuation of sedation at the end of rewarming. Awakening was defined as delayed when it occurred after more than 48 h. Results: 460 patients (134 in P2, 326 in P1) were included. CAHP score did not significantly differ between P2 and P1 (P = 0.93). Sixty percent of patients awoke in both periods (81/134 vs. 194/326, P = 0.85). Median time to awakening was 2.5 (IQR 1–9) hours in P2 vs. 17 (IQR 7–60) hours in P1. Awakening was delayed in 6% of patients in P2 vs. 29% in P1 (p < 0.001). After adjustment, P2 was associated with significantly lower odds of delayed awakening (OR 0.08, 95% CI 0.03–0.2; P < 0.001). Patients in P2 had significantly more ventilator-free days (25 vs. 24 days; P = 0.007), and lower catecholamine-free days within day 28. Survival and favorable neurologic outcome at discharge did not differ across periods. Conclusions: During TTM following resuscitation from CA, sedation with propofol-remifentanil was associated with significantly earlier awakening and more ventilator-free days as compared with midazolam-fentanyl.
Lingua originaleEnglish
pagine (da-a)204-210
Numero di pagine7
RivistaResuscitation
Volume128
DOI
Stato di pubblicazionePubblicato - 2018

Keywords

  • Adult
  • Aged
  • Anesthetics, Intravenous
  • Cardiac arrest
  • Cardiology and Cardiovascular Medicine
  • Coma
  • Deep Sedation
  • Drug Therapy, Combination
  • Emergency Medicine
  • Emergency Nursing
  • Female
  • Fentanyl
  • Humans
  • Hypothermia, Induced
  • Infusions, Intravenous
  • Male
  • Midazolam
  • Middle Aged
  • Out-of-Hospital Cardiac Arrest
  • Prognosis
  • Propofol
  • Prospective Studies
  • Registries
  • Remifentanil
  • Sedation
  • Shivering
  • Therapeutic hypothermia
  • Wakefulness

Fingerprint Entra nei temi di ricerca di 'Comparison of two sedation regimens during targeted temperature management after cardiac arrest'. Insieme formano una fingerprint unica.

Cita questo