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Sedation and analgesia in post-cardiac arrest care: a post hoc analysis of the TTM2 trial
A. Ceric, J. Dankiewicz, T. Cronberg, J. Düring, M. Moseby-Knappe, M. Annborn, TL. May, M. Thomas, AM. Grejs, C. Rylander, J. Belohlavek, P. Wendel-Garcia, M. Haenggi, C. Schrag, MP. Hilty, TR. Keeble, MP. Wise, P. Young, FS. Taccone, C. Robba,...
Language English Country England, Great Britain
Document type Journal Article, Randomized Controlled Trial
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BioMedCentral
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- MeSH
- Analgesics therapeutic use MeSH
- Analgesia * methods standards statistics & numerical data MeSH
- Deep Sedation methods standards MeSH
- Hypnotics and Sedatives therapeutic use MeSH
- Middle Aged MeSH
- Humans MeSH
- Logistic Models MeSH
- Propofol therapeutic use MeSH
- Aged MeSH
- Out-of-Hospital Cardiac Arrest * therapy MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Randomized Controlled Trial MeSH
BACKGROUND: The routine use of sedation and analgesia during post-cardiac arrest care and its association with clinical outcomes remain unclear. This study aimed to describe the use of sedatives and analgesics in post-cardiac arrest care, and evaluate associations with good functional outcome, survival, clinical seizures, and late awakening. METHODS: This was a post hoc analysis of the TTM2-trial, which randomized 1900 out-of-hospital cardiac arrest patients to either normothermia or hypothermia. In both groups, deep sedation (Richmond Agitation and Sedation Scale ≤ -4) was mandatory during the 40-h intervention. Cumulative doses of sedatives and analgesic drugs were recorded within the first 72 h from randomization. Outcomes were functional outcome (modified Rankin Scale) and survival status at 6 months, occurrence of clinical seizures during the intensive care stay, and late awakening (Full outline of unresponsiveness motor score of four 96 h after randomization). Cumulative propofol doses were divided into quartiles (Q1-Q4). Logistic regression models were used to assess associations between sedative doses and functional outcome and survival, clinical seizures, and late awakening, adjusting for the severity of illness and other clinical factors influencing sedation. RESULTS: A total of 1861 patients were analyzed. In a multivariable logistic regression model, higher propofol doses (Q3, 100.7-153.6 mg/kg) were associated with good functional outcome (OR 1.62, 95%CI 1.12-2.34) and (Q2 and Q3, 43.9-153.6 mg/kg) with survival (OR 1.49, 95%CI 1.05-2.12 and OR 1.84, 95%CI 1.27-2.65, respectively). Receiving fentanyl and remifentanil were associated with good functional outcome (OR 1.69, 95%CI 1.27-2.26 and OR 1.50, 95%CI 1.11-2.02) and survival (OR 1.80, 95%CI 1.35-2.40 and OR 1.56, 95%CI 1.16-2.10). Receiving fentanyl (OR 0.64, 95%CI 0.48-0.86) and higher propofol doses (Q2-4 (43.9-669.4 mg/kg) were associated with the occurrence of clinical seizures. The highest quartile of propofol dose (153.7-669.4 mg/kg, OR 3.19, 95%CI 1.91-5.42) was associated with late awakening. CONCLUSIONS: In this study, higher doses of propofol and the use of remifentanil and fentanyl were associated with good functional outcome and survival, occurrence of clinical seizures, and late awakening.
Adult Critical Care University Hospital of Wales Cardiff UK
Cardiology Department Lund University Skåne University Hospital Lund Lund Sweden
Department of Clinical Medicine Aarhus University Aarhus N Denmark
Department of Clinical Sciences Lund Neurology and Rehabilitation Lund University Lund Sweden
Department of Critical Care Maine Medical Center Portland ME USA
Department of Intensive Care Medicine Aarhus University Hospital Aarhus N Denmark
Department of Intensive Care Medicine University Hospital Bern University of Bern Bern Switzerland
Department of Intensive Care University Hospitals Bristol and Weston Bristol UK
Institute of Heart Diseases Wroclaw Medical University Wroclaw Poland
Intensive Care Department Kantonsspital St Gallen St Gallen Switzerland
Medical ICU Cochin University Hospital AP HP Centre Université Paris Cité Paris France
Neurology Department of Clinical Sciences Lund Lund University Skåne University Hospital Lund Sweden
Neurology Department of Clinical Sciences Lund University Lund Sweden
The Australian and New Zealand Intensive Care Research Centre Monash University Melbourne Australia
References provided by Crossref.org
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