Continuous neuromuscular blockade is associated with decreased mortality in post-cardiac arrest patients
| Autor: | John N. Clore, Benjamin S. Abella, Joseph P. Ornato, Mary Ann Peberdy, Justin D. Salciccioli, Shiva Gautam, Michael W. Donnino, Clifton W. Callaway, Michael N. Cocchi, Jon C. Rittenberger, Tyler Giberson, David F. Gaieski |
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| Rok vydání: | 2013 |
| Předmět: |
Adult
Male Emergency Nursing Return of spontaneous circulation Post-hoc analysis medicine Humans Prospective Studies Prospective cohort study Aged Neuromuscular Blockade business.industry Middle Aged Hypothermia medicine.disease Blockade Treatment Outcome Anesthesia Lactic acidosis Lactates Emergency Medicine Shivering Acidosis Lactic Female medicine.symptom Cardiology and Cardiovascular Medicine business Out-of-Hospital Cardiac Arrest |
| Zdroj: | Resuscitation. 84:1728-1733 |
| ISSN: | 0300-9572 |
| DOI: | 10.1016/j.resuscitation.2013.06.008 |
| Popis: | a b s t r a c t Aim: Neuromuscular blockade may improve outcomes in patients with acute respiratory distress syndrome. In post-cardiac arrest patients receiving therapeutic hypothermia, neuromuscular blockade is often used to prevent shivering. Our objective was to determine whether neuromuscular blockade is associated with improved outcomes after out-of-hospital cardiac arrest. Methods: A post hoc analysis of a prospective observational study of comatose adult (>18 years) out- of-hospital cardiac arrest at 4 tertiary cardiac arrest centers. The primary exposure of interest was neuromuscular blockade for 24 h following return of spontaneous circulation and primary outcomes were in-hospital survival and functional status at hospital discharge. Secondary outcomes were evolu- tion of oxygenation (PaO2:FiO2), and change in lactate. We tested the primary outcomes of in-hospital survival and neurologically intact survival with multivariable logistic regression. Secondary outcomes were tested with multivariable linear mixed-models. Results: A total of 111 patients were analyzed. In patients with 24 h of sustained neuromuscular blockade, the crude survival rate was 14/18 (78%) compared to 38/93 (41%) in patients without sustained neuro- muscular blockade (p = 0.004). After multivariable adjustment, neuromuscular blockade was associated with survival (adjusted OR: 7.23, 95% CI: 1.56-33.38). There was a trend toward improved functional outcome with neuromuscular blockade (50% versus 28%; p = 0.07). Sustained neuromuscular blockade was associated with improved lactate clearance (adjusted p = 0.01). Conclusions: We found that early neuromuscular blockade for a 24-h period is associated with an increased probability of survival. Secondarily, we found that early, sustained neuromuscular blockade is associated with improved lactate clearance. |
| Databáze: | OpenAIRE |
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