Abstract P203: Evaluation of Appropriate Sedative Agents in Therapeutic Hypothermia for Out-of-Hospital Cardiac Arrest from Multicenter Registry in Japan: J-PULSE-Hypo Registry
Background: Therapeutic hypothermia for return of spontaneous circulation after ventricular fibrillation improves neurological outcomes of patients with out-of-hospital cardiac arrest. With the recent introduction of therapeutic hypothermia the application of sedation becomes necessary in cardiac arrest patients. However, appropriate sedative agents during hypothermia procedure remain unclear.
Methods: We conducted a multicenter retrospective study of 281 patients at 12 institutions to evaluate the effect of therapeutic hypothermia on out-of-hospital cardiac arrest between January 2005 and December 2008. The committee entrusted each hospital with timing of cooling, cooling methods, target temperature, hypothermia duration, re-warming rate, complications, and sedation methods. Enrolled patients were divided into group M (sedative and/or analgesia with muscle relaxant) and group C (control: sedative and/or analgesia without muscle relaxant). Any complications, time to target temperature, stability of temperature, and neurological outcome were compared. A favorable outcome was defined as a Cerebral Performance Category (CPC) of 1–2 at 30 days.
Results: A total of 264 patients were evaluated in this study. There was no significant difference in two groups. As compared with group C (N=64), group M (N=200) had higher rates of temperature instability (45% vs. 9%, p<0.01), temperature over shoot (31% vs. 5%, p<0.01), low cardiac index (4.1 vs. 5.0, p<0.01), and blood transfusion (18% vs. 3%, p<0.05). Both groups have favorable outcomes (55% vs. 66%, NS).
Conclusions: This study suggested that muscle relaxant was not appropriate for therapeutic hypothermia because of higher complication rate.