Abstract 19369: Relation Between Sedative and Outcomes in Patients Undergoing Mild Therapeutic Hypothermia Following Cardiac Arrest
Introduction: Great variability in sedation protocols currently exists in treating patients undergoing mild therapeutic hypothermia (MTH) following cardiac arrest. Even though sedation may confound outcome prediction, the optimal agent to use remains unknown.
Methods: We retrospectively collected data on 201 consecutive adult patients admitted to Hartford Hospital who survived a cardiac arrest and were admitted to our cardiac intensive care unit (CICU). Use of sedatives, including propofol, midazolam, and lorazepam, was collected. The main outcome of interest was survival with good neurologic outcome defined using the Pittsburgh cerebral performance category (CPC) scale of 1-2. Multivariate logistic regression was used to control for potential confounders and identify independent predictors of good outcome.
Results: Of the 201 patients (mean age 61 ± 15 years), 99 (49.3%) had VF or VT and 102 (51.7%) had PEA or asystole. During their CICU stay, 172 (85.6%) patients received propofol, 134 (66.7%) received midazolam, and 111 (55.2%) received lorazepam. A positive correlation was seen between rate of survival with good neurologic outcome in patients who received propofol (p=0.01) or midazolam (p=0.021) while a negative correlation was seen with lorazepam (p=0.01). Multivariate analysis showed that propofol use (p=0.001) was a positive independent predictor of survival with good neurologic outcome during hospitalization in our population whereas lorazepam use (p=0.004), history of diabetes (p=0.004), and either asystole (p=0.004) or PEA (p=0.002) were negative predictors.
Conclusions: In our population, use of propofol or midazolam during MTH following cardiac arrest was positively associated with a good outcome while lorazepam use had a negative association. Direct head-to-head studies are required to identify the most appropriate sedation strategy to use in this population.
- © 2012 by American Heart Association, Inc.