Abstract 226: Neuromuscular Blockade in Post--Cardiac Arrest: Practice Patterns and Association with Outcome Measures
Introduction: Neuromuscular blockade (NMB) may improve outcomes in acute respiratory distress syndrome. In post-cardiac arrest (CA) patients receiving therapeutic hypothermia (TH) NMB is sometimes used to prevent shivering. Whether NMB improves outcomes from CA is unknown.
Objective: To assess the association between NMB and outcomes from CA.
Methods: A post-hoc analysis of a prospective multicenter observational study of adult CA from 6/2011 to 3/2012. Inclusion criteria were: adult (> 18 years), out-of-hospital CA, return of spontaneous circulation (ROSC), comatose following ROSC. Traumatic CA were excluded. Patient characteristics, vital signs, laboratory data and discharge data were recorded. The exposure of interest was NMB within 24hrs of ROSC. The primary outcome was in-hospital survival. Secondary outcomes were neurological status (Modified Rankin [MR]), oxygenation (PaO2:FiO2), and lactate clearance. We used simple descriptive statistics to describe the study population, Chi-square for unadjusted tests, and multivariable (age, downtime, rhythm, SOFA score) logistic regression or linear mixed-models for the relationship between NMB and outcomes.
Results: 111 patients were analyzed. The median age was 63 years (IQR: 50 - 75) and 41% were female. TH was completed in 97% and overall survival was 47%. 60% received any NMB within 12hrs of ROSC and 69% received any NMB within 24hrs of ROSC. With 12hrs of sustained NMB, the crude survival rate was 15/21 (71%) compared to 37/90 (41%) without 12hrs of NMB (p = 0.01). With 24hrs of sustained NMB, the crude survival rate was 14/18 (78%) compared to 38/93 (41%) in patients without sustained NMB (p = 0.004). There was a trend toward improved neurologic outcome with NMB: MR 0 - 2: 44% vs. 23% (p = 0.05). After multivariable adjustment, NMB was not associated with survival (adjusted OR: 3.35, 95% CI: 0.83 - 13.57, p = 0.09; H-L goodness-of-fit: p = 0.95). Sustained NMB improved lactate clearance over 24hrs (adjusted p = 0.03). There was no effect of NMB on PaO2:FiO2 (p = 0.5).
Conclusion: In post-CA early NMB is common. Early, sustained NMB is associated with improved lactate clearance and a trend in improved survival, but no effect was observed on PaO2:FiO2 ratio.
- © 2012 by American Heart Association, Inc.