Abstract 336: Selective Use of Neuromuscular Blockade in Therapeutic Hypothermia Does Not Delay Time to Target Temperature
Background: Optimal management of shivering during Therapeutic Hypothermia(TH) is important to quickly achieve target temperature with a goal of improving neurological outcomes. Interventions (pharmacological and non-pharmacological) to manage shivering vary among institutions. We developed a step-wise guideline approach to: 1) prevent and manage shivering during the different phases of TH, 2) avoid delays to achieving target temperature (TT) and 3) reduce the use of neuromuscular blocking agents (NMBA).
Methods: We report a single center experience examining the differences in time to target temperature, medication use and patient outcomes pre-(Jan2009-June2011) and post-(July2011-April2013) implementation of a TH Prevention and Management of Shivering algorithm.
Results: A total of 138 patients had TH (62 patients pre vs 76 in the post-guidelines).
Fewer patients post-guideline implementation received any NMBA (55.3% vs 83.9%, p=0.001), with a lower total dose of NMBA (59.4± 58.7 vs 99.8 ± 70.3 mg, p=0.001). In patients who received NMBA, the post group received more bolus only (64.3% vs 5.8%); and less infusion only (9.5% vs 48.1%) or infusion + bolus (26.2% vs 46.1% p <0.001) therapy. As expected, propofol use increased in the post- group (3.1 vs 2.5 mg/kg/hr, p=0.02) as did increased use of fentanyl boluses (n=44 [4.1 ± 3] vs n=17 [2.5 ± 1.4] p=0.03). While more shivering was noted in the post group (43.5% vs 27.4%; p=0.04), there was no significant difference between the groups in the ROSC to TT time or ICU days. Survival and neurological outcomes were similar between the two groups.
Conclusion: Selective use of NMBA as part of a shivering algorithm does not delay time to TT in TH. The decreased use of NMBA resulted in increased doses of sedation and analgesia without effects on patient survival or neurological outcome. Further research on optimal usage of NMBA in TH is needed.
- © 2013 by American Heart Association, Inc.