Abstract 11885: Neuromuscular Blockade Requirement is Associated With Good Neurologic Outcome in Cardiac Arrest Survivors Treated With Targeted Temperature Management
Introduction: The optimal method for neuromuscular blockade (NMB) in post-resuscitation care has not been fully elucidated. We aimed to examine the association of NMB use with neurologic outcome and lactate clearance in cardiac arrest survivors treated with targeted temperature management (TTM).
Methods: This retrospective observational study included consecutive adult cardiac arrest survivors treated with TTM from 2012 to 2015. NMB use was categorized into 3 groups: no NMB, bolus NMB (intermittent bolus use), and continuous NMB (continuous infusion). The serum lactate was obtained on admission and at 12 h, 24 h, and 48 h after admission. The primary outcome was poor neurologic outcome at hospital discharge. The secondary outcome was lactate clearance.
Results: A total of 309 patients were included, and 206 (66.7%) were discharged with poor neurologic outcomes. No NMB, bolus NMB, and continuous NMB groups included 93, 119, and 97 patients, respectively. No NMB, bolus NMB, and continuous NMB use was associated with poor neurologic outcomes in 81/93 (87.1%), 78/119 (65.5%), and 47/97 (48.5%), respectively (p < 0.001). Multivariate analysis revealed that older age (odd ratio [OR] 1.038, 95% confidence interval [CI] 1.015-1.061, p = 0.001), shockable rhythm (OR 0.273, 95% CI 0.125-0.599, p=0.001), cardiac etiology (OR 0.262, 95% CI 0.115-0.599, p=0.001), longer downtime (OR 1.051, 95% CI 1.026-1.076, p <0.001), high Glasgow coma scale (OR 0.550, 95% CI 0.416-0.728, p <0.001), and continuous NMB (OR 0.317, 95% CI 0.124-0.815, p=0.017) compared to no NMB use were associated with poor neurologic outcomes. Serum lactate level (p = 0.658) and lactate clearance (p = 0.440) were not different among NMB groups. The serum lactate level decreased significantly over time (p <0.001), and was different between good and poor neurologic outcomes (p <0.001), while lactate clearance was not different (p = 0.701).
Conclusions: Continuous NMB use, rather than no NMB use, was associated with good neurologic outcome at discharge in cardiac arrest survivors treated with TTM. The method of NMB was not associated with serum lactate level and lactate clearance.
Author Disclosures: D. Lee: None. B. Lee: None. K. Jeung: None. Y. Min: None.
- © 2016 by American Heart Association, Inc.