Dong Hun Lee1, Byung Kook Lee2, Kyung Woon Jeung1, Yong Hun Jung1, Yong Soo Cho1, Chun Song Youn3, Yong Il Min1. 1. Department of Emergency Medicine, Chonnam National University Hospital, 42 Jebong-ro, Donggu, Gwangju, Republic of Korea. 2. Department of Emergency Medicine, Chonnam National University Hospital, 42 Jebong-ro, Donggu, Gwangju, Republic of Korea. Electronic address: bbukkuk@hanmail.net. 3. Department of Emergency Medicine, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, Republic of Korea.
Abstract
PURPOSE: We examined the association between neuromuscular blockade (NMB) requirements and outcomes and lactate clearance in cardiac arrest survivors treated with targeted temperature management (TTM). METHODS: We included consecutive adult cardiac arrest survivors treated with TTM between 2012 and 2015. NMB use was categorized into 3 groups: no NMB, bolus NMB (intermittent bolus use), and continuous NMB (continuous infusion). Serum lactate levels were measured on admission and at 12h, 24h, and 48h after admission. The primary outcome was neurologic outcome at discharge. The secondary outcomes were in-hospital mortality and lactate clearance. RESULTS: In total, 309 patients were included. Of these, 206 (66.7%) and 73 (23.6%) were discharged with poor neurologic outcome and death, respectively. Multivariate analysis revealed that continuous NMB, as opposed to no NMB use, was associated with decreased poor neurologic outcomes (odds ratio [OR], 0.317; 95% confidence interval [CI], 0.124-0.815) and decreased in-hospital mortality (OR, 0.414; 95% CI, 0.183-0.941). There were no differences in lactate clearance between the NMB groups. CONCLUSION: Continuous NMB requirement was associated with improved neurologic outcome and decreased in-hospital mortality in cardiac arrest survivors treated with TTM. The NMB requirement was not associated with lactate clearance.
PURPOSE: We examined the association between neuromuscular blockade (NMB) requirements and outcomes and lactate clearance in cardiac arrest survivors treated with targeted temperature management (TTM). METHODS: We included consecutive adult cardiac arrest survivors treated with TTM between 2012 and 2015. NMB use was categorized into 3 groups: no NMB, bolus NMB (intermittent bolus use), and continuous NMB (continuous infusion). Serum lactate levels were measured on admission and at 12h, 24h, and 48h after admission. The primary outcome was neurologic outcome at discharge. The secondary outcomes were in-hospital mortality and lactate clearance. RESULTS: In total, 309 patients were included. Of these, 206 (66.7%) and 73 (23.6%) were discharged with poor neurologic outcome and death, respectively. Multivariate analysis revealed that continuous NMB, as opposed to no NMB use, was associated with decreased poor neurologic outcomes (odds ratio [OR], 0.317; 95% confidence interval [CI], 0.124-0.815) and decreased in-hospital mortality (OR, 0.414; 95% CI, 0.183-0.941). There were no differences in lactate clearance between the NMB groups. CONCLUSION: Continuous NMB requirement was associated with improved neurologic outcome and decreased in-hospital mortality in cardiac arrest survivors treated with TTM. The NMB requirement was not associated with lactate clearance.
Authors: Teresa L May; Richard R Riker; Gilles L Fraser; Karen G Hirsch; Sachin Agarwal; Christine Duarte; Hans Friberg; Eldar Søreide; John McPherson; Robert Hand; David Kent; Niklas Nielsen; David B Seder Journal: Crit Care Med Date: 2018-10 Impact factor: 7.598