%0 PDF %T Variation in Sedation and Neuromuscular Blockade Regimens on Outcome After Cardiac Arrest %A May, Teresa. %D 2018-09-11T11:06:04.913-04:00 %8 2018-09-11 %R http://localhost/files/v692tj60c %X Abstract: Background: Sedation and neuromuscular blockade (NMB) protocols in patients undergoing targeted temperature management (TTM) after cardiac arrest address patient discomfort and manage shivering. These protocols vary widely between centers and may affect outcomes. Methods: Consecutive patients admitted to 20 centers after resuscitation from cardiac arrest were prospectively entered into the International Cardiac Arrest Registry between 2004-2016. Additional data about each center's sedation and shivering management practice was obtained via survey. Sedation and shivering practices (SP) were categorized as deep sedation and minimal or no NMB (SP1), moderate-deep sedation with continuous or scheduled NMB (SP2), or moderate-deep sedation with as-needed NMB (SP3). Good outcome was defined as cerebral performance category (CPC) score of 1 or 2. A logistic regression hierarchical model was created with two levels (patient-level data with standard confounders at level one and hospitals at level two) and sedation practice as a random effect at the hospital level. The primary outcome was dichotomized CPC at 6 months and the secondary outcome was dichotomized CPC at ICU discharge. Results: A total of 4,267 patients were included, with mean age 62±15 years, 36% female, 77% out-of-hospital arrests, and mean ischemic time was 24(±18) minutes. The unadjusted odds ratio (OR) for good outcome at 6 months was 1.19 (0.88-1.42, p=0.07) and 1.65 (1.40-1.97, p<0.001) for SP2 and SP3 respectively, referenced to SP1. Adjusted odds ratio (for age, ischemic time, location of arrest, witnessed, initial rhythm, bystander CPR, and defibrillation, medical history and size of hospital) was 1.13 (0.74-1.73, p=0.56) and 1.45 (1.00-2.13, p=0.046) for SP2 and SP3 respectively, referenced to SP1. For the secondary endpoint of good outcomes at discharge, the unadjusted odds ratio for SP2 and SP3 was 1.10 (0.90-1.34, p=0.34) and 1.69 (1.41-2.01, p<0.001), with adjusted odds ratios of 0.86 (0.55-1.35, p-0.52) and 1.46 (0.97-2.20, p=0.07), respectively. Discussion: Cardiac arrest patients treated at centers using moderate-deep sedation and as-needed NMB had increased odds of good outcomes compared to centers using deep sedation and avoidance of NMB, even after adjusting for potential confounders. Using sedation alone to treat shivering associated with TTM could be harmful. These findings should be further investigated in prospective studies.; Thesis (M.S.)--Tufts University, 2018.; Submitted to the Dept. of Clinical & Translational Science.; Advisor: David Kent.; Committee: Farzad Noubary, Douglas Sawyer, and Gilles Fraser.; Keyword: Medicine. %[ 2022-10-12 %9 Text %~ Tufts Digital Library %W Institution