Neuromuscular blockade during therapeutic hypothermia after cardiac arrest: Observational study of neurological and infectious outcomes
Neuromuscular blockade during therapeutic hypothermia after cardiac arrest: Observational study of neurological and infectious outcomes
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DOI：
10.1016/j.resuscitation.2014.05.017
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发表时间：
2014-09-01
期刊：
影响因子：
6.5
通讯作者：
Reignier, Jean
中科院分区：
文献类型：
--
作者：
Lascarrou, Jean Baptiste;Le Gouge, Amelie;Reignier, Jean
简介：神经肌肉阻滞（NMB）被广泛用于心脏骤停后的治疗性低温（TH），但其对患者预后的影响尚不清楚。我们比较了神经肌肉对神经功能的影响和早发性肺炎的心脏骤停幸存者与TH.Methods管理的频率：我们回顾性研究了连续的成人心脏骤停幸存者与TH在三级重症监护病房2008年1月至2013年7月。对持续性寒战给予持续肌松的患者与未给予肌松的患者进行比较。记录早发性肺炎病例和ICU出院时的生命状态。为了避免偏见，由于组间基线差异，我们调整了分析的倾向scores.Results：311心脏骤停的幸存者，144接受TH，包括117个连续NMB和27个没有NMB。NMB组的ICU死亡率较低（风险比[HR]，0.54 [0.32; 0.89]，p = 0.016），但调整倾向评分后差异不显著（HR，0.70 [0.39; 1.25]，p = 0.22）。神经功能结局良好的患者比例无显著差异（36%伴NMB，22%不伴NMB，p = 0.16）。早发性肺炎更常见于NMB（HR，2.36 [1.24; 4.50]，p = 0.009），但调整倾向评分后差异不显著（HR，1.68 [0.90; 3.16]，p = 0.10）。心脏骤停后TH期间持续静脉注射NMB对ICU生存率有潜在的影响，早发性肺炎的频率有增加的趋势。需要进行随机对照试验来确定肌松在治疗TH诱导的寒战中的作用。(C)2014作者出版社：Elsevier爱尔兰Ltd.
Introduction: Neuromuscular blockade (NMB) is widely used during therapeutic hypothermia (TH) after cardiac arrest but its effect on patient outcomes is unclear. We compared the effects of NMB on neurological outcomes and frequency of early-onset pneumonia in cardiac-arrest survivors managed with TH.Methods: We retrospectively studied consecutive adult cardiac-arrest survivors managed with TH in a tertiary-level intensive care unit between January 2008 and July 2013. Patients given continuous NMB for persistent shivering were compared to those managed without NMB. Cases of early-onset pneumonia and vital status at ICU discharge were recorded. To avoid bias due to between-group baseline differences, we adjusted the analysis on a propensity score.Results: Of 311 cardiac-arrest survivors, 144 received TH, including 117 with continuous NMB and 27 without NMBs. ICU mortality was lower with NMB (hazard ratio [HR], 0.54 [0.32; 0.89], p = 0.016) but the difference was not significant after adjustment on the propensity score (HR, 0.70 [0.39; 1.25], p = 0.22). The proportion of patients with good neurological outcomes was not significantly different (36% with and 22% without NMB, p = 0.16). Early-onset pneumonia was more common with NMB (HR, 2.36 [1.24; 4.50], p = 0.009) but the difference was not significant after adjustment on the propensity score (HR, 1.68 [0.90; 3.16], p = 0.10).Conclusions: Continuous intravenous NMB during TH after cardiac arrest has potential owns effects on ICU survival with a trend increase in the frequency of early-onset pneumonia. Randomised controlled trials are needed to define the role for NMB among treatments for TH-induced shivering. (C) 2014 The Authors. Published by Elsevier Ireland Ltd.