Variation in Sedation and Neuromuscular Blockade Regimens on Outcome After Cardiac Arrest

Targeted temperature management (TTM) may improve functional outcomes of patients with hypoxic ischemic encephalopathy after cardiac arrest and is recommended for these patients after the return of spontaneous circulation (ROSC). Sedative and analgesic infusions and neuromuscular blockade (NMB) agents are commonly used during TTM for comfort, suppression of shivering, and reduction of metabolic activity, but the optimal regimens are unknown, and dosing strategies vary widely. During TTM, shivering increases the systemic metabolic rate, reduces brain oxygen levels, increases intracranial pressure, and cause variability in body temperature, each of which can worsen secondary neurologic injury. To counteract these effects, different strategies have been proposed, ranging from high dose of sedatives and analgesics without NMB to much lower dose with intermittent or continuous NMB.

Crit Care Med. 2018 Oct;46(10):e975-e980. doi: 10.1097/CCM.0000000000003301