Department of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo, Japan.
Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan.
J Crit Care. 2021 Apr;62:276-282. doi: 10.1016/j.jcrc.2021.01.002. Epub 2021 Jan 14.
Whether intermittent or continuous neuromuscular-blocking agents (NMBAs) would be appropriate during target temperature management (TTM) after cardiac arrest remains unclear.
In this retrospective cohort study, we utilized the Japanese Diagnosis Procedure Combination inpatient database from July 2010 to March 2018 and identified patients who received NMBAs during TTM after cardiac arrest on the day of admission. We compared the in-hospital mortality between the propensity-score-matched intermittent and continuous NMBA groups.
We identified 5584 eligible patients; 1488 received intermittent NMBAs and 4096 received continuous NMBAs. After propensity score matching, there was no significant difference in the in-hospital mortality between the intermittent and continuous NMBA groups (32.9% vs. 33.1%; odds ratio, 0.98; 95% confidence interval, 0.82-1.18). In subgroup analyses, in-hospital mortality of the continuous NMBA group was significantly higher than that of the intermittent NMBA group in patients aged ≥65 years (p for interaction = 0.021).
This large retrospective study did not suggest that intermittent NMBAs may be inferior to continuous NMBAs in terms of mortality reduction in the overall population receiving TTM for cardiac arrest. However, continuous NMBAs may be inferior to intermittent NMBAs for reducing mortality in elderly patients.
心脏骤停后目标温度管理（TTM）期间使用间断性或连续性神经肌肉阻滞剂（NMBAs）是否合适仍不清楚。
在这项回顾性队列研究中，我们利用日本 2010 年 7 月至 2018 年 3 月的诊断程序组合住院患者数据库，确定了在心脏骤停后 TTM 当天入院时接受 NMBAs 的患者。我们比较了接受 NMBA 间断治疗和连续治疗两组患者的院内死亡率。
我们共纳入了 5584 名符合条件的患者；其中 1488 名患者接受间断性 NMBA 治疗，4096 名患者接受连续性 NMBA 治疗。在倾向评分匹配后，间断性 NMBA 组和连续性 NMBA 组的院内死亡率无显著差异（32.9%比 33.1%；比值比，0.98；95%置信区间，0.82-1.18）。亚组分析显示，在年龄≥65 岁的患者中，连续 NMBA 组的院内死亡率显著高于间断性 NMBA 组（交互作用 P 值=0.021）。
这项大型回顾性研究并未表明在接受心脏骤停 TTM 的总体人群中，间断性 NMBA 在降低死亡率方面可能不如连续性 NMBA。然而，在降低老年患者死亡率方面，连续 NMBA 可能不如间断性 NMBA。
