Jansen Gerrit, Latka Eugen, Bernhard Michael, Deicke Martin, Fischer Daniel, Hoyer Annika, Keller Yacin, Kobiella André, Linder Sissy, Strickmann Bernd, Strototte Lisa Marie, Thies Karl Christian, Johanning Kai, von Dossow Vera, Hinkelbein Jochen
University Department of Anesthesiology, Intensive Care Medicine and Emergency Medicine, Johannes Wesling Klinikum Minden, Ruhr-University Bochum, Minden, Germany; Medical School OWL, Bielefeld University, Bielefeld, Germany; Department of Medical and Emergency Services, Study Institute Westfalen-Lippe, Bielefeld, Germany; Emergency Department, University Hospital of Düsseldorf, Düsseldorf, Germany; Medical Director of Rescue Service, Osnabrück District, Germany; Department of Anesthesiology and Operative Intensive Care Medicine, Hochschule Osnabrück - University of Applied Sciences, Osnabrück, Germany; Rescue Service Lippe District, Germany; Biostatistics and Medical Biometry, Medical School OWL, Bielefeld University, Bielefeld, Germany; Rescue Service, Integrated Regional Control Center Dresden, Dresden, Germany; Rescue Service, Gütersloh District, Germany; Skillslab, Medical School OWL, Bielefeld University, Bielefeld, Germany; University Department of Anesthesiology, Intensive Care Medicine, Emergency Medicine, Transfusion Medicine, and Pain Therapy, Evangelisches Klinikum Bethel, University Hospital OWL, Bielefeld University, Bielefeld, Germany; Department of Anesthesiology, Operative Intensive Care Medicine, Emergency Medicine and Pain Therapy, Municipal Hospital of Bielefeld, Bielefeld, Germany; Institute of Anesthesiology and Pain Therapy, Heart and Diabetes Center NRW, University Hospital of the Ruhr-University Bochum, Bad Oeynhausen, Germany.
Dtsch Arztebl Int. 2024 Apr 5;121(7):214-221. doi: 10.3238/arztebl.m2023.0277.
An out-of-hospital cardiac arrest (OHCA) with return of spontaneous circulation (ROSC) may need to be treated with airway management, emergency ventilation, invasive interventions, and post-arrest sedation. We investigated the influence of the use of midazolam for post-arrest sedation on achieving postresuscitation care targets and the associated risk of hemodynamic complications.
All emergency rescue missions of the Dresden, Gütersloh, and Lippe medical rescue services in the years 2019-2021 were reviewed to identify adult patients who had OHCA, unconsciousness, and sustained ROSC with spontaneous circulation until arrival at the hospital; the findings were supplemented with data from the German Resuscitation Registry. Patients who received midazolam (alone or in combination with other anesthetic agents) for post-arrest sedation were compared with those who did not. The endpoints were the regaining of a systolic blood pressure ≥ 100 mmHg, end-tidal pCO2 35-45 mmHg, and oxygen saturation (SpO2) 94-98%. A propensity score analysis was used to adjust for age, sex, and variables potentially affecting hemodynamic status or the targets for oxygenation and ventilation.
There were 2335 cases of OHCA among 391 305 emer - gency rescue missions. 571 patients had ROSC before arrival in the hospital (24.5%; female, 33.6%; age, 68 ± 14 years). Of the 395 among them (69.2%) who were treated with postarrest sedation, 249 (63.0%) received midazolam. Patients who received midazolam reached the guideline- recommended targets for oxygenation, ventilation, and blood pressure more frequently than those who were not sedated: the respective odds ratios and 95% confidence intervals were 2.00 [1.20; 3.34], 1.57 [0.99; 2.48], and 1.41 [0.89; 2.21].
The pre-hospital administration of midazolam leads to more frequent pre-hospital attainment of the oxygenation and ventilation targets in post-resuscitation care, without any evidence of an elevated risk of hemodynamic complications.
院外心脏骤停（OHCA）且恢复自主循环（ROSC）的患者可能需要进行气道管理、紧急通气、侵入性干预及心脏骤停后镇静治疗。我们研究了使用咪达唑仑进行心脏骤停后镇静对实现复苏后护理目标的影响以及血流动力学并发症的相关风险。
回顾了2019年至2021年德累斯顿、 Gütersloh和利珀医疗救援服务机构的所有紧急救援任务，以确定患有OHCA、昏迷且在入院前维持自主循环的ROSC成年患者；研究结果补充了德国复苏登记处的数据。将接受咪达唑仑（单独或与其他麻醉剂联合使用）进行心脏骤停后镇静的患者与未接受的患者进行比较。终点指标为收缩压恢复至≥100 mmHg、呼气末二氧化碳分压为35 - 45 mmHg以及血氧饱和度（SpO2）为94 - 98%。采用倾向评分分析来调整年龄、性别以及可能影响血流动力学状态或氧合与通气目标的变量。
在391305次紧急救援任务中有2335例OHCA病例。571例患者在入院前恢复自主循环（24.5%；女性占33.6%；年龄68±14岁）。其中395例（69.2%）接受了心脏骤停后镇静治疗，249例（63.0%）接受了咪达唑仑治疗。接受咪达唑仑治疗的患者比未接受镇静治疗的患者更频繁地达到指南推荐的氧合、通气和血压目标：各自的比值比及95%置信区间分别为2.00 [1.20；3.34]、1.57 [0.99；2.48]和1.41 [0.89；2.21]。
院前给予咪达唑仑可使复苏后护理中更频繁地在院前达到氧合和通气目标，且没有任何证据表明血流动力学并发症风险增加。
