Ceric Ameldina, Dankiewicz Josef, Cronberg Tobias, Düring Joachim, Moseby-Knappe Marion, Annborn Martin, May Teresa L, Thomas Matthew, Grejs Anders Morten, Rylander Christian, Belohlavek Jan, Wendel-Garcia Pedro, Haenggi Matthias, Schrag Claudia, Hilty Matthias P, Keeble Thomas R, Wise Matt P, Young Paul, Taccone Fabio Silvio, Robba Chiara, Cariou Alain, Eastwood Glenn, Saxena Manoj, Ullén Susann, Lilja Gisela, Jakobsen Janus C, Lybeck Anna, Nielsen Niklas
Anesthesia & Intensive Care, Department of Clinical Sciences, Lund University, Skane University Hospital, Carl Bertil Laurels Gata 9, 214 28, Malmö, Sweden.
Cardiology Department, Lund University, Skåne University Hospital Lund, Lund, Sweden.
Crit Care. 2025 Jun 17;29(1):247. doi: 10.1186/s13054-025-05461-0.
The routine use of sedation and analgesia during post-cardiac arrest care and its association with clinical outcomes remain unclear. This study aimed to describe the use of sedatives and analgesics in post-cardiac arrest care, and evaluate associations with good functional outcome, survival, clinical seizures, and late awakening.
This was a post hoc analysis of the TTM2-trial, which randomized 1900 out-of-hospital cardiac arrest patients to either normothermia or hypothermia. In both groups, deep sedation (Richmond Agitation and Sedation Scale ≤ -4) was mandatory during the 40-h intervention. Cumulative doses of sedatives and analgesic drugs were recorded within the first 72 h from randomization. Outcomes were functional outcome (modified Rankin Scale) and survival status at 6 months, occurrence of clinical seizures during the intensive care stay, and late awakening (Full outline of unresponsiveness motor score of four 96 h after randomization). Cumulative propofol doses were divided into quartiles (Q1-Q4). Logistic regression models were used to assess associations between sedative doses and functional outcome and survival, clinical seizures, and late awakening, adjusting for the severity of illness and other clinical factors influencing sedation.
A total of 1861 patients were analyzed. In a multivariable logistic regression model, higher propofol doses (Q3, 100.7-153.6 mg/kg) were associated with good functional outcome (OR 1.62, 95%CI 1.12-2.34) and (Q2 and Q3, 43.9-153.6 mg/kg) with survival (OR 1.49, 95%CI 1.05-2.12 and OR 1.84, 95%CI 1.27-2.65, respectively). Receiving fentanyl and remifentanil were associated with good functional outcome (OR 1.69, 95%CI 1.27-2.26 and OR 1.50, 95%CI 1.11-2.02) and survival (OR 1.80, 95%CI 1.35-2.40 and OR 1.56, 95%CI 1.16-2.10). Receiving fentanyl (OR 0.64, 95%CI 0.48-0.86) and higher propofol doses (Q2-4 (43.9-669.4 mg/kg) were associated with the occurrence of clinical seizures. The highest quartile of propofol dose (153.7-669.4 mg/kg, OR 3.19, 95%CI 1.91-5.42) was associated with late awakening.
In this study, higher doses of propofol and the use of remifentanil and fentanyl were associated with good functional outcome and survival, occurrence of clinical seizures, and late awakening.
心脏骤停后护理期间镇静和镇痛的常规使用及其与临床结局的关联仍不明确。本研究旨在描述心脏骤停后护理中镇静剂和镇痛药的使用情况，并评估其与良好功能结局、生存、临床癫痫发作和延迟苏醒的关联。
这是对TTM2试验的事后分析，该试验将1900例院外心脏骤停患者随机分为正常体温组或低温组。在两组中，40小时干预期间均强制进行深度镇静（里士满躁动镇静量表≤-4）。记录随机分组后前72小时内镇静剂和镇痛药的累积剂量。结局指标为功能结局（改良Rankin量表）和6个月时的生存状态、重症监护期间临床癫痫发作的发生情况以及延迟苏醒（随机分组后96小时的无反应运动评分全量表）。丙泊酚累积剂量分为四分位数（Q1-Q4）。采用逻辑回归模型评估镇静剂剂量与功能结局、生存、临床癫痫发作和延迟苏醒之间的关联，并对疾病严重程度和其他影响镇静的临床因素进行校正。
共分析了1861例患者。在多变量逻辑回归模型中，较高的丙泊酚剂量（Q3，100.7-153.6mg/kg）与良好的功能结局相关（比值比1.62，95%置信区间1.12-2.34），（Q2和Q3，43.9-153.6mg/kg）与生存相关（比值比分别为1.49，95%置信区间1.05-2.12和1.84，95%置信区间1.27-2.65）。接受芬太尼和瑞芬太尼与良好的功能结局相关（比值比1.69，95%置信区间1.27-2.26和1.50，95%置信区间1.11-2.02）和生存相关（比值比1.80，95%置信区间1.35-2.40和1.56，95%置信区间1.16-2.10）。接受芬太尼（比值比0.64，95%置信区间0.48-0.86）和较高的丙泊酚剂量（Q2-4（43.9-669.4mg/kg）与临床癫痫发作的发生相关。丙泊酚剂量的最高四分位数（153.7-669.4mg/kg，比值比3.19，95%置信区间1.91-5.42）与延迟苏醒相关。
在本研究中，较高剂量的丙泊酚以及瑞芬太尼和芬太尼的使用与良好的功能结局、生存以及临床癫痫发作和延迟苏醒相关。
