Association between neuromuscular blocking agent use and outcomes among out-of-hospital cardiac arrest patients treated with extracorporeal cardiopulmonary resuscitation and target temperature management: A secondary analysis of the SAVE-J II study
Background: Neuromuscular blocking agents are used to control shivering in cardiac arrest patients treated with target temperature management. However, their effect on outcomes in patients treated with extracorporeal cardiopulmonary resuscitation is unclear. Methods: This study was a secondary analy...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2023-12-01
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| Series: | Resuscitation Plus |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666520423001194 |
| _version_ | 1827615724981452800 |
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| author | Masatoshi Uchida Migaku Kikuchi Yasuo Haruyama Toru Takiguchi Toru Hifumi Akihiko Inoue Tetsuya Sakamoto Yasuhiro Kuroda |
| author_facet | Masatoshi Uchida Migaku Kikuchi Yasuo Haruyama Toru Takiguchi Toru Hifumi Akihiko Inoue Tetsuya Sakamoto Yasuhiro Kuroda |
| author_sort | Masatoshi Uchida |
| collection | DOAJ |
| description | Background: Neuromuscular blocking agents are used to control shivering in cardiac arrest patients treated with target temperature management. However, their effect on outcomes in patients treated with extracorporeal cardiopulmonary resuscitation is unclear. Methods: This study was a secondary analysis of the SAVE-J II study, a retrospective multicenter study of 2175 out-of-hospital cardiac arrest patients treated with extracorporeal cardiopulmonary resuscitation in Japan. We classified patients into those who received neuromuscular blocking agents and those who did not and compared in-hospital mortality and incidence rates of favorable neurological outcome and in-hospital pneumonia between the groups using multivariable regression models and stabilized inverse probability weighting with propensity scores. Results: Six hundred sixty patients from the SAVE-J II registry were analyzed. Neuromuscular blocking agents were used in 451 patients (68.3%). After adjusting for potential confounders, neuromuscular blocking agents use was not significantly associated with in-hospital mortality (aHR 0.88; 95% CI, 0.67–1.14), favorable neurological outcome (aOR 0.85; 95% CI, 0.60–1.11), or pneumonia (aOR 1.52; 95% CI, 0.85–2.71). The results for in-hospital mortality (aHR 0.89; 95% CI, 0.64–1.25), favorable neurological outcome (aOR 0.94; 95% CI, 0.59–1.48) and pneumonia (aOR 1.59; 95% CI, 0.74–3.41) were similar after weighting was performed. Conclusions: Although data on the rationale for using neuromuscular blocking agents were unavailable, their use was not significantly associated with outcomes in out-of-hospital cardiac arrest patients treated with extracorporeal cardiopulmonary resuscitation and targeted temperature management. Neuromuscular blocking agents should be used based on individual clinical indications. |
| first_indexed | 2024-03-09T09:15:47Z |
| format | Article |
| id | doaj.art-6720f6ac27d2491da6dd502956f02c49 |
| institution | Directory Open Access Journal |
| issn | 2666-5204 |
| language | English |
| last_indexed | 2024-03-09T09:15:47Z |
| publishDate | 2023-12-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Resuscitation Plus |
| spelling | doaj.art-6720f6ac27d2491da6dd502956f02c492023-12-02T07:06:54ZengElsevierResuscitation Plus2666-52042023-12-0116100476Association between neuromuscular blocking agent use and outcomes among out-of-hospital cardiac arrest patients treated with extracorporeal cardiopulmonary resuscitation and target temperature management: A secondary analysis of the SAVE-J II studyMasatoshi Uchida0Migaku Kikuchi1Yasuo Haruyama2Toru Takiguchi3Toru Hifumi4Akihiko Inoue5Tetsuya Sakamoto6Yasuhiro Kuroda7Department of Emergency and Critical Care Medicine, Dokkyo Medical University, Tochigi, Japan; Corresponding author: Department of Emergency and Critical Care Medicine, Dokkyo Medical University, 880 Kitakobayashi, Mibu-machi, Shimotuga-gun, Tochigi 321-0293, Japan.Department of Emergency and Critical Care Medicine, Dokkyo Medical University, Tochigi, JapanIntegrated Research Faculty for Advanced Medical Sciences, Dokkyo Medical University, Tochigi, JapanDepartment of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo, JapanDepartment of Emergency and Critical Care Medicine, St. Luke’s International Hospital, Tokyo, JapanDepartment of Emergency and Critical Care Medicine, Hyogo Emergency Medical Center, Kobe, JapanDepartment of Emergency Medicine, Teikyo University School of Medicine, Tokyo, JapanDepartment of Emergency, Disaster and Critical Care Medicine, Kagawa University Hospital, Kagawa, JapanBackground: Neuromuscular blocking agents are used to control shivering in cardiac arrest patients treated with target temperature management. However, their effect on outcomes in patients treated with extracorporeal cardiopulmonary resuscitation is unclear. Methods: This study was a secondary analysis of the SAVE-J II study, a retrospective multicenter study of 2175 out-of-hospital cardiac arrest patients treated with extracorporeal cardiopulmonary resuscitation in Japan. We classified patients into those who received neuromuscular blocking agents and those who did not and compared in-hospital mortality and incidence rates of favorable neurological outcome and in-hospital pneumonia between the groups using multivariable regression models and stabilized inverse probability weighting with propensity scores. Results: Six hundred sixty patients from the SAVE-J II registry were analyzed. Neuromuscular blocking agents were used in 451 patients (68.3%). After adjusting for potential confounders, neuromuscular blocking agents use was not significantly associated with in-hospital mortality (aHR 0.88; 95% CI, 0.67–1.14), favorable neurological outcome (aOR 0.85; 95% CI, 0.60–1.11), or pneumonia (aOR 1.52; 95% CI, 0.85–2.71). The results for in-hospital mortality (aHR 0.89; 95% CI, 0.64–1.25), favorable neurological outcome (aOR 0.94; 95% CI, 0.59–1.48) and pneumonia (aOR 1.59; 95% CI, 0.74–3.41) were similar after weighting was performed. Conclusions: Although data on the rationale for using neuromuscular blocking agents were unavailable, their use was not significantly associated with outcomes in out-of-hospital cardiac arrest patients treated with extracorporeal cardiopulmonary resuscitation and targeted temperature management. Neuromuscular blocking agents should be used based on individual clinical indications.http://www.sciencedirect.com/science/article/pii/S2666520423001194Cardiac arrestExtracorporeal cardiopulmonary resuscitationTargeted temperature managementNeuromuscular blocking agents |
| spellingShingle | Masatoshi Uchida Migaku Kikuchi Yasuo Haruyama Toru Takiguchi Toru Hifumi Akihiko Inoue Tetsuya Sakamoto Yasuhiro Kuroda Association between neuromuscular blocking agent use and outcomes among out-of-hospital cardiac arrest patients treated with extracorporeal cardiopulmonary resuscitation and target temperature management: A secondary analysis of the SAVE-J II study Resuscitation Plus Cardiac arrest Extracorporeal cardiopulmonary resuscitation Targeted temperature management Neuromuscular blocking agents |
| title | Association between neuromuscular blocking agent use and outcomes among out-of-hospital cardiac arrest patients treated with extracorporeal cardiopulmonary resuscitation and target temperature management: A secondary analysis of the SAVE-J II study |
| title_full | Association between neuromuscular blocking agent use and outcomes among out-of-hospital cardiac arrest patients treated with extracorporeal cardiopulmonary resuscitation and target temperature management: A secondary analysis of the SAVE-J II study |
| title_fullStr | Association between neuromuscular blocking agent use and outcomes among out-of-hospital cardiac arrest patients treated with extracorporeal cardiopulmonary resuscitation and target temperature management: A secondary analysis of the SAVE-J II study |
| title_full_unstemmed | Association between neuromuscular blocking agent use and outcomes among out-of-hospital cardiac arrest patients treated with extracorporeal cardiopulmonary resuscitation and target temperature management: A secondary analysis of the SAVE-J II study |
| title_short | Association between neuromuscular blocking agent use and outcomes among out-of-hospital cardiac arrest patients treated with extracorporeal cardiopulmonary resuscitation and target temperature management: A secondary analysis of the SAVE-J II study |
| title_sort | association between neuromuscular blocking agent use and outcomes among out of hospital cardiac arrest patients treated with extracorporeal cardiopulmonary resuscitation and target temperature management a secondary analysis of the save j ii study |
| topic | Cardiac arrest Extracorporeal cardiopulmonary resuscitation Targeted temperature management Neuromuscular blocking agents |
| url | http://www.sciencedirect.com/science/article/pii/S2666520423001194 |
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