Comparison of sedation using propofol vs. midazolam in patients admitted to the intensive care unit after extracorporeal cardiopulmonary resuscitation for out-of-hospital cardiac arrest: a multicentre observational study

Abstract

Background Optimal sedation regimens for patients after extracorporeal cardiopulmonary resuscitation (ECPR) remain unclear. This study compared the outcomes of patients who received propofol and midazolam for sedation post-ECPR for out-of-hospital cardiac arrest (OHCA). Methods A retrospective cohort study analysed data from the Study of Advanced life support for Ventricular fibrillation with Extracorporeal circulation in Japan, including patients admitted to 36 intensive care units (ICU) in Japan post-ECPR for OHCA of cardiac aetiology between 2013 and 2018. One-to-one propensity score-matched analysis compared outcomes between patients post-ECPR for OHCA who received exclusive treatment with a continuous propofol infusion (propofol users) and those who received exclusive treatment with a continuous midazolam infusion (midazolam users). The cumulative incidence and competing risk methodology were used to compare the time to liberation from mechanical ventilation and ICU discharge. Results Propensity score-matching created 109 matched pairs of propofol and midazolam users with balanced baseline characteristics. Competing risk analysis for the 30-day ICU period showed no significant difference in the probability of liberation from mechanical ventilation (0.431 vs. 0.422, P = 0.882) and ICU discharge (0.477 vs. 0.440, P = 0.634). Furthermore, there was no significant difference in the proportion of 30-day survival (0.399 vs. 0.398, P = 0.999), 30-day favourable neurological outcome (0.176 vs. 0.185, P = 0.999), and vasopressor requirement within 24-h post-ICU admission (0.651 vs. 0.670, P = 0.784). Conclusions This multicentre cohort study revealed no significant differences in mechanical ventilation duration, ICU stay length, survival, neurological outcomes, and vasopressor requirement between propofol and midazolam users admitted to the ICU after ECPR for OHCA.

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

“…However, the impact of this for patient outcomes appear to be minimal because a study has reported no significant differences in outcomes between propofol and midazolam users among patients treated with ECPR. 49 …”

Impact of center volume on in-hospital mortality in adult patients with out‑of‑hospital cardiac arrest resuscitated using extracorporeal cardiopulmonary resuscitation: a secondary analysis of the SAVE-J II study

“…To examine whether center ECPR volume was associated with survival rate at the time of discharge in patients with OHCA who underwent ECPR, we used a dataset from the SAVE-J II study cohort. The study design has been described in detail elsewhere 8 , 9 . In brief, this cohort derived from a retrospective multicenter study in Japan that included 36 university and community hospitals and enrolled 2,157 consecutive patients with OHCA aged ≥ 18 years who were resuscitated using ECPR between January 1, 2013, and December 31, 2018.…”

Impact of center volume on in-hospital mortality in adult patients with out‑of‑hospital cardiac arrest resuscitated using extracorporeal cardiopulmonary resuscitation: A secondary analysis of the SAVE-J II study

“…To examine whether center ECPR volume was associated with survival rate at the time of discharge in patients with OHCA who underwent ECPR, we used a dataset from the SAVE-J II study cohort. The study design has been described in detail elsewhere [8,9]. In brief, this cohort derived from a retrospective multicenter study in Japan that included 36 university and community hospitals and enrolled 2,157 consecutive patients with OHCA aged ≥ 18 years who were resuscitated using ECPR between January 1, 2013, andDecember 31, 2018. In the SAVE-J II study, ECPR was de ned as resuscitation with veno-arterial ECMO in patients with refractory cardiac arrest.…”