Intermittent versus continuous neuromuscular blockade during target temperature management after cardiac arrest: A nationwide observational study

Toru Takiguchi; Hiroyuki Ohbe; Mikio Nakajima; Yusuke Sasabuchi; Takashi Tagami; Hiroki Matsui; Kiyohide Fushimi; Shoji Yokobori; Hideo Yasunaga

doi:10.1016/j.jcrc.2021.01.002

Intermittent versus continuous neuromuscular blockade during target temperature management after cardiac arrest: A nationwide observational study

J Crit Care. 2021 Apr:62:276-282. doi: 10.1016/j.jcrc.2021.01.002. Epub 2021 Jan 14.

Authors

Toru Takiguchi¹, Hiroyuki Ohbe², Mikio Nakajima³, Yusuke Sasabuchi⁴, Takashi Tagami⁵, Hiroki Matsui², Kiyohide Fushimi⁶, Shoji Yokobori⁷, Hideo Yasunaga²

Affiliations

¹ Department of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo, Japan. Electronic address: toru-takiguchi@nms.ac.jp.
² Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan.
³ Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan; Emergency and Critical Care Center, Tokyo Metropolitan Hiroo Hospital, Tokyo, Japan.
⁴ Data Science Center, Jichi Medical University, Tochigi, Japan.
⁵ Department of Emergency and Critical Care Medicine, Nippon Medical School Musashikosugi Hospital, Kanagawa, Japan.
⁶ Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan.
⁷ Department of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo, Japan.

PMID: 33508762
DOI: 10.1016/j.jcrc.2021.01.002

Abstract

Purpose: Whether intermittent or continuous neuromuscular-blocking agents (NMBAs) would be appropriate during target temperature management (TTM) after cardiac arrest remains unclear.

Materials and methods: 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.

Results: 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).

Conclusions: 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.

Keywords: Cardiac arrest; Continuous; Intermittent; Neuromuscular-blocking agent; Targeted temperature management; Therapeutic hypothermia.

Publication types

Observational Study
Research Support, Non-U.S. Gov't

MeSH terms

Aged
Heart Arrest* / therapy
Humans
Hypothermia, Induced*
Neuromuscular Blockade*
Neuromuscular Blocking Agents*
Out-of-Hospital Cardiac Arrest* / therapy
Retrospective Studies
Temperature

Substances

Neuromuscular Blocking Agents