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
Author:
Shibahashi Keita1ORCID, Hifumi Toru2, Sugiyama Kazuhiro1, Inoue Akihiko3, Sakamoto Tetsuya4, Yasuhiro Kuroda5, Sawano Hirotaka, Egawa Yuko, Kato Shunichi, Sugiyama Kazuhiro, Tanabe Maki, Bunya Naofumi, Kasai Takehiko, Ijuin Shinichi, Nakayama Shinichi, Kanda Jun, Kanou Seiya, Takiguchi Toru, Yokobori Shoji, Takada Hiroaki, Inoue Kazushige, Takeuchi Ichiro, Honzawa Hiroshi, Kobayashi Makoto, Hamagami Tomohiro, Takayama Wataru, Otomo Yasuhiro, Maekawa Kunihiko, Shimizu Takafumi, Nara Satoshi, Nasu Michitaka, Takahashi Kuniko, Hagiwara Yoshihiro, Kushimoto Shigeki, Fukuda Reo, Ogura Takayuki, Shiraishi Shin-ichiro, Zushi Ryosuke, Otani Norio, Okamoto Hiroshi, Kikuchi Migaku, Watanabe Kazuhiro, Nakagami Takuo, Shoko Tomohisa, Kitamura Nobuya, Otani Takayuki, Matsuoka Yoshinori, Aoki Makoto, Sakuraya Masaaki, Arimoto Hideki, Homma Koichiro, Naito Hiromichi, Nakao Shunichiro, Okazaki Tomoya, Kunikata Jun, Yokoi Hideto, Tahara Yoshio,
Affiliation:
1. Tertiary Emergency Medical Center, Tokyo Metropolitan Bokutoh Hospital , 4-23-15, Kotobashi, Sumida-ku, Tokyo 130-8575 , Japan 2. Department of Emergency and Critical Care Medicine, St. Luke's International Hospital , 9-1 Akashi-cho, Chuo-ku, Tokyo 104-8560 , Japan 3. Department of Emergency and Critical Care Medicine, Hyogo Emergency Medical Center , 1-3-1 Wakinohamakaigandori, Chuo-ku, Kobe 651-0073 , Japan 4. Department of Emergency Medicine, Teikyo University School of Medicine , 2-11-1 Kaga, Itabashi-Ku, Tokyo 173-8606 , Japan 5. Department of Emergency, Disaster and Critical Care Medicine, Kagawa University Hospital , 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa 761-0793 , Japan
Abstract
AbstractAimsOptimal 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 and resultsA 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 (ICUs) 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. 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).ConclusionThis 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.
Publisher
Oxford University Press (OUP)
Subject
Cardiology and Cardiovascular Medicine,Critical Care and Intensive Care Medicine,General Medicine
Cited by
7 articles.
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