Impact of sedation depth on neurological outcome in post-cardiac arrest patients – A retrospective cohort study

Aims

Whether targeted temperature management (TTM) might improve neurologic prognosis in patients after cardiac arrest is currently under debate. Data concerning sedation depth during TTM is rare. This study aimed to compare the impact of different sedation depths on neurological outcomes in post-cardiac arrest patients undergoing TTM.

Methods

In this retrospective, before-and-after registry study, all patients receiving TTM on a medical ICU between 08/2016 and 03/2021 were included. This study evaluated the following sedation targets: RASS-target during TTM −5 until 08/2019 and RASS-target −4 since 09/2019. The primary endpoint was favorable neurological outcome at ICU discharge, defined as a Cerebral Performance Category (CPC) score of 1 or 2.

Results

403 patients were included (RASS-target −5: N = 285; RASS-target −4: N = 118). Favorable neurological outcome was documented in 54/118 (45.8 %) patients in the group with a RASS-target of −4 compared to 111/285 (38.9 %) in the group with a RASS-target of −5. After adjustment for age, sex, initial shockable rhythm, bystander CPR, duration of CPR and mean arterial pressure 12 h after CPR, favorable neurological outcome was associated with RASS-target −4 (OR 1.82 (95 % CI: 1.02–3.23); p = 0.042). ICU survival was similar in both groups while 30-day survival was associated with RASS-target −4 (OR 1.81 (1.01–3.26); p = 0.047).

Conclusion

Lighter sedation strategies during TTM after cardiac arrest might improve outcome and should be further investigated.