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

Masatoshi Uchida; Migaku Kikuchi; Yasuo Haruyama; Toru Takiguchi; Toru Hifumi; Akihiko Inoue; Tetsuya Sakamoto; Yasuhiro Kuroda; SAVE-J II study group

doi:10.1016/j.resplu.2023.100476

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

Resusc Plus. 2023 Sep 26:16:100476. doi: 10.1016/j.resplu.2023.100476. eCollection 2023 Dec.

Authors

Masatoshi Uchida¹, Migaku Kikuchi¹, Yasuo Haruyama², Toru Takiguchi³, Toru Hifumi⁴, Akihiko Inoue⁵, Tetsuya Sakamoto⁶, Yasuhiro Kuroda⁷; SAVE-J II study group

Affiliations

¹ Department of Emergency and Critical Care Medicine, Dokkyo Medical University, Tochigi, Japan.
² Integrated Research Faculty for Advanced Medical Sciences, Dokkyo Medical University, Tochigi, Japan.
³ Department of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo, Japan.
⁴ Department of Emergency and Critical Care Medicine, St. Luke's International Hospital, Tokyo, Japan.
⁵ Department of Emergency and Critical Care Medicine, Hyogo Emergency Medical Center, Kobe, Japan.
⁶ Department of Emergency Medicine, Teikyo University School of Medicine, Tokyo, Japan.
⁷ Department of Emergency, Disaster and Critical Care Medicine, Kagawa University Hospital, Kagawa, Japan.

Abstract

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.

Keywords: Cardiac arrest; Extracorporeal cardiopulmonary resuscitation; Neuromuscular blocking agents; Targeted temperature management.