rocuronium and Out-of-Hospital-Cardiac-Arrest

Topics: Aged; Cardiopulmonary Resuscitation; Female; Humans; Hypothermia, Induced; Infusions, Intravenous; Lactic Acid; Male; Middle Aged; Neuromuscular Blockade; Neuromuscular Nondepolarizing Agents; Out-of-Hospital Cardiac Arrest; Rocuronium; Survival Analysis; Treatment Outcome; United States

Current guidelines recommend targeted temperature management to improve neurological outcome after cardiac arrest. Evidence regarding an ideal sedative/analgesic regimen including skeletal muscle paralysis is limited.. Patients were randomized to either a continuous administration of rocuronium (continuous-NMB-group) or to a continuous administration of saline supplemented by rocuronium bolus administration if demanded (bolus-NMB-group). The primary outcome was the number of shivering episodes. Secondary outcomes included survival and neurological status one year after cardiac arrest, time to awakening, length of stay as well as required cumulative dose of rocuronium, midazolam and fentanyl.. Sixty-three patients (32 continuous-NMB-group; 31 bolus-NMB-group) were enrolled. Differences in baseline characteristics were not significant. Shivering episodes were detected in 94% of the patients in the bolus-NMB-group compared to 25% of the patients receiving continuous rocuronium infusion (p<0.01). The continuous-NMB-group received significant lower doses of midazolam (4.3±0.8mg/kg vs. 5.1±0.9mg/kg, p<0.01) and fentanyl (62±14μg/kg vs. 71±7μg/kg, p<0.01), but higher cumulative doses of rocuronium (7.8±1.8mg/kg vs. 2.3±1.6mg/kg, p<0.01). Earlier awakening (2 [IQR 2;3] vs. 4 [IQR 2;7.5] days, p=0.04) and decreased length of stay at the ICU (6 [IQR 3;5.9] vs. 10 [IQR 5;15] days, p=0.03) were observed in the continuous-NMB-group. There were no significant differences in survival and quality of life 12 months after cardiac arrest.. Continuous neuromuscular blockade during the first day after resuscitation reduced shivering, midazolam and fentanyl requirement, time to awakening and discharge from intensive care unit. There were no differences in overall survival, cooling rate and time to target temperature.

Topics: Aged; Androstanols; Cardiopulmonary Resuscitation; Double-Blind Method; Female; Humans; Hypothermia, Induced; Length of Stay; Male; Middle Aged; Neuromuscular Blockade; Neuromuscular Nondepolarizing Agents; Out-of-Hospital Cardiac Arrest; Rocuronium; Shivering

The Incidence of peri-intubation cardiac arrest (PICA) has been rarely assessed in the out-of-hospital setting. The objectives of this study were to assess the incidence and factors associated with PICA (cardiac arrest occurring within 15 min of intubation) in an out-of-hospital emergency setting, wherein emergency physicians perform standardized airway management using a rapid sequence intubation technique in adult patients. This was a secondary analysis of the "Succinylcholine versus Rocuronium for out-of-hospital emergency intubation" (CURASMUR) trial, which compared the first attempt intubation success rate between succinylcholine and rocuronium in adult patients requiring emergency tracheal intubation for any vital distress except cardiac arrest. Enrollment occurred from January 2014 to August 2016 in 17 French out-of-hospital emergency medical units. All operators were emergency physicians. The PICA incidence was recorded and multivariable logistic regression analysis was used to identify the factors associated with its occurrence. A total of 1226 patients were included with a mean age of 55.9 ± 19 years. PICA was recorded in 35 (2.8%) patients. Multivariable analysis indicated that the occurrence of PICA was independently associated with a body mass index (BMI) > 30 kg m

Topics: Adult; Aged; Hospitals; Humans; Hypoxia; Incidence; Intubation, Intratracheal; Middle Aged; Out-of-Hospital Cardiac Arrest; Rocuronium; Succinylcholine

Following the return of spontaneous circulation after out-of-hospital cardiac arrest, neurological dysfunction, airway or ventilatory compromise can impede transport to early percutaneous coronary intervention, necessitating pre-hospital or emergency department anaesthesia to facilitate this procedure. There are no published reports of the ideal induction agents in these patients. We sought to describe haemodynamic changes associated with induction of anaesthesia using a midazolam (0.1 mg.kg

Topics: Adult; Aged; Anesthesia; Anesthetics, Intravenous; Dose-Response Relationship, Drug; Emergency Medical Services; Female; Fentanyl; Guideline Adherence; Hemodynamics; Humans; Hypertension; Hypnotics and Sedatives; Hypotension; Male; Midazolam; Middle Aged; Neuromuscular Nondepolarizing Agents; Out-of-Hospital Cardiac Arrest; Retrospective Studies; Rocuronium