Stockl
Trial question
What is the role of continuous neuromuscular blockade in patients during targeted temperature management after resuscitation from cardiac arrest?
Study design
Single center
Double blinded
RCT
Population
Characteristics of study participants
17.0% female
83.0% male
N = 63
63 patients (11 female, 52 male).
Inclusion criteria: adult patients who were resuscitated from non-traumatic out-of-hospital cardiac arrest within six hours prior to arrival at the emergency department.
Key exclusion criteria: known terminal illness, obvious intoxication, pregnancy, a known allergic reaction against rocuronium, history of myasthenia gravis, or known epileptic disease.
Interventions
N=32 continuous neuromuscular blockade (continuous administration of rocuronium 0.25 mg/kg/hr).
N=31 bolus neuromuscular blockade (continuous administration of saline supplemented by rocuronium bolus of 0.25 mg/kg administration if demanded).
Primary outcome
Shivering episodes
25%
94%
94.0 %
70.5 %
47.0 %
23.5 %
0.0 %
Continuous neuromuscular
blockade
Bolus neuromuscular
blockade
Significant
decrease ▼
NNT = 1
Significant decrease in shivering episodes (25% vs. 94%; RR 0.27, 95% CI 0.06 to 0.48).
Secondary outcomes
No significant difference in the rate of overall death after 12 months (47% vs. 39%; HR 1.34, 95% CI 0.63 to 2.87).
No significant difference in the rate of favorable neurological outcome after 12 months (53% vs. 55%; RR 0.97, 95% CI 0.61 to 1.53).
Significant decrease in length of stay in the ICU (6 days vs. 10 days; AD -4 days, 95% CI -7.62 to -0.38).
Safety outcomes
No significant differences in signs of polyneuropathy, cooling rate, time to achieve target temperature.
Significant differences in doses of midazolam (4.3 mg/kg vs. 5.1 mg/kg), doses of fentanyl (0.062 mg/kg vs. 0.071 mg/kg), cumulative doses of rocuronium (7.8 mg/kg vs. 2.3 mg/kg), earlier awakening (2 days vs. 4 days).
Conclusion
In adult patients who were resuscitated from non-traumatic out-of-hospital cardiac arrest within six hours prior to arrival at the emergency department, continuous neuromuscular blockade was superior to bolus neuromuscular blockade with respect to shivering episodes.
Reference
Mathias Stöckl, Christoph Testori, Fritz Sterz et al. Continuous versus intermittent neuromuscular blockade in patients during targeted temperature management after resuscitation from cardiac arrest-A randomized, double blinded, double dummy, clinical trial. Resuscitation. 2017 Nov;120:14-19.
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