Abstract
Introduction: It is well recognized that the actions of neuromuscular blockers are enhanced in patients undergoing mild therapeutic hypothermia (MTH) following cardiac arrest. Little data on the association between various NMB agents and outcomes are available. Methods: We retrospectively collected data on 201 consecutive adult patients (mean age 61 ± 15 years) admitted to Hartford Hospital who survived a cardiac arrest and were admitted to our cardiac intensive care unit (CICU). Of the 201 patients, 99 (49.3%) had VF or VT and 102 (51.7%) had PEA or asystole. Use of neuromuscular blockers, including cisatracurium and vecuronium, was collected. The main outcome of interest was survival with good neurologic outcome defined using the Pittsburgh cerebral performance category (CPC) scale of 1-2. Multivariate logistic regression was used to control for potential confounders and identify independent predictors of good outcome. Results: During their CICU stay, 60 (29.9%) patients received cisatracurium and 36 (17.9%) received vecuronium. A positive correlation was seen between rate of survival with good neurologic outcome was seen in patients who received cisatracurium (p<0.001) but not in those receiving vecuronium (p=0.183). Neither agent was correlated with length of stay in the CICU. Multivariate analysis showed that cisatracurium use (p=0.014) was a positive independent predictor of survival with good neurologic outcome during hospitalization in our population whereas history of diabetes (p=0.004), and either asystole (p=0.006) or PEA (p=0.002) were negative predictors. Conclusions: In our population, use of cisatracurium during MTH following cardiac arrest was positively associated with a good outcome while vecuronium did not seem to affect this outcome. A prospective direct head-to-head study is required to better characterize potential differences between neuromuscular blocking agents.
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