Isoflurane or propofol sedation in patients with targeted temperature management after cardiopulmonary resuscitation: A single center study

Abstract

ProposeTargeted temperature management improves outcomes in comatose patients after cardiac arrest. Short lasting sedatives might enable rapid awakening after targeted temperature management and therefore early prognostication and extubation. Aim of the present study was to compare sedation with volatile isoflurane to intravenous propofol. Materials and methodsAll patients after cardiopulmonary resuscitation undergoing targeted temperature management treated between 01/2014 and 02/2017 at a single tertiary referral hospital were screened. Exclusion criteria included extracorporeal support or a survival below 48 h. ResultsData on 214 patients (median age 66.1 years, 62.6% shockable rhythm, survival 69.6%) are reported, 178 patients on propofol and sufentanil and 36 patients on isoflurane and sufentanil. Median time to first spontaneous breathing (9.3 h vs. 9.5 h, p = .373), median duration on mechanical ventilation in extubated patients (99.4 h vs. 105.7 h, p = .692) and median ICU stay (11.1d vs. 9.8d, p = .320) were similar in patients on propofol or isoflurane, respectively. Findings were confirmed by propensity score matching. Opioid dose was significantly lower in the isoflurane group (p < .001) while norepinephrine dose was significantly higher (p = .004). ConclusionIsoflurane sedation is feasible on during targeted temperature management. Time to spontaneous breathing, mechanical ventilation duration or ICU stay was not reduced by isoflurane.