Skip to main content

Lund University Publications

LUND UNIVERSITY LIBRARIES

Sedation and analgesia in post-cardiac arrest care : a post hoc analysis of the TTM2 trial

Ceric, Ameldina LU ; Dankiewicz, Josef LU orcid ; Cronberg, Tobias LU ; Düring, Joachim LU orcid ; Moseby-Knappe, Marion LU ; Annborn, Martin LU ; May, Teresa L. ; Thomas, Matthew ; Grejs, Anders Morten and Rylander, Christian , et al. (2025) In Critical Care 29(1).
Abstract

Background: The routine use of sedation and analgesia during post-cardiac arrest care and its association with clinical outcomes remain unclear. This study aimed to describe the use of sedatives and analgesics in post-cardiac arrest care, and evaluate associations with good functional outcome, survival, clinical seizures, and late awakening. Methods: This was a post hoc analysis of the TTM2-trial, which randomized 1900 out-of-hospital cardiac arrest patients to either normothermia or hypothermia. In both groups, deep sedation (Richmond Agitation and Sedation Scale ≤ -4) was mandatory during the 40-h intervention. Cumulative doses of sedatives and analgesic drugs were recorded within the first 72 h from randomization. Outcomes were... (More)

Background: The routine use of sedation and analgesia during post-cardiac arrest care and its association with clinical outcomes remain unclear. This study aimed to describe the use of sedatives and analgesics in post-cardiac arrest care, and evaluate associations with good functional outcome, survival, clinical seizures, and late awakening. Methods: This was a post hoc analysis of the TTM2-trial, which randomized 1900 out-of-hospital cardiac arrest patients to either normothermia or hypothermia. In both groups, deep sedation (Richmond Agitation and Sedation Scale ≤ -4) was mandatory during the 40-h intervention. Cumulative doses of sedatives and analgesic drugs were recorded within the first 72 h from randomization. Outcomes were functional outcome (modified Rankin Scale) and survival status at 6 months, occurrence of clinical seizures during the intensive care stay, and late awakening (Full outline of unresponsiveness motor score of four 96 h after randomization). Cumulative propofol doses were divided into quartiles (Q1-Q4). Logistic regression models were used to assess associations between sedative doses and functional outcome and survival, clinical seizures, and late awakening, adjusting for the severity of illness and other clinical factors influencing sedation. Results: A total of 1861 patients were analyzed. In a multivariable logistic regression model, higher propofol doses (Q3, 100.7–153.6 mg/kg) were associated with good functional outcome (OR 1.62, 95%CI 1.12—2.34) and (Q2 and Q3, 43.9–153.6 mg/kg) with survival (OR 1.49, 95%CI 1.05—2.12 and OR 1.84, 95%CI 1.27—2.65, respectively). Receiving fentanyl and remifentanil were associated with good functional outcome (OR 1.69, 95%CI 1.27—2.26 and OR 1.50, 95%CI 1.11—2.02) and survival (OR 1.80, 95%CI 1.35—2.40 and OR 1.56, 95%CI 1.16—2.10). Receiving fentanyl (OR 0.64, 95%CI 0.48—0.86) and higher propofol doses (Q2-4 (43.9–669.4 mg/kg) were associated with the occurrence of clinical seizures. The highest quartile of propofol dose (153.7–669.4 mg/kg, OR 3.19, 95%CI 1.91—5.42) was associated with late awakening. Conclusions: In this study, higher doses of propofol and the use of remifentanil and fentanyl were associated with good functional outcome and survival, occurrence of clinical seizures, and late awakening.

(Less)
Please use this url to cite or link to this publication:
author
; ; ; ; ; ; ; ; and , et al. (More)
; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; and (Less)
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Cardiac arrest, Midazolam, Propofol, Sedation, Seizures, Targeted temperature management
in
Critical Care
volume
29
issue
1
article number
247
publisher
BioMed Central (BMC)
external identifiers
  • pmid:40528173
  • scopus:105008238900
ISSN
1364-8535
DOI
10.1186/s13054-025-05461-0
language
English
LU publication?
yes
id
88063031-eb7d-46ab-98ea-3940917ccccd
date added to LUP
2025-10-27 10:21:42
date last changed
2025-10-28 03:27:34
@article{88063031-eb7d-46ab-98ea-3940917ccccd,
  abstract     = {{<p>Background: The routine use of sedation and analgesia during post-cardiac arrest care and its association with clinical outcomes remain unclear. This study aimed to describe the use of sedatives and analgesics in post-cardiac arrest care, and evaluate associations with good functional outcome, survival, clinical seizures, and late awakening. Methods: This was a post hoc analysis of the TTM2-trial, which randomized 1900 out-of-hospital cardiac arrest patients to either normothermia or hypothermia. In both groups, deep sedation (Richmond Agitation and Sedation Scale ≤ -4) was mandatory during the 40-h intervention. Cumulative doses of sedatives and analgesic drugs were recorded within the first 72 h from randomization. Outcomes were functional outcome (modified Rankin Scale) and survival status at 6 months, occurrence of clinical seizures during the intensive care stay, and late awakening (Full outline of unresponsiveness motor score of four 96 h after randomization). Cumulative propofol doses were divided into quartiles (Q1-Q4). Logistic regression models were used to assess associations between sedative doses and functional outcome and survival, clinical seizures, and late awakening, adjusting for the severity of illness and other clinical factors influencing sedation. Results: A total of 1861 patients were analyzed. In a multivariable logistic regression model, higher propofol doses (Q3, 100.7–153.6 mg/kg) were associated with good functional outcome (OR 1.62, 95%CI 1.12—2.34) and (Q2 and Q3, 43.9–153.6 mg/kg) with survival (OR 1.49, 95%CI 1.05—2.12 and OR 1.84, 95%CI 1.27—2.65, respectively). Receiving fentanyl and remifentanil were associated with good functional outcome (OR 1.69, 95%CI 1.27—2.26 and OR 1.50, 95%CI 1.11—2.02) and survival (OR 1.80, 95%CI 1.35—2.40 and OR 1.56, 95%CI 1.16—2.10). Receiving fentanyl (OR 0.64, 95%CI 0.48—0.86) and higher propofol doses (Q2-4 (43.9–669.4 mg/kg) were associated with the occurrence of clinical seizures. The highest quartile of propofol dose (153.7–669.4 mg/kg, OR 3.19, 95%CI 1.91—5.42) was associated with late awakening. Conclusions: In this study, higher doses of propofol and the use of remifentanil and fentanyl were associated with good functional outcome and survival, occurrence of clinical seizures, and late awakening.</p>}},
  author       = {{Ceric, Ameldina and Dankiewicz, Josef and Cronberg, Tobias and Düring, Joachim and Moseby-Knappe, Marion and Annborn, Martin and May, Teresa L. and Thomas, Matthew and Grejs, Anders Morten and Rylander, Christian and Belohlavek, Jan and Wendel-Garcia, Pedro and Haenggi, Matthias and Schrag, Claudia and Hilty, Matthias P. and Keeble, Thomas R. and Wise, Matt P. and Young, Paul and Taccone, Fabio Silvio and Robba, Chiara and Cariou, Alain and Eastwood, Glenn and Saxena, Manoj and Ullén, Susann and Lilja, Gisela and Jakobsen, Janus C. and Lybeck, Anna and Nielsen, Niklas}},
  issn         = {{1364-8535}},
  keywords     = {{Cardiac arrest; Midazolam; Propofol; Sedation; Seizures; Targeted temperature management}},
  language     = {{eng}},
  number       = {{1}},
  publisher    = {{BioMed Central (BMC)}},
  series       = {{Critical Care}},
  title        = {{Sedation and analgesia in post-cardiac arrest care : a post hoc analysis of the TTM2 trial}},
  url          = {{http://dx.doi.org/10.1186/s13054-025-05461-0}},
  doi          = {{10.1186/s13054-025-05461-0}},
  volume       = {{29}},
  year         = {{2025}},
}