title: Neuromuscular blockade during therapeutic hypothermia after cardiac arrest: observational study of neurological and infectious outcomes.
abstract: BACKGROUND
  Neuromuscular blockade (NMB) is widely used during therapeutic hypothermia (TH) after cardiac arrest but its effect on patient outcomes is unclear. We compared the effects of NMB on neurological outcomes and frequency of early-onset pneumonia in cardiac-arrest survivors managed with TH.
  
  
  METHODS
  We retrospectively studied consecutive adult cardiac-arrest survivors managed with TH in a tertiary-level intensive care unit between January 2008 and July 2013. Patients given continuous NMB for persistent shivering were compared to those managed without NMB. Cases of early-onset pneumonia and vital status at ICU discharge were recorded. To avoid bias due to between-group baseline differences, we adjusted the analysis on a propensity score.
  
  
  RESULTS
  Of 311 cardiac-arrest survivors, 144 received TH, including 117 with continuous NMB and 27 without NMBs. ICU mortality was lower with NMB (hazard ratio [HR], 0.54 [0.32; 0.89], p=0.016) but the difference was not significant after adjustment on the propensity score (HR, 0.70 [0.39; 1.25], p=0.22). The proportion of patients with good neurological outcomes was not significantly different (36% with and 22% without NMB, p=0.16). Early-onset pneumonia was more common with NMB (HR, 2.36 [1.24; 4.50], p=0.009) but the difference was not significant after adjustment on the propensity score (HR, 1.68 [0.90; 3.16], p=0.10).
  
  
  CONCLUSIONS
  Continuous intravenous NMB during TH after cardiac arrest has potential owns effects on ICU survival with a trend increase in the frequency of early-onset pneumonia. Randomised controlled trials are needed to define the role for NMB among treatments for TH-induced shivering.
authors.affiliation: Medical-Surgical Intensive Care Unit, District Hospital Center, La Roche-sur-Yon, France. Electronic address: jean-baptiste.lascarrou@chd-vendee.fr.
authors.forename: Jean Baptiste
authors.initials: JB
authors.lastname: Lascarrou
authors.affiliation: INSERM CIC 1415, University Hospital Center, Tours, France.
authors.forename: Amélie
authors.initials: A
authors.lastname: Le Gouge
authors.affiliation: Clinical Research Unit, District Hospital Center, La Roche-sur-Yon, France.
authors.forename: Jérome
authors.initials: J
authors.lastname: Dimet
authors.affiliation: Medical-Surgical Intensive Care Unit, District Hospital Center, La Roche-sur-Yon, France.
authors.forename: Jean Claude
authors.initials: JC
authors.lastname: Lacherade
authors.affiliation: Medical-Surgical Intensive Care Unit, District Hospital Center, La Roche-sur-Yon, France.
authors.forename: Laurent
authors.initials: L
authors.lastname: Martin-Lefèvre
authors.affiliation: Medical-Surgical Intensive Care Unit, District Hospital Center, La Roche-sur-Yon, France.
authors.forename: Maud
authors.initials: M
authors.lastname: Fiancette
authors.affiliation: Medical-Surgical Intensive Care Unit, District Hospital Center, La Roche-sur-Yon, France.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Vinatier
authors.affiliation: Medical-Surgical Intensive Care Unit, District Hospital Center, La Roche-sur-Yon, France.
authors.forename: Christine
authors.initials: C
authors.lastname: Lebert
authors.affiliation: Medical-Surgical Intensive Care Unit, District Hospital Center, La Roche-sur-Yon, France.
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Bachoumas
authors.affiliation: Medical-Surgical Intensive Care Unit, District Hospital Center, La Roche-sur-Yon, France.
authors.forename: Aihem
authors.initials: A
authors.lastname: Yehia
authors.affiliation: Medical-Surgical Intensive Care Unit, District Hospital Center, La Roche-sur-Yon, France.
authors.forename: Matthieu Henry
authors.initials: MH
authors.lastname: Lagarrigue
authors.affiliation: Medical-Surgical Intensive Care Unit, District Hospital Center, La Roche-sur-Yon, France.
authors.forename: Gwenhael
authors.initials: G
authors.lastname: Colin
authors.affiliation: Medical-Surgical Intensive Care Unit, District Hospital Center, La Roche-sur-Yon, France; Clinical Research Unit, District Hospital Center, La Roche-sur-Yon, France.
authors.forename: Jean
authors.initials: J
authors.lastname: Reignier
mesh_terms: D000368:Aged; D005260:Female; D006323:Heart Arrest / Q000628:therapy*; D006801:Humans; D007036:Hypothermia, Induced / Q000379:methods; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000209:etiology*; D019148:Neuromuscular Blockade / Q000009:adverse effects*; D018410:Pneumonia, Bacterial / Q000209:etiology*; D012189:Retrospective Studies
keywords: Cardiac arrest; Induced hypothermia; Neuromuscular blockade; Pneumonia