title: Use of Neuromuscular Blockers During Therapeutic Hypothermia After Cardiac Arrest: A Nursing Protocol.
abstract: BACKGROUND
  Neuromuscular blockers used to prevent shivering during therapeutic hypothermia in comatose patients after out-of-hospital cardiac arrest are associated with adverse events.
  
  
  OBJECTIVE
  To assess the influence of a nurse-implemented protocol on use of neuromuscular blockers in patients treated with 24-hour therapeutic hypothermia after out-of-hospital cardiac arrest.
  
  
  METHODS
  A before and after study was done in a 24-bed cardiac arrest center. During the before period, paralysis was maintained by continuous infusion of vecuronium during therapeutic hypothermia. During the after period, a nurse-implemented protocol was used to strictly control use of neuromuscular blockers. The primary outcome measure was duration of infusion of neuromuscular blockers; secondary end points included rates of ventilator-associated pneumonia and intensive care unit mortality.
  
  
  RESULTS
  Among the 22 patients in the before group and the 23 patients in the after group, most were men (78%) with a median age of 66 years. Baseline characteristics were similar between the 2 groups. Median duration of sedation was 36 hours, shorter in the after group (34 hours) than in the before group (38 hours; P = .02). Median duration of infusion of neuromuscular blockers was significantly shorter in the after group (6 hours) than in the before group (33 hours; P < .001). Ventilator-associated pneumonia occurred more frequently in the before group (45%) than in the after group (13%; P = .02). Overall intensive care unit mortality rate was 58%, similar in both groups (P = .44).
  
  
  CONCLUSIONS
  Use of a nurse-implemented protocol to reduce use of neuromuscular blockers is feasible.
authors.affiliation: Coraline Boulila, Samia Ben Abdallah, Aude Marincamp, Vincent Coic, and Romuald Lauverjat are research nurses and Nicole Ericher is the charge nurse, medical intensive care unit, Cochin Hospital, Assistance Publique Hôpitaux de Paris, Paris, France.|Wulfran Bougouin is a critical care physician, medical intensive care unit, Cochin Hospital, Assistance Publique Hôpitaux de Paris, a clinical fellow, Paris Descartes University, and a scientist, Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research, Paris, France.|Jean-Paul Mira is a critical care physician and head, medical intensive care unit, Cochin Hospital, Assistance Publique Hôpitaux de Paris and a professor of critical care medicine, Paris Descartes University.|Alain Cariou is a critical care physician, medical intensive care unit, Cochin Hospital, Assistance Publique Hôpitaux de Paris, a professor of critical care medicine, Paris Descartes University, and a scientist, Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research.|Guillaume Geri is a critical care physician, medical intensive care unit, Cochin Hospital, Assistance Publique Hôpitaux de Paris, a clinical fellow, Paris Descartes University, and a scientist, Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research.
authors.forename: Coraline
authors.initials: C
authors.lastname: Boulila
authors.affiliation: Coraline Boulila, Samia Ben Abdallah, Aude Marincamp, Vincent Coic, and Romuald Lauverjat are research nurses and Nicole Ericher is the charge nurse, medical intensive care unit, Cochin Hospital, Assistance Publique Hôpitaux de Paris, Paris, France.|Wulfran Bougouin is a critical care physician, medical intensive care unit, Cochin Hospital, Assistance Publique Hôpitaux de Paris, a clinical fellow, Paris Descartes University, and a scientist, Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research, Paris, France.|Jean-Paul Mira is a critical care physician and head, medical intensive care unit, Cochin Hospital, Assistance Publique Hôpitaux de Paris and a professor of critical care medicine, Paris Descartes University.|Alain Cariou is a critical care physician, medical intensive care unit, Cochin Hospital, Assistance Publique Hôpitaux de Paris, a professor of critical care medicine, Paris Descartes University, and a scientist, Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research.|Guillaume Geri is a critical care physician, medical intensive care unit, Cochin Hospital, Assistance Publique Hôpitaux de Paris, a clinical fellow, Paris Descartes University, and a scientist, Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research.
authors.forename: Samia
authors.initials: S
authors.lastname: Ben Abdallah
authors.affiliation: Coraline Boulila, Samia Ben Abdallah, Aude Marincamp, Vincent Coic, and Romuald Lauverjat are research nurses and Nicole Ericher is the charge nurse, medical intensive care unit, Cochin Hospital, Assistance Publique Hôpitaux de Paris, Paris, France.|Wulfran Bougouin is a critical care physician, medical intensive care unit, Cochin Hospital, Assistance Publique Hôpitaux de Paris, a clinical fellow, Paris Descartes University, and a scientist, Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research, Paris, France.|Jean-Paul Mira is a critical care physician and head, medical intensive care unit, Cochin Hospital, Assistance Publique Hôpitaux de Paris and a professor of critical care medicine, Paris Descartes University.|Alain Cariou is a critical care physician, medical intensive care unit, Cochin Hospital, Assistance Publique Hôpitaux de Paris, a professor of critical care medicine, Paris Descartes University, and a scientist, Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research.|Guillaume Geri is a critical care physician, medical intensive care unit, Cochin Hospital, Assistance Publique Hôpitaux de Paris, a clinical fellow, Paris Descartes University, and a scientist, Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research.
authors.forename: Aude
authors.initials: A
authors.lastname: Marincamp
authors.affiliation: Coraline Boulila, Samia Ben Abdallah, Aude Marincamp, Vincent Coic, and Romuald Lauverjat are research nurses and Nicole Ericher is the charge nurse, medical intensive care unit, Cochin Hospital, Assistance Publique Hôpitaux de Paris, Paris, France.|Wulfran Bougouin is a critical care physician, medical intensive care unit, Cochin Hospital, Assistance Publique Hôpitaux de Paris, a clinical fellow, Paris Descartes University, and a scientist, Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research, Paris, France.|Jean-Paul Mira is a critical care physician and head, medical intensive care unit, Cochin Hospital, Assistance Publique Hôpitaux de Paris and a professor of critical care medicine, Paris Descartes University.|Alain Cariou is a critical care physician, medical intensive care unit, Cochin Hospital, Assistance Publique Hôpitaux de Paris, a professor of critical care medicine, Paris Descartes University, and a scientist, Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research.|Guillaume Geri is a critical care physician, medical intensive care unit, Cochin Hospital, Assistance Publique Hôpitaux de Paris, a clinical fellow, Paris Descartes University, and a scientist, Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research.
authors.forename: Vincent
authors.initials: V
authors.lastname: Coic
authors.affiliation: Coraline Boulila, Samia Ben Abdallah, Aude Marincamp, Vincent Coic, and Romuald Lauverjat are research nurses and Nicole Ericher is the charge nurse, medical intensive care unit, Cochin Hospital, Assistance Publique Hôpitaux de Paris, Paris, France.|Wulfran Bougouin is a critical care physician, medical intensive care unit, Cochin Hospital, Assistance Publique Hôpitaux de Paris, a clinical fellow, Paris Descartes University, and a scientist, Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research, Paris, France.|Jean-Paul Mira is a critical care physician and head, medical intensive care unit, Cochin Hospital, Assistance Publique Hôpitaux de Paris and a professor of critical care medicine, Paris Descartes University.|Alain Cariou is a critical care physician, medical intensive care unit, Cochin Hospital, Assistance Publique Hôpitaux de Paris, a professor of critical care medicine, Paris Descartes University, and a scientist, Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research.|Guillaume Geri is a critical care physician, medical intensive care unit, Cochin Hospital, Assistance Publique Hôpitaux de Paris, a clinical fellow, Paris Descartes University, and a scientist, Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research.
authors.forename: Romuald
authors.initials: R
authors.lastname: Lauverjat
authors.affiliation: Coraline Boulila, Samia Ben Abdallah, Aude Marincamp, Vincent Coic, and Romuald Lauverjat are research nurses and Nicole Ericher is the charge nurse, medical intensive care unit, Cochin Hospital, Assistance Publique Hôpitaux de Paris, Paris, France.|Wulfran Bougouin is a critical care physician, medical intensive care unit, Cochin Hospital, Assistance Publique Hôpitaux de Paris, a clinical fellow, Paris Descartes University, and a scientist, Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research, Paris, France.|Jean-Paul Mira is a critical care physician and head, medical intensive care unit, Cochin Hospital, Assistance Publique Hôpitaux de Paris and a professor of critical care medicine, Paris Descartes University.|Alain Cariou is a critical care physician, medical intensive care unit, Cochin Hospital, Assistance Publique Hôpitaux de Paris, a professor of critical care medicine, Paris Descartes University, and a scientist, Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research.|Guillaume Geri is a critical care physician, medical intensive care unit, Cochin Hospital, Assistance Publique Hôpitaux de Paris, a clinical fellow, Paris Descartes University, and a scientist, Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research.
authors.forename: Nicole
authors.initials: N
authors.lastname: Ericher
authors.affiliation: Coraline Boulila, Samia Ben Abdallah, Aude Marincamp, Vincent Coic, and Romuald Lauverjat are research nurses and Nicole Ericher is the charge nurse, medical intensive care unit, Cochin Hospital, Assistance Publique Hôpitaux de Paris, Paris, France.|Wulfran Bougouin is a critical care physician, medical intensive care unit, Cochin Hospital, Assistance Publique Hôpitaux de Paris, a clinical fellow, Paris Descartes University, and a scientist, Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research, Paris, France.|Jean-Paul Mira is a critical care physician and head, medical intensive care unit, Cochin Hospital, Assistance Publique Hôpitaux de Paris and a professor of critical care medicine, Paris Descartes University.|Alain Cariou is a critical care physician, medical intensive care unit, Cochin Hospital, Assistance Publique Hôpitaux de Paris, a professor of critical care medicine, Paris Descartes University, and a scientist, Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research.|Guillaume Geri is a critical care physician, medical intensive care unit, Cochin Hospital, Assistance Publique Hôpitaux de Paris, a clinical fellow, Paris Descartes University, and a scientist, Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research.
authors.forename: Wulfran
authors.initials: W
authors.lastname: Bougouin
authors.affiliation: Coraline Boulila, Samia Ben Abdallah, Aude Marincamp, Vincent Coic, and Romuald Lauverjat are research nurses and Nicole Ericher is the charge nurse, medical intensive care unit, Cochin Hospital, Assistance Publique Hôpitaux de Paris, Paris, France.|Wulfran Bougouin is a critical care physician, medical intensive care unit, Cochin Hospital, Assistance Publique Hôpitaux de Paris, a clinical fellow, Paris Descartes University, and a scientist, Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research, Paris, France.|Jean-Paul Mira is a critical care physician and head, medical intensive care unit, Cochin Hospital, Assistance Publique Hôpitaux de Paris and a professor of critical care medicine, Paris Descartes University.|Alain Cariou is a critical care physician, medical intensive care unit, Cochin Hospital, Assistance Publique Hôpitaux de Paris, a professor of critical care medicine, Paris Descartes University, and a scientist, Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research.|Guillaume Geri is a critical care physician, medical intensive care unit, Cochin Hospital, Assistance Publique Hôpitaux de Paris, a clinical fellow, Paris Descartes University, and a scientist, Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research.
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Mira
authors.affiliation: Coraline Boulila, Samia Ben Abdallah, Aude Marincamp, Vincent Coic, and Romuald Lauverjat are research nurses and Nicole Ericher is the charge nurse, medical intensive care unit, Cochin Hospital, Assistance Publique Hôpitaux de Paris, Paris, France. alain.cariou@cch.aphp.fr.|Wulfran Bougouin is a critical care physician, medical intensive care unit, Cochin Hospital, Assistance Publique Hôpitaux de Paris, a clinical fellow, Paris Descartes University, and a scientist, Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research, Paris, France. alain.cariou@cch.aphp.fr.|Jean-Paul Mira is a critical care physician and head, medical intensive care unit, Cochin Hospital, Assistance Publique Hôpitaux de Paris and a professor of critical care medicine, Paris Descartes University. alain.cariou@cch.aphp.fr.|Alain Cariou is a critical care physician, medical intensive care unit, Cochin Hospital, Assistance Publique Hôpitaux de Paris, a professor of critical care medicine, Paris Descartes University, and a scientist, Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research. alain.cariou@cch.aphp.fr.|Guillaume Geri is a critical care physician, medical intensive care unit, Cochin Hospital, Assistance Publique Hôpitaux de Paris, a clinical fellow, Paris Descartes University, and a scientist, Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research. alain.cariou@cch.aphp.fr.
authors.forename: Alain
authors.initials: A
authors.lastname: Cariou
authors.affiliation: Coraline Boulila, Samia Ben Abdallah, Aude Marincamp, Vincent Coic, and Romuald Lauverjat are research nurses and Nicole Ericher is the charge nurse, medical intensive care unit, Cochin Hospital, Assistance Publique Hôpitaux de Paris, Paris, France.|Wulfran Bougouin is a critical care physician, medical intensive care unit, Cochin Hospital, Assistance Publique Hôpitaux de Paris, a clinical fellow, Paris Descartes University, and a scientist, Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research, Paris, France.|Jean-Paul Mira is a critical care physician and head, medical intensive care unit, Cochin Hospital, Assistance Publique Hôpitaux de Paris and a professor of critical care medicine, Paris Descartes University.|Alain Cariou is a critical care physician, medical intensive care unit, Cochin Hospital, Assistance Publique Hôpitaux de Paris, a professor of critical care medicine, Paris Descartes University, and a scientist, Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research.|Guillaume Geri is a critical care physician, medical intensive care unit, Cochin Hospital, Assistance Publique Hôpitaux de Paris, a clinical fellow, Paris Descartes University, and a scientist, Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research.
authors.forename: Guillaume
authors.initials: G
authors.lastname: Geri
mesh_terms: D000368:Aged; D016887:Cardiopulmonary Resuscitation / Q000379:methods; D015331:Cohort Studies; D003422:Critical Care / Q000379:methods; D064648:Critical Care Nursing / Q000379:methods*; D004632:Emergency Medical Services; D005260:Female; D005500:Follow-Up Studies; D005602:France; D006801:Humans; D007036:Hypothermia, Induced / Q000379:methods*; D007262:Infusions, Intravenous; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D003473:Neuromuscular Nondepolarizing Agents / Q000008:administration & dosage*; D024802:Nurse's Role; D058687:Out-of-Hospital Cardiac Arrest / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D010343:Patient Admission; D058996:Quality Improvement; D012189:Retrospective Studies; D018570:Risk Assessment; D018709:Statistics, Nonparametric; D016896:Treatment Outcome
chemical_list: D003473:Neuromuscular Nondepolarizing Agents