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• W4361197110 abstract "The optimal first-line sedative in critically ill patients is evolving, and sedation choice has the potential to influence clinical outcomes.1,2 The current data, however, on strategies in the critically ill cardiac patient requiring continuous infusion of sedative drugs remains limited. Prior randomized controlled trials (RCTs) including general medical and surgical critical care patients have demonstrated that the use of benzodiazepines in patients undergoing mechanical ventilation (MV) has been associated with higher rates of delirium, prolonged intensive care unit (ICU) length-of-stay, and longer MV duration.3,4 Similarly, in observational studies, the use of benzodiazepines for sedation has been associated with a higher risk mortality compared to propofol or dexmedetomidine-based sedation5,6 There is paucity of high-quality evidence on the optimal sedation practices in patients with cardiac arrest or in those undergoing extracorporeal cardiopulmonary resuscitation (ECPR). Defining the optimal analgosedation strategies, which refers to the combination of analgesia and sedation, in patients undergoing ECPR for out-of-hospital cardiac arrest (OHCA) remains an unmet clinical research need given ECPRs rapidly growing use worldwide and the potential for sedative choices to confound timing of neuroprognostication7,8 or influence post-arrest neurotoxicity.9–11 Studies focusing specifically in patients admitted to ICUs after OHCA have suggested that propofol-based sedation is associated with better outcomes. In a small open-label RCT that included 59 patients in Norway, the authors demonstrated that propofol plus remifentanil allowed faster neuroprognostication assessment and shorter MV duration when compared to midazolam plus fentanyl.12 Notably, in this small RCT, patients receiving propofol plus remifentanyl infusion required higher vasopressor doses administration, though it was underpowered for major clinical endopoints.12 Another study of 460 patients with OHCA from a prospective registry reported shorter awakening times and shorter MV duration with propofol-remifentanyl combination when compared to midazolam-fentanyl.13 These results remained consistent in a propensity-matched analysis including 80 matched-pairs from the original cohort. Such associations may be dependent on benzodiazepine dose, as recently demonstrated by a retrospective study of 2778 OHCA patients, where the use of more than 10 mg of midazolam/per day was associated with significant longer awakening times after OHCA.14 Little is known about the association between first-line sedative agents and outcomes in patients treated with ECPR." @default.
• W4361197110 created "2023-03-31" @default.
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• W4361197110 date "2023-03-29" @default.
• W4361197110 modified "2023-10-06" @default.
• W4361197110 title "Sedation strategies in patients undergoing extracorporeal cardiopulmonary resuscitation" @default.
• W4361197110 doi "https://doi.org/10.1093/ehjacc/zuad028" @default.
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