AI Article Synopsis
- An investigation was conducted to assess the impact of midazolam used for post-arrest sedation on achieving essential post-resuscitation care targets and the risk of hemodynamic complications in patients who experienced out-of-hospital cardiac arrest (OHCA).
- The study reviewed emergency rescue missions from 2019-2021 and found that among patients with return of spontaneous circulation (ROSC), those receiving midazolam were more likely to meet recommended targets for blood pressure, oxygen levels, and carbon dioxide levels compared to those who did not receive sedation.
- The results suggest that using midazolam during the pre-hospital phase improves the chances of meeting critical oxygenation and ventilation goals in post-arrest patients, indicating its potential benefit in
Article Abstract
Background: An out-of-hospital cardiac arrest (OHCA) with return of spontaneous circulation (ROSC) may need to be treated with airway management, emergency ventilation, invasive interventions, and post-arrest sedation. We investigated the influence of the use of midazolam for post-arrest sedation on achieving postresuscitation care targets and the associated risk of hemodynamic complications.
Methods: All emergency rescue missions of the Dresden, Gütersloh, and Lippe medical rescue services in the years 2019-2021 were reviewed to identify adult patients who had OHCA, unconsciousness, and sustained ROSC with spontaneous circulation until arrival at the hospital; the findings were supplemented with data from the German Resuscitation Registry. Patients who received midazolam (alone or in combination with other anesthetic agents) for post-arrest sedation were compared with those who did not. The endpoints were the regaining of a systolic blood pressure ≥ 100 mmHg, end-tidal pCO2 35-45 mmHg, and oxygen saturation (SpO2) 94-98%. A propensity score analysis was used to adjust for age, sex, and variables potentially affecting hemodynamic status or the targets for oxygenation and ventilation.
Results: There were 2335 cases of OHCA among 391 305 emer - gency rescue missions. 571 patients had ROSC before arrival in the hospital (24.5%; female, 33.6%; age, 68 ± 14 years). Of the 395 among them (69.2%) who were treated with postarrest sedation, 249 (63.0%) received midazolam. Patients who received midazolam reached the guideline- recommended targets for oxygenation, ventilation, and blood pressure more frequently than those who were not sedated: the respective odds ratios and 95% confidence intervals were 2.00 [1.20; 3.34], 1.57 [0.99; 2.48], and 1.41 [0.89; 2.21].
Conclusion: The pre-hospital administration of midazolam leads to more frequent pre-hospital attainment of the oxygenation and ventilation targets in post-resuscitation care, without any evidence of an elevated risk of hemodynamic complications.
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Source |
|---|---|
| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC11539870 | PMC |
| http://dx.doi.org/10.3238/arztebl.m2023.0277 | DOI Listing |
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