Agarwal, Sachin

Duarte, Christine W, PhD

Fraser, Gilles

Hans, Friberg

Hirsh, Karen

Kent, David

May, Teresa

Mooney, Michael R, MD

Nielsen, Niklas, MD, PhD

Patel, Nainesh C, MD

Riker, Richard R, MD

Seder, David B, MD

Soreid, Eldar

Lehigh Valley Health Network: LVHN Scholarly Works

Lehigh Valley Health Network LVHN Scholarly Works Department of Medicine 51: EFFECT OF SEDATION AND NEUROMUSCULAR BLOCKADE REGIMENS ON OUTCOMES AFTER CARDIAC ARREST Teresa May Richard R. Riker MD Gilles Fraser Christine W. Duarte PhD Sachin Agarwal See next page for additional authors Follow this and additional works at: https://scholarlyworks.lvhn.org/medicine  Part of the Medical Sciences Commons Published In/Presented At May,T. Riker, R. Fraser, G. Duarte, C. Agarwal, S. Hirsh, K. Soreid, E. Patel, N. Mooney, M. Hans, F. Kent, D. Niklas, N. Seder, D. (2018). 51: EFFECT OF SEDATION AND NEUROMUSCULAR BLOCKADE REGIMENS ON OUTCOMES AFTER CARDIAC ARREST. Critical Care Medicine, 46(1), 26. doi: 10.1097/01.ccm.0000528106.49650.fd This Article is brought to you for free and open access by LVHN Scholarly Works. It has been accepted for inclusion in LVHN Scholarly Works by an authorized administrator. For more information, please contact LibraryServices@lvhn.org. Authors Teresa May; Richard R. Riker MD; Gilles Fraser; Christine W. Duarte PhD; Sachin Agarwal; Karen Hirsh; Eldar Soreid; Nainesh C. Patel MD; Michael R. Mooney MD; Friberg Hans; David Kent; Niklas Nielsen MD, PhD; and David B. Seder MD This article is available at LVHN Scholarly Works: https://scholarlyworks.lvhn.org/medicine/1419 Copyright © 2017 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.www.ccmjournal.org Critical Care Medicine • Volume 46 • Number 1 (Supplement)STAR Research Presentation: CPR and ResuscitationLearning Objectives: Post reperfusion syndrome (PRS) is a major and potentially lethal intra- operative event occurring in 20% of patients undergoing liver transplantation (LTx). PRS is character-ized by significant hypotension and bradycardia following allograft implantation and it’s mainly exacerbated by ischemia-reperfusion injuries (IRI) stemming from liver procurement and preservation. A prospective preclinical study was conducted in a swine model comparing the post reperfusion events in 12 animals undergoing orthotopic LTx after 9 hours of cold ischemia time (CIT).Methods: The study group (n = 6) animals had their liver allografts (LA) preserved with machine perfusion (MP) combined with a hemoglobin-based oxygen carrier (HBOC) at 21°C. The control group (n = 6) had their LA preserved under cold storage (CS) with UW at 4°C. The animals had a 5-day post-transplant follow-up before the end-study necropsy.Results: The MP group had 100% survival and no signs of PRS, requiring significantly less intravenous fluid (p = 0.0061), blood products and vasopressors and demonstrative change in lactate. The CS group had 17% survival with moderate to severe signs of PRS. The MP group animals had a significantly (p < 0.05) higher bile secretion and urine output while displaying a significantly (p < 0.05) lower incidence of lactic acidosis and peak in liver enzymes (AST, ALT) during the postoperative period. The CS animals showed clear histological signs of moderate to severe IRI in their LA at the end-study necropsy, where massive centrilobular necro-sis and cholestasis were documented. The MP animals had signs of none to mild IRI and normal LA function post-operatively.Conclusions: MP combined with HBOC at 21°C showed a signifi-cant (p < 0.05) decrease in the incidence of PRS in a swine model with CIT = 9 hours when compared to CS. MP provides effec-tive ex-vivo oxygenation during LA preservation and significantly eliminates PRS in this challenging preclinical swine model.52POST-REPERFUSION SYNDROME IN LIVER TRANSPLANTATION: THE END OF AN ERAKyle Kettler, Paulo Fontes, Roberto Lopez, Wallis Marsh, Kyle Soltys, Arjan van der Plaats, Marta Minervini, Victor ScottCCMLearning Objectives: Sedation and neuromuscular blockade (NMB) protocols in patients undergoing targeted temperature management (TTM) after cardiac arrest need to address patient discomfort and manage shivering. These protocols vary widely between centers and may affect outcomes.Methods: Consecutive patients resuscitated from cardiac arrest and admitted to 20 cardiac arrest centers were prospectively col-lected for the observational International Cardiac Arrest Registry between (2004–2016). Centers self-reported sedation/shivering practices using a REDCap-based survey. Sedation and shivering practices (SP) were categorized as SP1 (deep sedation and mini-mal or no NMB), SP2 (moderate-deep sedation with continu-ous or scheduled NMB), or SP3 (moderate- deep sedation with as-needed NMB). Good outcome was defined as cerebral perfor-mance category (CPC) score of 1 or 2 at discharge and 6 months. A logistic regression hierarchical model was created with two lev-els (patient-level data with standard confounders at level one and hospitals at level two) and sedation practice as a random effect at the hospital level.Results: There were 4,267 patients, mean age 62 ± 15 years, 36% female, 77% out-of-hospital arrests, and mean ischemic time was 24(± 18) minutes. The unadjusted odds ratio for good outcome at 6 months was 1.19 (0.88–1.42, p = 0.07) and 1.65 (1.40–1.97, p < 0.001) for SP2 and SP3 respectively, referenced to SP1. Adjusted odds ratio (for age, ischemic time, location of arrest, witnessed, initial rhythm, bystander CPR, and defibrillation, medical his-tory and size of hospital) was 1.13 (0.74–1.73, p = 0.56) and 1.45 (1.00–2.13, p = 0.046). For the secondary endpoint of good out-comes at discharge, compared to patients in SP1 group, the unad-justed odds ratio for SP2 and SP3 was 1.10 (0.90–1.34, p = 0.34) and 1.69 (1.41–2.01, p < 0.001), with adjusted odds ratios of 0.86 (0.55–1.35, p-0.52) and 1.46 (0.97–2.20, p = 0.07), respectively.Conclusions: Cardiac arrest patients treated at centers using mod-erate-deep sedation and as-needed NMB had increased odds of good outcomes compared to centers using deep sedation and avoidance of NMB. Deeper sedation after cardiac arrest could be harmful due to multiple mechanisms, including incomplete shivering control, hypotension, neurotoxic effects of sedatives, or confounding of prognostication. These findings should be further investigated in prospective studies.1Maine Medical Center, Portland, ME, 2Maine Medical Center, Center for Out-comes Research, Portland, ME, 3Columbia University Medical Center, New York, NY, 4Stanford University School of Medicine, Standford, CA, 5Stavanger University Hospital, Stavanger, Stavanger, 6Lehigh Valley Hospital, Allentown, PA, 7Minneapolis Heart Institute, Minneapolis, MN, 8Skane University Hospital, Lund, Sweden, 9Tufts Medical Center, Boston, MA, 10Helsingborg Hospital, Hel-singborg, Sweden46151EFFECT OF SEDATION AND NEUROMUSCULAR BLOCKADE REGIMENS ON OUTCOMES AFTER CARDIAC ARRESTTeresa May, Richard Riker, Gilles Fraser, Christine Duarte, Sachin Agarwal, Karen Hirsh, Eldar Soreid, Nainesh Patel, Michael Mooney, Hans Friberg, David Kent, Niklas Nielsen, David Seder1Augustana University, Sioux Falls, SD, 2University of Pittsburgh School of Medi-cine, Pittsburgh, PA, 3University of Pittsburgh Physicians, Pittsburgh, PA, 4Organ Assist, Groningen, Netherlands, 5UPMC Montefiore Hospital, Pittsburgh, PA, 6N/A, Sioux Falls, SD

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51:  EFFECT OF SEDATION AND NEUROMUSCULAR BLOCKADE REGIMENS ON OUTCOMES AFTER CARDIAC ARREST

51: EFFECT OF SEDATION AND NEUROMUSCULAR BLOCKADE REGIMENS ON OUTCOMES AFTER CARDIAC ARREST

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