Propofol and remifentanil versus midazolam and fentanyl for sedation during therapeutic hypothermia after cardiac arrest: a randomised trial

Intensive Care Medicine,

Bjelland TW et al. – Time to offset was significantly shorter in patients treated with propofol and remifentanil. However, the clinical course in 40 % of patients prevented discontinuation of sedation and potential benefits from a faster recovery. The propofol and remifentanil group required norepinephrine twice as often, but both protocols were tolerated in most patients.

Methods

  • This was an open, randomised, controlled trial on 59 patients treated with therapeutic hypothermia (33–34 °C for 24h) after cardiac arrest in two Norwegian university hospitals between April 2008 and May 2009.
  • The intervention was random allocation to sedation and analgesia with propofol/remifentanil or midazolam/fentanyl.

Results

  • Twenty–nine patients received propofol and remifentanil, and 30 midazolam and fentanyl.
  • Baseline characteristics were similar.
  • Sedation and analgesia were stopped in 35 patients, and extubation was performed in 17 of these.
  • Sedation had to be continued for 24 patients.
  • Time to offset was significantly lower in patients given propofol and remifentanil [mean (95 % confidence intervals) 13.2 (2.3–24) vs. 36.8 (28.5–45.1)h, respectively, p<0.001].
  • Patients given propofol and remifentanil needed norepinephrine infusions twice as often (23 vs. 12 patients, p=0.003).
  • Incidence of pneumonia and 3–month neurological outcome were similar in the two groups.

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