Jansen, G., Latka, E., Bernhard, M., Deicke, M., Fischer, D., Hoyer, A., Keller, Y., Kobiella, A., Linder, S., Strickmann, B., Strototte, L. M., Thies, K. C., Johanning, K., von Dossow, V., and Hinkelbein, J.
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 post-resuscitation care targets and the associated risk of hemodynamic complications. Methods: All emergency rescue missions of the Dresden, Gtersloh, and Lippe medical rescue services in the years 20192021 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 ≥100mmHg, end-tidal pCO2 3545mmHg, and oxygen saturation (SpO2) 9498%. 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 emergency rescue missions. 571 patients had ROSC before arrival in the hospital (24.5%; female,33.6%; age, 6814 years). Of the 395 among them (69.2%) who were treated with post-arrest 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. [ABSTRACT FROM AUTHOR]