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Sevoflurane combined with a modified cooling strategy significantly reduces ventilator dependency, icu and hospital length of stay in post-cardiac arrest survivors

AT Bos, Q Muijrers, L Janssen, NA Foudraine

Background: Use of volatile anaesthetics (VA) has gained interest as an alternative to intravenous sedatives in ICU patients mainly because of their very short half-life. So the combination of sevoflurane with targeted temperature management might both improve quality of care and length of stay of out of hospital resuscitated (OHCA) patients. We studied the effects of a protocol change including sevoflurane on the duration of ventilation and ICU length of stay. The secondary endpoint was the incidence of delirium. Methods: We retrospectively compared two successive protocols in 128 OHCA survivors, admitted between January 2015 and April 2017. In the first period patients were intravenously sedated and deeply cooled (TTM/ IV) (n=77), and from 2016 onwards patients were sedated with sevoflurane and mildly cooled (mTTM/sevo) (n=51). Patients were compared protocol-wise. In normally distributed variables a Student T-test was used, otherwise non-parametric analyses (Mann-Whitney U) were used. Clinical endpoints were studied in patients with full neurologic recovery. Results: The duration of ventilation and ICU length of stay were both shorter in the mTTM/sevo group ((median 28.2 h, IQR 26.4-38.5) vs. median 90.1 h, IQR 59.1-159.2; p<0.01) and median 2.3 days (IQR 1.9-2.7) vs. 5.6 days (IQR 3.9-7.9); (p<0.01), respectively. Moreover, hospital length of stay was shorter in the mTTM/ sevo group, median of 8.9 days (IQR 5.4-16.9) vs. 15.8 days (IQR 11.7-23.3) in the TTM/IV-group (p<0.01). The incidence of delirium was higher in the TTM/IV group ((51.8%) vs. (11.5%) in the mTTM/sevo group; p<0.01). Conclusion: Sevoflurane combined with mTTM is a safe alternative in OHCA survivors. We demonstrated a shorter ventilator dependency, and both a shorter ICU and hospital length of stay. The lower delirium incidence in patients with full neurologic recovery is of particular interest and deserves further research. It is possibly associated to less benzodiazepine administration.