• Toru Takiguchi, Hiroyuki Ohbe, Mikio Nakajima, Yusuke Sasabuchi, Takashi Tagami, Hiroki Matsui, Kiyohide Fushimi, Shoji Yokobori, and Hideo Yasunaga.
• Department of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo, Japan. Electronic address: toru-takiguchi@nms.ac.jp.
• J Crit Care. 2021 Apr 1; 62: 276-282.

PurposeWhether intermittent or continuous neuromuscular-blocking agents (NMBAs) would be appropriate during target temperature management (TTM) after cardiac arrest remains unclear.Materials And MethodsIn this retrospective cohort study, we utilized the Japanese Diagnosis Procedure Combination inpatient database from July 2010 to March 2018 and identified patients who received NMBAs during TTM after cardiac arrest on the day of admission. We compared the in-hospital mortality between the propensity-score-matched intermittent and continuous NMBA groups.ResultsWe identified 5584 eligible patients; 1488 received intermittent NMBAs and 4096 received continuous NMBAs. After propensity score matching, there was no significant difference in the in-hospital mortality between the intermittent and continuous NMBA groups (32.9% vs. 33.1%; odds ratio, 0.98; 95% confidence interval, 0.82-1.18). In subgroup analyses, in-hospital mortality of the continuous NMBA group was significantly higher than that of the intermittent NMBA group in patients aged ≥65 years (p for interaction = 0.021).ConclusionsThis large retrospective study did not suggest that intermittent NMBAs may be inferior to continuous NMBAs in terms of mortality reduction in the overall population receiving TTM for cardiac arrest. However, continuous NMBAs may be inferior to intermittent NMBAs for reducing mortality in elderly patients.Copyright © 2021 Elsevier Inc. All rights reserved.

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