• Gerrit Jansen, Eugen Latka, Michael Bernhard, Martin Deicke, Daniel Fischer, Annika Hoyer, Yacin Keller, André Kobiella, Sissy Linder, Bernd Strickmann, Lisa Marie Strototte, Karl Christian Thies, Kai Johanning, von DossowVeraV, and Jochen Hinkelbein.
• University Department of Anesthesiology, Intensive Care Medicine and Emergency Medicine, Johannes Wesling Klinikum Minden, Ruhr-University Bochum, Minden, Germany; Medical School OWL, Bielefeld University, Bielefeld, Germany; Department of Medical and Emergency Services, Study Institute Westfalen-Lippe, Bielefeld, Germany; Emergency Department, University Hospital of Düsseldorf, Düsseldorf, Germany; Medical Director of Rescue Service, Osnabrück District, Germany; Department of Anesthesiology and Operative Intensive Care Medicine, Hochschule Osnabrück - University of Applied Sciences, Osnabrück, Germany; Rescue Service Lippe District, Germany; Biostatistics and Medical Biometry, Medical School OWL, Bielefeld University, Bielefeld, Germany; Rescue Service, Integrated Regional Control Center Dresden, Dresden, Germany; Rescue Service, Gütersloh District, Germany; Skillslab, Medical School OWL, Bielefeld University, Bielefeld, Germany; University Department of Anesthesiology, Intensive Care Medicine, Emergency Medicine, Transfusion Medicine, and Pain Therapy, Evangelisches Klinikum Bethel, University Hospital OWL, Bielefeld University, Bielefeld, Germany; Department of Anesthesiology, Operative Intensive Care Medicine, Emergency Medicine and Pain Therapy, Municipal Hospital of Bielefeld, Bielefeld, Germany; Institute of Anesthesiology and Pain Therapy, Heart and Diabetes Center NRW, University Hospital of the Ruhr-University Bochum, Bad Oeynhausen, Germany.
• Dtsch Arztebl Int. 2024 Apr 5; 121 (7): 214221214-221.

BackgroundAn 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 postresuscitation care targets and the associated risk of hemodynamic complications.MethodsAll emergency rescue missions of the Dresden, Gütersloh, and Lippe medical rescue services in the years 2019-2021 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 ≥ 100 mmHg, end-tidal pCO2 35-45 mmHg, and oxygen saturation (SpO2) 94-98%. A propensity score analysis was used to adjust for age, sex, and variables potentially affecting hemodynamic status or the targets for oxygenation and ventilation.ResultsThere were 2335 cases of OHCA among 391 305 emer - gency rescue missions. 571 patients had ROSC before arrival in the hospital (24.5%; female, 33.6%; age, 68 ± 14 years). Of the 395 among them (69.2%) who were treated with postarrest 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].ConclusionThe 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.

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