Sedation and analgesia in post-cardiac arrest care: a post hoc analysis of the TTM2 trial

PMCID: PMC12175406

PMID: 40528173

DOI: 10.1186/s13054-025-05461-0

Journal: Critical care (London, England)

Publication Date: 2025-6-17

Authors: Ceric A, Dankiewicz J, Cronberg T, Düring J, Moseby-Knappe M, et al.

Key Points

• Higher propofol doses (Q3: 100.7-153.6 mg/kg) significantly improved functional outcomes and survival
• Fentanyl and remifentanil use associated with 50-80% increased odds of good functional outcome and survival
• Careful titration of sedatives is crucial, as higher doses may simultaneously improve outcomes while increasing risks of seizures and delayed awakening

Summary

This post hoc analysis of the TTM2 trial investigated the impact of sedation and analgesia strategies in post-cardiac arrest patients, examining how different medication doses and types correlate with clinical outcomes. Among 1,861 out-of-hospital cardiac arrest patients, the study revealed nuanced associations between sedative and analgesic administration and patient recovery, challenging previous assumptions about sedation management in critical care.

The research demonstrated that higher doses of propofol (particularly in the 100.7-153.6 mg/kg range) were independently associated with improved functional outcomes (OR 1.62, 95% CI 1.12-2.34) and increased survival rates. Additionally, opioid analgesics like fentanyl and remifentanil showed positive correlations with good functional outcomes and survival, while also being linked to increased risks of clinical seizures and potential delayed awakening.