Evidence map›Paper›PMID 40528173›Full record

Trial reportCritical care (London, England)2025

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

Ameldina Ceric, Josef Dankiewicz, Tobias Cronberg, Joachim Düring, Marion Moseby-Knappe, Martin Annborn, Teresa L May, Matthew Thomas, Anders Morten Grejs, Christian Rylander and 18 more

Abstract readRandomized Controlled Trial
In one paragraph

Trial report in Critical care (London, England), 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
5citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

5 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
  2. Article
  3. Article
  4. Review
  5. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

28 authors.

Ameldina CericAnesthesia & Intensive Care, Department of Clinical Sciences, Lund University, Skane University Hospital, Carl Bertil Laurels Gata 9, 214 28, Malmö, Sweden. ameldina.ceric@med.lu.se.
Josef DankiewiczCardiology Department, Lund University, Skåne University Hospital Lund, Lund, Sweden.
Tobias CronbergNeurology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden.
Joachim DüringDepartment of Clinical Sciences, Anaesthesia and Intensive Care, Lund University, Skåne University Hospital, Malmö, Sweden.
Marion Moseby-KnappeDepartment of Clinical Sciences Lund, Neurology and Rehabilitation, Lund University, Lund, Sweden.
Martin AnnbornDepartment of Clinical Sciences, Anaesthesia and Intensive Care, Lund University, Helsingborg Hospital, Helsingborg, Sweden.
Teresa L MayDepartment of Critical Care, Maine Medical Center, Portland, ME, USA.
Matthew ThomasDepartment of Intensive Care, University Hospitals Bristol and Weston, Bristol, UK.
Anders Morten GrejsDepartment of Intensive Care Medicine, Aarhus University Hospital, Aarhus N, Denmark.
Christian RylanderAnaesthesiology and Intensive Care, Department of Surgical Sciences, Uppsala University and Uppsala University Hospital, Uppsala, Sweden.
Jan Belohlavek2Nd Department of Internal Mediciny, Cardiovascular Medicine, General University Hospital, and 1St Medical School in Prague, Prague, Czech Republic.
Pedro Wendel-GarciaInstitute of Intensive Care Medicine, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland.
Matthias HaenggiInstitute of Intensive Care Medicine, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland.
Claudia SchragIntensive Care Department, Kantonsspital St. Gallen, St. Gallen, Switzerland.
Matthias P HiltyInstitute of Intensive Care Medicine, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland.
Thomas R KeebleAnglia Ruskin School of Medicine, Essex Cardiothoracic Centre, MSE NHS Trust, Essex, UK. MTRC, Chelmsford, Essex, UK.
Matt P WiseAdult Critical Care, University Hospital of Wales, Cardiff, UK.
Paul YoungIntensive Care Unit, Wellington Hospital, Wellington, New Zealand and Medical Research Institute of New Zealand, Wellington, New Zealand.
Fabio Silvio TacconeDepartment of Intensive Care, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium.
Chiara RobbaIRCCS Policlinico San Martino; Genoa, Italy and Dipartimento Di Scienze Chirurgiche Diagnostiche E Integrate, University of Genoa, Genoa, Italy.
Alain CariouMedical ICU Cochin University Hospital, AP-HP Centre Université Paris Cité, Paris, France.
Glenn EastwoodThe Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Australia.
Manoj SaxenaDivision of Critical Care and Trauma, George Institute for Global Health, and Bankstown-Lidcombe Hospital, South Western Sydney Local Health District, Sydney, Australia.
Susann UllénSkåne University Hospital Lund, Lund University and Clinical Studies Sweden - Forum South, Skåne University Hospital, Lund, Sweden.
Gisela LiljaNeurology Department of Clinical Sciences, Lund University, Lund, Sweden.
Janus C JakobsenCopenhagen Trial Unit - Centre for Clinical Intervention Research, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
Anna LybeckDepartment of Clinical Sciences, Anaesthesia and Intensive Care, Skåne University Hospital, Lund University, Lund, Sweden.
Niklas NielsenDepartment of Clinical Sciences, Anaesthesia and Intensive Care, Lund University, Helsingborg Hospital, Helsingborg, Sweden.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundThe routine use of sedation and analgesia during post-cardiac arrest care and its association with clinical outcomes remain unclear. This study aimed to describe the use of sedatives and analgesics in post-cardiac arrest care, and evaluate associations with good functional outcome, survival, clinical seizures, and late awakening.

methodsThis was a post hoc analysis of the TTM2-trial, which randomized 1900 out-of-hospital cardiac arrest patients to either normothermia or hypothermia. In both groups, deep sedation (Richmond Agitation and Sedation Scale ≤ -4) was mandatory during the 40-h intervention. Cumulative doses of sedatives and analgesic drugs were recorded within the first 72 h from randomization. Outcomes were functional outcome (modified Rankin Scale) and survival status at 6 months, occurrence of clinical seizures during the intensive care stay, and late awakening (Full outline of unresponsiveness motor score of four 96 h after randomization). Cumulative propofol doses were divided into quartiles (Q1-Q4). Logistic regression models were used to assess associations between sedative doses and functional outcome and survival, clinical seizures, and late awakening, adjusting for the severity of illness and other clinical factors influencing sedation.

resultsA total of 1861 patients were analyzed. In a multivariable logistic regression model, higher propofol doses (Q3, 100.7-153.6 mg/kg) were associated with good functional outcome (OR 1.62, 95%CI 1.12-2.34) and (Q2 and Q3, 43.9-153.6 mg/kg) with survival (OR 1.49, 95%CI 1.05-2.12 and OR 1.84, 95%CI 1.27-2.65, respectively). Receiving fentanyl and remifentanil were associated with good functional outcome (OR 1.69, 95%CI 1.27-2.26 and OR 1.50, 95%CI 1.11-2.02) and survival (OR 1.80, 95%CI 1.35-2.40 and OR 1.56, 95%CI 1.16-2.10). Receiving fentanyl (OR 0.64, 95%CI 0.48-0.86) and higher propofol doses (Q2-4 (43.9-669.4 mg/kg) were associated with the occurrence of clinical seizures. The highest quartile of propofol dose (153.7-669.4 mg/kg, OR 3.19, 95%CI 1.91-5.42) was associated with late awakening.

conclusionsIn this study, higher doses of propofol and the use of remifentanil and fentanyl were associated with good functional outcome and survival, occurrence of clinical seizures, and late awakening.

Indexed as

AnalgesiaOut-of-Hospital Cardiac ArrestAgedAnalgesicsDeep SedationFemaleHumansHypnotics and SedativesLogistic ModelsMaleMiddle AgedPropofolAnalgesicsHypnotics and SedativesPropofolCardiac arrestMidazolamPropofolSedationSeizuresTargeted temperature management

Identifiers

PMID40528173
PMCPMC12175406

What Socratic holds

Textmetadata
LicenceCC BY
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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.