This retrospective analysis of the prospective AfterROSC1 & 2 cohort studies compared 1,596 out-of-hospital cardiac arrest (OHCA) patients who did vs. did not receive sedation between ROSC and ICU admission, examining day-90 survival and favorable neurological outcome (mRS 0–3).
83% of patients (n=1,324) received pre-ICU sedation; favorable day-90 neurological outcome was higher in the sedated group (32.4% vs. 11.8%, P=0.001). After mCAHP score and center adjustment, the benefit persisted (aOR 2.19, 95% CI 1.31–3.65), but was no longer significant after propensity score adjustment (OR 1.40, 95% CI 0.70–2.09, P=0.26).
- Residual indication bias cannot be ruled out: sicker patients (higher mCAHP scores) were more likely to be withheld sedation, inflating the apparent benefit. - Observational design precludes causal inference between pre-hospital sedation and neurological recovery. - Propensity score adjustment eliminated statistical significance, highlighting the confounding not fully captured by available variables.
Pre-hospital sedation after ROSC appears associated with better 90-day neurological outcomes, but this likely reflects selection bias — less severely ill patients are more often sedated. Clinicians should not alter sedation practice based on this data alone; a randomized trial is needed to clarify causality.
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