EEG-guided early cessation of sedation and TTM in patients after cardiac arrest: a feasibility and safety study

Objective: Despite substantial variability in the severity of post-anoxic encephalopathy, all comatose patients after cardiac arrest are usually treated according to the same standardised intensive care protocol, including sedation, mechanical ventilation, and targeted temperature management (TTM). We hypothesise that patients with a favourable EEG pattern (continuous EEG within 12 h after cardiac arrest) may not benefit from prolonged sedation and TTM. We studied the feasibility and safety of early cessation of sedation and TTM in this subgroup. Methods: We conducted a non-randomised, controlled intervention study including 40 adult patients admitted to the ICU with postanoxic encephalopathy after cardiac arrest and an early (<12 h) favourable EEG pattern. The control group received standard care with sedation and TTM for at least 24 h, whereas the intervention group underwent early cessation of sedation and TTM as soon as possible after establishing a favourable EEG, followed by weaning from mechanical ventilation. The primary outcome was duration of mechanical ventilation. Secondary outcomes included ICU length of stay, total sedation time, number of ICU complications, and neurological outcomes at 3 and 6 months. Results: Duration of mechanical ventilation was significantly shorter in the intervention than in the control group (median 12 vs 28 h, p < 0.001). Median ICU length of stay and median total sedation time were also reduced by more than 50% in the intervention group, from respectively 2.5 to 1.2 days (p = 0.001) and 27 to 12 h (p < 0.001). There was no increase in ICU complications in the intervention group. No statistically significant differences in neurological outcomes at 3 or 6 months were observed. Conclusion: Early withdrawal of sedation is feasible and safe in patients with an early favourable EEG following cardiac arrest. The study was underpowered to detect possible differences in long-term neurological recovery. Significance: Shortening sedation and mechanical ventilation is likely to contribute to more appropriate care. Larger studies are needed to evaluate the impact on long-term neurological outcomes.