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July 4, 2026ResuscitationOpen Access

Sedation early after return of spontaneous circulation and during pre-hospital transport after out-of-hospital cardiac arrest: retrospective analysis of the AfterROSC1 & 2 database

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Authors

JPJuliette PreaubertGGGuillaume GériJBJérémie Bourenne

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Overview

Cohort study finds improved 90-day neurological outcomes with early pre-hospital sedation in cardiac arrest patients, suggesting potential benefits despite unconfirmed causality.

Key Points

  • To assess whether initiating sedation prior to intensive care unit admission after return of spontaneous circulation relates to improved 90-day functional recovery in out-of-hospital cardiac arrest.
  • Retrospective analysis of 1,596 out-of-hospital cardiac arrest patients from the prospective AfterROSC1 and AfterROSC2 cohort studies.
  • Compared patients receiving versus not receiving sedation during pre-hospital care after return of spontaneous circulation.
  • Evaluated day-90 survival with favorable neurological outcome (modified Rankin Scale 0–3) adjusted for modified Cardiac Arrest Hospital Prognosis (mCAHP) score, center effect, and propensity score.
  • Sedation before ICU admission was administered to 83% of patients (1,324/1,596), and these patients had lower median baseline severity mCAHP scores than non-sedated patients (90 vs. 105, P = 0.001).
  • Favorable day-90 neurological outcome occurred in 32.4% of pre-ICU sedated patients versus 11.8% of non-sedated patients (P = 0.001; adjusted OR 2.19, 95% CI 1.31–3.65, P = 0.003).
  • The association between pre-ICU sedation and favorable neurological recovery was not statistically significant after propensity score adjustment (OR 1.40, 95% CI 0.70–2.09, P = 0.26).

Cite This Study

Preaubert et al. (2026) studied this question.

synapsesocial.com/papers/6aaa0bce1a5deadb6735e8a9https://doi.org/10.1016/j.resuscitation.2026.111196
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Sedation and analgesia in post-cardiac arrest care: a post hoc analysis of the TTM2 trial2025 · 9 citations
  2. 2EEG-guided early cessation of sedation and TTM in patients after cardiac arrest: a feasibility and safety study2026 · 3 citations
  3. 3Use of Analgesics and Sedatives in Nontraumatic Patients after Sudden Cardiac Arrest during the Peri-Resuscitation Period in the Emergency Department2024
  4. 4Midazolam for post-arrest sedation in pre-hospital emergency care—a multicenter propensity score analysis2024 · 5 citations
  5. 5Early Versus Late Wake‐Up Call After Out‐Of‐Hospital Cardiac Arrest: Protocol for a Multicenter Randomized Comparison Within the Danish Out‐of‐Hospital Cardiac Arrest ( <scp>DANOHCA</scp> ) Trial2026