Neuromuscular blockade (NMB) agents are often used to control shivering during temperature management that is followed by cardiac arrest. In this study, we hypothesized that early, continuous NMB would result in a more significant reduction in serum lactate levels among comatose patients after cardiac arrest.

Randomized trial for continuous usual care versus NMB for 24 hours following cardiac arrest was conducted at five major urban centers in the U.S. Adult patients who underwent targeted temperature management and achieved spontaneous circulation return remained unresponsive after cardiac arrest were included. The primary outcome was a change in lactate for over 24 hours. 80 patients were analyzed in total (43 and 37 in the usual care arms and NMB, respectively). There was no significant interaction between treatment and time group with respect to change in lactate over 24 hours in the NMB arm. There was no difference in-hospital survival (38% [NMB] versus 33% [usual care]) or survival with good functional outcome (30% vs. 21%).

In this trial, continuous and early NMB compared with usual care following cardiac arrest was not associated with a decrease in serum lactate levels after trial enrollment. There was no difference in overall adverse events, hospital survival with the good neurologic outcome, or hospital survival.