Abstract 18615: Magnesium Sulfate Revisited: Administration of Magnesium Sulfate in the Early Post-Resuscitation Phase is Associated With Improved Survival and Neurological Outcomes in This Era of Therapeutic Hypothermia

Background: Therapeutic hypothermia (TH) is associated with QT prolongation which may increase the risk of cardiac arrhythmia. Magnesium sulfate (MgSO 4 ) has long been the standard treatment for long QT syndrome. In addition, magnesium has been shown to dilate cerebral blood vessels and improve the compromised brain perfusion in the post-resuscitation phase. It may also have a role in neuroprotection in hypoxic-ischemic encephalopathy. We therefore evaluated in a retrospective series the role of MgSO 4 in early post-resuscitation care in this era of TH. Methods: From Jan 2008 to May 2013, post-resuscitated patients who remained comatose when admitted to National Taiwan University Hospital were included. Univariate analysis was first employed for sorting out clinical factors associated with survival and neurological outcomes. Those reaching statistical significance were then entered in binary logistic regression analysis for searching independent predictors. Results: During this period, 231 patients were included. The mean age was 68.5 ± 16.4 years old and 141 were male. Thirty seven (16.0%) had initial rhythm of Vf/VT. The total CPR time was 21.9 ± 15.9 min. The patients receiving TH (n = 110) had significantly better survival (58.2% vs. 21.5%, P < 0.001) and neurological prognoses (20.9% vs. 6.6%, P = 0.001). MgSO 4 was administered in the early post-resuscitation phase in 74 patients (52 with TH, 22 without), and was associated with better survival (60.8% vs. 28.7%, P < 0.001) and neurological outcomes (21.6% vs. 9.6%, P < 0.05). In univariate analysis, TH, MgSO 4 , age, Vf/VT, shorter CPR time, lower epinephrine dose and no use of vasopressors in the post-resuscitation phase were associated with better survival and neurological outcomes, while seizure was associated with poorer neurological recovery. In binary logistic regression analysis, TH, MgSO 4 , Vf/VT and CPR time were independently associated with survival, while age, Vf/VT and seizure serve as independent predictors for neurological prognosis. Conclusions: Administration of MgSO 4 in the early post-resuscitation phase is associated with improved survival and neurological outcomes in this era of TH. Further well-designed prospective study is warranted for verifying its roles and potentials.