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

doi:10.1016/j.resuscitation.2026.111196

Acute cardiac care & resuscitationCohort study

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

ResuscitationPublished 4 Jul 2026

retrospective analysis of the AfterROSC1 & 2 database
data from the prospective AfterROSC1 and AfterROSC2 cohort studies

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Authors' conclusion

The decision of sedation started after ROSC and before ICU admission was associated with a good functional recovery on day 90. However, the design of this study does not allow us to establish a causal link between pre-hospital sedation and improved neurological recovery. In particular, it is not possible to formally rule out residual indication bias. A randomized trial assessing the effect of early sedation on treatment strategies and patient outcomes is needed.

Study context

Population: Post-cardiac arrest patients after out-of-hospital cardiac arrest with return of spontaneous circulation (ROSC)sedated before intensive-care-unit (ICU) admission 1,324 (83%) · not sedated before ICU admission 272 (17%)
Participants: 1,596 included patients

Exposure: pre-ICU sedated group vs group without pre-ICU sedation
pre-ICU sedated groupn = 1,324
group without pre-ICU sedationn = 272reference

Main finding

As reported in the abstract

mCAHP score

The mCAHP score was higher in the group without pre-ICU sedation (median)

90 [70-106] vs. 105 [90-116], P = 0.001

Observational data: associations, not effects.

Further findings

Outcome	pre-ICU sedated group	group without pre-ICU sedation	Lower with pre-ICU sedated group ←→ Higher with pre-ICU sedated group	Estimate	P value
Favorable day-90 outcome (modified Rankin scale 0-3) · adjusted for the mCAHP score and center	32.4%	11.8%		adjusted odds ratio 2.19 (95% CI 1.31–3.65)	P = 0.003
Favorable day-90 outcome (modified Rankin scale 0-3) · not significant after propensity score adjustment				odds ratio, propensity score adjustment 1.40 (95% CI 0.70–2.09)	P = 0.26
			0.20.5125Ratio (log scale)

Favorable day-90 outcome (modified Rankin scale 0-3): unadjusted P = 0.001

Original publication

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. Resuscitation. Published 4 July 2026. doi:10.1016/j.resuscitation.2026.111196

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Summarised from the published abstract; every number is checked against it