Early Cessation of Sedation and TTM in Patients With a Favourable EEG After Cardiac Arrest

Comatose patients after cardiac arrest are treated on intensive care units with sedative medication, targeted temperature management (TTM), mechanical ventilation, and hemodynamic support. Despite substantial variation in the severity of the encephalopathy and even lack of unequivocal evidence of efficacy of sedation and TTM, all patients receive standard treatment. The severity of the postanoxic encephalopathy can reliably be assessed with the electroencephalogram (EEG). A continuous EEG pattern within the first 12 hours after cardiac arrest ("favorable EEG") is strongly associated with a good neurological outcome and reflects a very mild or transient encephalopathy. The investigators hypothesize that this subgroup of patients, with a favorable EEG will not benefit from prolonged sedation and TTM.

The objective of this study is to estimate the feasibility and safety of early weaning from ICU treatment in patients after cardiac arrest and an early (\< 12 h) favourable EEG pattern. The study design is a cluster randomized crossover design with two treatment arms. The intervention contrast will be early cessation of sedation and TTM, with subsequent weaning from mechanical ventilation if appropriate (intervention group) vs. standard care, including sedation and TTM for at least 24-48 hours (control group). The investigators will include forty adult patients admitted to the ICU with postanoxic encephalopathy after cardiac arrest and an early (\<12 hours) favorable EEG pattern.

• Length of ICU stay [Срок оценки: During the complete ICU admission (from admission to the ICU until discharge from the ICU, up to 30 days).]
• Total sedation time [Срок оценки: During the complete ICU admission (from admission to the ICU until discharge from the ICU, up to 30 days).]
• Need for re-intubation [Срок оценки: During the complete ICU admission (from admission to the ICU until discharge from the ICU, up to 30 days).]
• Need for restarting sedation [Срок оценки: During the complete ICU admission (from admission to the ICU until discharge from the ICU, up to 30 days).]
• Number of serious adverse events (SAEs) [Срок оценки: at 3 and 6 months]
• Mortality [Срок оценки: at 30 days, 3 months and 6 months]
• Complications during intensive care admission [Срок оценки: During the complete ICU admission (from admission to the ICU until discharge from the ICU, up to 30 days).]
• Neurological outcome measured at the Extended Glasgow Outcome Scale (GOSE) [Срок оценки: at 3 and 6 months]
• Neurological outcome measured at the Cerebral Performance Category (CPC) [Срок оценки: at 3 and 6 months]
• Cognitive functioning [Срок оценки: at 3 and 6 months]