PURPOSE: Although guidelines on post-resuscitation care recommend the use of 
short-acting agents for sedation during targeted temperature management (TTM) 
after cardiac arrest (CA), the potential advantages of this strategy have not 
been clinically demonstrated.
METHODS: We compared two sedation regimens (propofol-remifentanil, period P2, vs 
midazolam-fentanyl, period P1) among comatose TTM-treated CA survivors. 
Management protocol, apart from sedation and neuromuscular blockers use, did not 
change between the two periods. Baseline severity was assessed with 
Cardiac-Arrest-Hospital-Prognosis (CAHP) score. Time to awakening was measured 
starting from discontinuation of sedation at the end of rewarming. Awakening was 
defined as delayed when it occurred after more than 48 h.
RESULTS: 460 patients (134 in P2, 326 in P1) were included. CAHP score did not 
significantly differ between P2 and P1 (P = 0.93). Sixty percent of patients 
awoke in both periods (81/134 vs. 194/326, P = 0.85). Median time to awakening 
was 2.5 (IQR 1-9) hours in P2 vs. 17 (IQR 7-60) hours in P1. Awakening was 
delayed in 6% of patients in P2 vs. 29% in P1 (p < 0.001). After adjustment, P2 
was associated with significantly lower odds of delayed awakening (OR 0.08, 95% 
CI 0.03-0.2; P < 0.001). Patients in P2 had significantly more ventilator-free 
days (25 vs. 24 days; P = 0.007), and lower catecholamine-free days within day 
28. Survival and favorable neurologic outcome at discharge did not differ across 
periods.
CONCLUSIONS: During TTM following resuscitation from CA, sedation with 
propofol-remifentanil was associated with significantly earlier awakening and 
more ventilator-free days as compared with midazolam-fentanyl.