Tyler Chanas, BCCCP, PharmD
Critical Care Clinical Pharmacist
Vidant Medical Center
Greenville, North Carolina
Disclosure information not submitted.
Title: Levetiracetam for shivering suppression during targeted temperature management after cardiac arrest
INTRODUCTION/HYPOTHESIS: Targeted temperature management (TTM) may help improve neurologic recovery in nonresponsive patients after cardiac arrest. Pharmacologic and nonpharmacologic measures are used to prevent shivering and control body temperature. Even in the absence of seizures, certain antiepileptic medications may be given to help reduce myoclonus and shivering. The purpose of this study was to evaluate the effectiveness of levetiracetam (LEV) at preventing shivering and stabilizing body temperature.
Methods: Single-center retrospective review of electronic medical records including patients who received LEV during TTM following cardiac arrest from May 2018 through December 2020 and had documented bedside shivering assessment scores (BSAS). Patients previously on LEV or with documented seizures were excluded. The primary endpoint was mean BSAS during TTM within 24 hours prior to first dose of LEV, compared to 24 hours after. Secondary endpoints included number of patients experiencing uncontrolled shivering (BSAS ≥ 2), body temperatures, and water temperatures from Artic Sun temperature management device.
Results: Of 1000 cardiac arrest patients, 202 received LEV, and 90 met inclusion criteria. There was no difference in mean BSAS before vs after the start of LEV (0.16 vs 0.16, p = 0.93). There was no difference in percentage of patients who experienced at least one episode of uncontrolled shivering before vs after the start of LEV (18% vs 21%, p = 0.63). There was no difference in body temperature (33.8 C vs 33.9 C, p = 0.52). Water temperature was significantly higher following administration of LEV (19.8 C vs 31.8 C, p < 0.01).
Conclusions: In patients undergoing TTM after cardiac arrest, there was no change in BSAS following administration of LEV. Body temperature did not change, although cooling device water temperature was significantly higher after administration.