Abstract Body (Do not enter title and authors here): Introduction: Cardiac arrests result in significant mortality and morbidity, with therapeutic hypothermia (TH) being a mainstay in post-cardiac arrest care to enhance neurological outcomes. The use of neuromuscular blockade (NMB) agents with TH aims to manage shivering, ventilator asynchrony, and reduce cerebral oxygen demand. However with recent studies showing normothermia to be effective in achieving good neurological outcomes, the use of these agents remains debatable.This study investigates the comparative outcomes of cardiac arrest survivors with and without the use of NMB agents.

Methods: A retrospective cohort study was conducted at a tertiary care hospital in North Carolina involving 4047 patients with cardiac arrest from 01/01/2012, to 12/12/2017. Adults surviving beyond 24 hours post-cardiac arrest were included, while those with a Glasgow Coma Scale ≥8, actively bleeding or pregnant patients were excluded. Demographic, comorbid variables and clinical outcomes were collected and analyzed to compare the efficacy of NMB use. We examined the 30 day mortality and neurological outcomes of both groups

Results: Of total 976 patients, 364 (37.3%) received NMB agents.58.5% of patients received NMB as part of hypothermia protocol .Vasopressor use was also more in paralytic group (81.9% vs. 73.5%) p.004. There was no significant difference in 30-day (54.1% vs. 51.7%, p=0.45), 60-day (56.6% vs. 52.5%, p=0.2) mortality among two groups. The use of NMB agents was not associated with better neurological outcomes (66.2% vs 65.7%)

Conclusion: The use of NMB agents in cardiac arrest survivors did not improve survival or neurological outcomes regardless of their use with or without therapeutic hypothermia. Compared to previous studies, our study did not find NMB agents to be superior. Further studies are needed to delienate the specific contexts when the use of NMB agents may be beneficial.