Lauren Albert, BCCCP, BCPS, PharmD
Yale New Haven Hospital
New Haven, Connecticut
Disclosure information not submitted.
Abdalla Ammar, PharmD, BCCCP, BCPS,
Critical Care Pharmacist, Neurocritical Care
New York Presbyterian Hospital - Weill Cornell Medical College
New York, NY
Disclosure information not submitted.
Bryan McGill, PharmD,
Senior Pharmacy Specialist, Critical Care
Yale New Haven Health, United States
Disclosure information not submitted.
Ginger Rouse, BCCCP, PharmD, BCPS,
Clinical Pharmacy Specialist II, Medical Intensive Care
Yale New Haven Hospital
New Haven, Connecticut
Disclosure information not submitted.
Evan Zahn, PharmD, BCCCP
Emergency Medicine Clinical Pharmacy Specialist
Yale New Haven Hospital, Connecticut, United States
Disclosure information not submitted.
Mahmoud Ammar, BCCCP, PharmD, BCPS,
Critical Care Pharmacist
Yale New Haven Hospital
New Haven, Connecticut
Disclosure information not submitted.
Title: Cisatracurium Versus Rocuronium in Acute Respiratory Distress Syndrome
Introduction: Acute Respiratory Distress Syndrome (ARDS) is characterized by hypoxemic respiratory failure and a high mortality rate. Clinical guidelines recommend neuromuscular blockade in moderate-severe ARDS. While cisatracurium (CIS) is the most studied agent, it is unclear if these recommendations can be extrapolated to alternative paralytics. We evaluated the efficacy and safety of CIS versus rocuronium (ROC) in patients with moderate-severe ARDS.
Methods: Patient charts were reviewed from January 2020-August 2020 in a retrospective, single-center cohort study. Mechanically ventilated adult patients who received a continuous infusion of ROC or CIS for at least 12 hours were included. Patients were excluded if mechanical ventilation (MV) duration was less than 48 hours and for lack of PaO2/FiO2 (PF) ratio during the analysis period. The primary outcome was 28-day ventilator-free days post paralytic initiation. Secondary outcomes included improvement in oxygenation at 24-hour intervals through day 28, duration of MV, intensive care unit (ICU) length of stay (LOS), and 28-day mortality. Safety analysis included incidence of seizures, bradycardia, and hypotension.
Results: Seventy-four patients were included (ROC=31, CIS=43). There was no difference in baseline characteristics, except ROC patients had lower baseline serum creatinine (1.0 vs 2.4 mg/dL, p< 0.01). The median [IQR] maximum dose and duration of therapy was 6.0 mcg/kg/min for 74 [27.7-93.9] hours and 2.5 mcg/kg/min for 49.9 [25.5-94.2] hours for ROC and CIS, respectively, with no difference in duration of therapy between cohorts (p=0.63). There was no difference in 28-day ventilator-free days (0 [0-14] days for both cohorts, p=0.68). There was no difference in highest PF ratio at all time points except at 24 hours (ROC, 182 [141-302] mmHg vs CIS, 265 [191-352] mmHg, p=0.03).There was no difference in duration of MV (ROC, 15.5 vs CIS, 11.9 days, p=0.45) or ICU LOS (ROC, 19.0 vs CIS, 20.0 days, p=0.61). There were no differences in mortality and safety outcomes.
Conclusion: In this cohort, patients receiving ROC compared to CIS demonstrated no difference in clinical or safety outcomes. Larger studies are needed to confirm these findings.