Risk of post-intubation cardiac arrest with the use of high-dose rocuronium in COVID-19 patients with acute respiratory distress syndrome: A retrospective cohort study.

Autor:	Kandinata N; Department of Internal Medicine, Cape Fear Valley Medical Center, Fayetteville, NC, 28306, United States of America., Acharya R; Department of Internal Medicine, Cape Fear Valley Medical Center, Fayetteville, NC, 28306, United States of America., Patel A; Department of Internal Medicine, Cape Fear Valley Medical Center, Fayetteville, NC, 28306, United States of America., Parekh A; Department of Internal Medicine, Cape Fear Valley Medical Center, Fayetteville, NC, 28306, United States of America., Santana J; Department of Internal Medicine, Campbell University School of Osteopathic Medicine, Buies Creek, NC, 27506, United States of America., Darden A; Department of Respiratory Therapy, Cape Fear Valley Medical Center, Fayetteville, NC, 28306, United States of America., Sedhai YR; Department of Internal Medicine, Virginia Commonwealth University School of Medicine, Richmond, VA, 23970, United States of America., Kafle S; Bachelor of Science in Nursing, Fayetteville State University School of Nursing, Fayetteville, NC, 28301, United States of America., Younus U; Department of Critical Care Medicine, Cape Fear Valley Medical Center, Fayetteville, NC, 28306, United States of America.
Jazyk:	angličtina
Zdroj:	Journal of clinical and translational research [J Clin Transl Res] 2021 Oct 30; Vol. 7 (6), pp. 717-722. Date of Electronic Publication: 2021 Oct 30 (Print Publication: 2021).
Abstrakt:	Background: Post-intubation cardiac arrest (PICA) is an uncommon complication of intubation, but numbers have risen to over 1.5 times the usual number since the coronavirus disease 2019 (COVID-19) pandemic. Due to expert recommendations, high-dose rocuronium (HDR) has become a commonly used pre-intubation neuromuscular blocking agent. Aim: We conducted this retrospective case-control observational study with the hypothesis that high-dose rocuronium was not associated with higher incidence of PICA. Methods: We included 93 patients who were intubated using the rapid sequence intubation (RSI) technique with rocuronium for acute respiratory distress syndrome (ARDS) due to confirmed COVID-19 pneumonia, admitted from March 2020 to February 2021 to a tertiary care hospital in North Carolina, USA. The patients were grouped based on high (1.5 mg/kg of ideal body weight and above) versus low (<1.5 mg/kg of ideal body weight) dose rocuronium used for RSI. The differences of the various outcomes between the groups were analyzed. Results: The baseline demographics were similar in both groups except for higher body mass index in high-dose group 39 versus 32 (kg/m 2 ), p = 0.009. There was a total of six PICA events (6.45%). The HDR group had 8.0% of PICA versus 4.7% in the low-dose group. In-hospital mortality was 60.0% in the HDR group versus 72.1% in the low-dose group. Conclusion: The incidence of PICA in COVID-19 patients with ARDS who were intubated using the RSI technique was higher than in the pre-COVID-19 era. Relevance for Patients: The use of high-dose paralytics during invasive ventilation with RSI and their consequences should be explored with the help of large-scale studies. The rate of PICA is still very low, and perhaps, the use of HDR is safe, as suggested by the expert panel. Competing Interests: The authors declare that there are no conflicts of interest. (Copyright: © Whioce Publishing Pte. Ltd.)
Databáze:	MEDLINE
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