Cisatracurium dosing requirements in COVID-19 compared to non-COVID-19 patients

ABSTRACT

INTRODUCTION: Patients infected with the novel SARSCoV- 2 virus may progress to develop acute respiratory distress syndrome (ARDS). Neuromuscular blockade is often used in ARDS to assist with ventilator synchrony, improve oxygenation, and facilitate prone positioning. Current guidelines recommend that neuromuscular blockade may be used in patients with COVID-19 and ARDS. Our study aimed to investigate differences in cisatracurium dosing requirements for ARDS in COVID-19 versus non-COVID-19 patients. METHODS: We conducted a retrospective cohort analysis of adult patients who received continuous infusion cisatracurium for ARDS or hypoxia from January 2020 to May 2020. Exclusion criteria included patients receiving cisatracurium continuous infusion <24 hours or who were also administered another neuromuscular blocking agent other than cisatracurium. The primary outcome was total dose of cisatracurium in COVID-19 versus non-COVID-19 patients. Secondary outcomes included total duration of cisatracurium infusion and total number of separate infusions. RESULTS: 107 patients were included;72.9% (n=78) had COVID-19 and 27.1% (n=29) did not. Non-COVID-19 patients were significantly younger (p<0.001) than COVID-19 patients with a mean age of 44.1 (SD ±14.2) versus 57.3 (SD ±14.5). Other baseline characteristics were similar between the groups. The median PaO2/FiO2 ratio was not different between the groups (p=0.563) with a median overall value of 68 (interquartile range [IQR] 60.1, 83.1). There was no difference in SOFA scores (p=0.063) with a mean overall score of 9.6 (SD ±3.1). There was no difference in the primary outcome of total dose of cisatracurium with a mean of 20.6 mg/hour (SD ±8.7) versus 21.6 mg/hour (SD ±11) between COVID-19 and non-COVID-19 patients (p=0.637). No difference was found after comparing weight-adjusted total dose between groups (p=0.113). The total duration of the infusion was similar with a median duration of 4 days (IQR 2.5, 7.5) in COVID-19 patients versus 3.7 days (IQR 2.3, 7) in non-COVID-19 patients (p=0.747). CONCLUSIONS: Dosing and duration of cisatracurium infusion was found to be similar for treatment of ARDS in COVID-19 and non-COVID-19 patients in this study. Further evaluation of the benefit and utilization of cisatracurium in the treatment of COVID-19 ARDS is warranted.