Pharmacology

Star Research Presentations: Pharmacology, Precision Medicine in Sepsis and Patient Safety

A Multicenter Comparison of Cisatracurium Versus Atracurium in Acute Respiratory Distress Syndrome

Sunday, February 23, 2025

2:15pm – 3:45pm Eastern Time

Location: Connections Central Theater 1

MD

Mitchell Daley, BCCCP, PharmD, FCCM

Seton Famiy Healthcare, University of Texas

Disclosure(s): No relevant financial relationship(s) to disclose.
PD

Paul Dobry, PharmD

Pharmacist
Ascension Saint John Michigan

Disclosure information not submitted.
RL

Richard Lane, PharmD

Pharmacist
Ascension St. Vincent's Riverside

Disclosure information not submitted.
PW

Paige Whittaker, PharmD

Pharmacist
Ascension Genesys Hospital

Disclosure information not submitted.
AG

Andrew Gwaltney, PharmD

Pharmacist
Ascension St. Vincent’s Alabama

Disclosure information not submitted.
SS

Sloan Smith, PharmD

Pharmacist
Ascension Saint Thomas Hospital Midtown

Disclosure information not submitted.
BH

Brionna Hudson, PharmD

Pharmacist
Ascension Seton Healthcare

Disclosure information not submitted.
SC

Shannon Carabetta, PharmD,

Pharmacist
Saint Vincent's Medical Center Riverside

Disclosure information not submitted.
RB

Rochelle Brual, PharmD

Pharmacist
Ascension Genesys Hospital

Disclosure information not submitted.
LS

Logan Sawyer, PharmD

Pharmacist
Ascension St. Vincent’s Alabama

Disclosure information not submitted.
MP

Mary Perez, PharmD

Pharmacist
Ascension St. Vincent’s Alabama

Disclosure information not submitted.
MT

Mimi Truong, PharmD

Pharmacist
Ascension Saint Thomas Hospital

Disclosure information not submitted.
MD

Margaret DeVier, BCPS, PharmD

PharmD
Saint Thomas Health Services

Disclosure information not submitted.
KD

Kaitly Dalton, PharmD

Pharmacist
Dell Seton Medical Center at The University of Texas

Disclosure information not submitted.
Stephanie B. Edwin, PharmD, BCPS

Ascension Saint John Hospital
Henry Ford St. John Hospital

Disclosure information not submitted.
CG

Christopher Giuliano, PharmD, MPH

Professor, Department of Pharmacy Practice
Wayne State University Eugene Applebaum College of Pharmacy and Health Sciences

Disclosure information not submitted.
BH

Bradley Haan, PharmD, BCCCP,

Clinical Pharmacy Specialist - Critical Care
Ascension Genesys Hospital

Disclosure information not submitted.

Disclosure(s):

Mitchell Daley, BCCCP, PharmD, FCCM: No relevant financial relationship(s) to disclose.

Introduction: Neuromuscular blocking agent (NMBA) infusions are recommended for adult patients with moderate-to-severe acute respiratory distress syndrome (ARDS) when clinicians determine patients require ongoing deep sedation and NMBA to facilitate lung protective ventilation. While cisatracurium has been employed in the majority of ARDS studies, utilization of atracurium is more cost-effective. The purpose of this study is to compare atracurium and cisatracurium and assess clinical outcomes in moderate-to-severe ARDS.

Methods: This was a multicenter, retrospective, observational study conducted across 11 Ascension Health sites in 5 US States between January 2017 and December 2023. Adult patients with a diagnosis of ARDS (baseline PaO2/FiO2 ratio < 150) and receipt of a continuous infusion of atracurium or cisatracurium for at least 12 hours within 48 hours of ARDS onset were included. The primary endpoint was mechanical ventilator-free days at day 28.

Results: This study included 384 patients, with 192 in the atracurium group and 192 in the cisatracurium group. The primary outcome of 28-day mechanical ventilator-free days was similar in the atracurium group compared to the cisatracurium group with no difference observed in both the unmatched (0 [IQR 0-16.7] vs 0 [IQR 0-16.4], p=0.72) and propensity score matched cohorts (0 [IQR 0-18.3] vs 0 [IQR 0-14.4], p=0.09). Multivariable analysis also indicated no difference in ventilator-free days (OR, 1.14; 95% CI 0.98-1.29). Of all 12 secondary outcomes examined, no difference was noted between groups in the propensity score matched cohort analysis, including 90-day inpatient mortality (50% vs 57.1%, p=0.32), length of stay (19.2 [IQR 4.7-13] vs 18.5 [3.3-11.2], p=0.14), and safety endpoints such as the incidence of new seizures (5.1% vs 4.1%, p=0.72).

Conclusions: This study found no significant difference in 28-day mechanical ventilator-free days between patients who received atracurium and cisatracurium for moderate-to-severe ARDS. Furthermore, no difference was seen in adverse events between groups, including incidence the seizure, a theoretical concern related to differences in laudanosine concentrations following Hofmann elimination. Atracurium is a viable and cost-effective alternative to cisatracurium.