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.
【저자키워드】 COVID-19, acute respiratory distress syndrome, etomidate, peri-intubation cardiac arrest, post-intubation cardiac arrest, rocuronium, rapid sequence intubation, 【초록키워드】 coronavirus disease, ARDS, pandemic, Mortality, Pneumonia, hospital, intubation, outcome, invasive ventilation, body mass index, low-dose, Patient, incidence, USA, group, Care, recommendations, acute respiratory distress, retrospective, Hypothesis, dose, COVID-19 patient, Safe, demographics, High-dose, Intubated, high-dose group, sequence, syndrome, help, North, consequence, event, blocking agent, analyzed, conducted, suggested, baseline, in both group, Relevance, 【제목키워드】 acute respiratory distress, COVID-19 patient, retrospective cohort study, High-dose,