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120. Early short course of neuromuscular blocking agents in patients with COVID-19 ARDS: a propensity score analysis

Author

Li Bassi, G., Gibbons, K., Suen, J. Y., Dalton, H. J., White, N., Corley, A., Shrapnel, S., Hinton, S., Forsyth, S., Laffey, J. G., Fan, E., Fanning, J. P., Panigada, M., Bartlett, R., Brodie, D., Burrell, A., Chiumello, D., Elhazmi, A., Esperatti, M., Grasselli, G., Hodgson, C., Ichiba, S., Luna, C., Marwali, E., Merson, L., Murthy, S., Nichol, A., Ogino, M., Pelosi, P., Torres, A., P. Y., Ng, Fraser, J. F., Al-Dabbous, T., Alfoudri, H., Shamsah, M., Elapavaluru, S., Berg, A., Horn, C., Mayasi, Y., Schroll, S., Meyer, D., Velazco, J., Ploskanych, L., Fikes, W., Bagewadi, R., Dao, M., White, H., Ehlers, A., Shalabi-McGuire, M., Witt, T., Grazioli, L., Lorini, L., Grandin, E. W., Nunez, J., Reyes, T., Obriain, D., Hunter, S., Ramanan, M., Affleck, J., Veerendra, H. H., Rai, S., Russell-Brown, J., Nourse, M., Joseph, M., Mitchell, B., Tenzer, M., Abe, R., Cho, H. J., Jeong, I. S., Rahman, N., Kakar, V., Brozzi, N., Mehkri, O., Krishnan, S., Duggal, A., Houltham, S., Graf, J., Diaz, R., Orrego, R., Delgado, C., Gonzalez, J., Sanchez, M. S., Piagnerelli, M., Sarrazin, J. V., Zabert, A. /P. G., Espinosa, L., Delgado, P., Delgado, V., Rincon, D. F. B., Yanten, A. M. M., Duque, M. B., Al-Hudaib, A., Callahan, M., Taufik, M. A., Wardoyo, E. Y., Gunawan, M., Trisnaningrum, N. S., Irawany, V., Rayhan, M., Pesenti, A., Zanella, A., Leone, M., Coppola, S., Colombo, S., Antonelli, M., Carelli, S., Grieco, D. L., Asaki, M., Hoshino, K., Salazar, L., Duarte, L., Laffey, J., Mcnicholas, B., Cosgrave, D., Mccaffrey, J., Bone, A., Hakeem, Y., Winearls, J., Tallott, M., Thomson, D., Arnold-Day, C., Cupido, J., Fanie, Z., Miller, M., Seymore, L., van Straaten, D., Hssain, A. A., Aliudin, J., Alqahtani, A. -R., Mohamed, K., Mohamed, A., Tan, D., Villanueva, J., Zaqout, A., Kurtzman, E., Ademi, A., Dobrita, A., El Aoudi, K., Segura, J., Giwangkancana, G., Ohshimo, S., Hitoshi, S., Osatnik, J., Joosten, A., Yang, M., Motos, A., Arancibia, F., Williams, V., Noel, A., Luque, N., Trung, T. H., Yacoub, S., Fantini, M., Garcia, R. N. J., Alvarez, E. C., Greti, A., Ceccato, A., Sanchez, A., Vazquez, A. L., Roche-Campo, F., Franch-Llasat, D., Tuazon, D., Amato, M., Cassimiro, L., Pola, F., Ribeiro, F., Fonseca, G., Dalton, H., Desai, M., Osborn, E., Deeb, H., Arcadipane, A., Martucci, G., Panarello, G., Vitiello, C., Bianco, C., Occhipinti, G., Rossetti, M., Cuffaro, R., Cho, S. -M., Shimizu, H., Moriyama, N., Kim, J. -B., Kitamura, N., Gebauer, J., Yokoyama, T., Al-Fares, A., Buabbas, S., Alamad, E., Alawadhi, F., Alawadi, K., Tanaka, H., Hashimoto, S., Yamazaki, M., T. -H., Oh, Epler, M., Forney, C., Kruse, L., Feister, J., Williamson, J., Grobengieser, K., Gnall, E., Golden, S., Caroline, M., Shapiro, T., Karaj, C., Thome, L., Sher, L., Vanderland, M., Welch, M., Mcdermott, S., Brain, M., Mineall, S., Kimura, D., Brazzi, L., Sales, G., Ogston, T., Nagpal, D., Fischer, K., Lorusso, R., Rangappa, R., Appu, A., Carton, E. G., Sen, A., Palacios, A., Rainey, D., Samoukoviv, G., Campisi, J., Durham, L., Neumann, E., Seefeldt, C., Falcucci, O., Emmrich, A., Guy, J., Johns, C., Potzner, K., Zimmermann, C., Espinal, A., Buchtele, N., Schwameis, M., Stecher, S. -S., Singh, D., Barnikel, M., Arenz, L., Zaaqoq, A., Galloway, L. A., Merley, C., Csete, M., Quesada, L., Saba, I., Kasugai, D., Hiraiwa, H., Tanaka, T., Purnama, Y., Dewayanti, S. R., Ardiyan, Juzar, D. A., Siagian, D., Chen, Y. -S., Ratsep, I., Oigus, G., Erikson, K., Post, A. -M., Enneveer, L., Sillaots, P., Manetta, F., Mihelis, E., Sarmiento, I. C., Narasimhan, M., Varrone, M., Komats, M., Garcia-Diaz, J., Harmon, C., Satyapriya, S. V., Bhatt, A., Mokadam, N. A., Uribe, A., Gonzalez, A., Shi, H., Mckeown, J., Pasek, J., Fiorda, J., Echeverria, M., Moreno, R., Zakhary, B., Cavana, M., Cucino, A., Foti, G., Giani, M., Russotto, V., Castagna, V., Dellamore, A., Navalesi, P., Shum, H. -P., Vuysteke, A., Usman, A., Acker, A., Smood, B., Mergler, B., Sertic, F., Subramanian, M., Sperry, A., Rizer, N., Burhan, E., Rasmin, M., Akmal, E., Sitompul, F., Lolong, N., Naivedh, B., Erickson, S., Barrett, P., Dean, D., Daugherty, J., Loforte, A., Khan, I., Abraar Quraishi, M., Desantis, O., So, D., Kandamby, D., Mandei, J. M., Natanael, H., Yudhalantang, E., Lantang, A., Wijaya, S. O., Jung, A., Ng, G., W. Y., Ng, Fang, S., Tabah, A., Ratcliffe, M., Duroux, M., Adachi, S., Nakao, S., Blanco, P., Prieto, A., Sanchez, J., Nicholson, M., Butt, W., Serratore, A., Delzoppo, C., Janin, P., Yarad, E., Totaro, R., Coles, J., Pujo, B., Balk, R., Vissing, A., Kapania, E., Hays, J., Fox, S., Yantosh, G., Mishin, P., Yuliarto, S., Hari Santoso, K., Djajalaksana, S., Fatoni, A. Z., Fukuda, M., Liu, K., Battaglini, D., Jimenez, J. F. M., Bastos, D., Gaiao, S., Rusmawatiningtyas, D., Buchner, J., Cho, Y. -J., Lee, S. H., Kawasaki, T., Munshi, L., Sakiyalak, P., Nitayavardhana, P., Seitz, T., Arora, R., Kent, D., Marino, D., Parwar, S., Cheng, A., Miller, J., Fujitani, S., Shimizu, N., Madhok, J., Owyang, C., Buscher, H., Reynolds, C., Maasikas, O., Beljantsev, A., Mihnovits, V., Akimoto, T., Aizawa, M., Horibe, K., Onodera, R., Young, M., George, T., Shekar, K., Mcguinness, N., Irvine, L., Flynn, B., Endo, T., Sugiyama, K., Shimizu, K., Exconde, K., Lussier, L., Lotz, G., Malfertheiner, M., Maier, L., Dreier, E., Kusumastuti, N. P., Mccloskey, C., Dabaliz, A. -A., Elshazly, T. B., Smith, J., Szuldrzynski, K. S., Bielanski, P., Wille, K., Parhar, K. K. S., Fiest, K. M., Codan, C., Shahid, A., Fayed, M., Evans, T., Garcia, R., Gutierrez, A., Song, T., Rose, R., Bennett, S., Richardson, D., Peek, G., Arora, L., Rappapport, K., Rudolph, K., Sibenaller, Z., Stout, L., Walter, A., Herr, D., Vedadi, N., Thompson, S., Sindt, L., Rajnic, S., Ewald, C., Hoffman, J., Ying, X., Kennedy, R., Griffee, M., Ciullo, A., Kida, Y., Roca, R. F., Riera, J. I., Contreras, S., Alegre, C., Kay, C., Fischer, I., Renner, E., Taniguci, H., Fraser, J., Bassi, G. L., Suen, J., Barnett, A., Pearse, I., Abbate, G., Hassan, H., Heinsar, S., Karnik, V. A., Ki, K., Oneill, H. F., Obonyo, N., Pimenta, L. P., Reid, J. D., Sato, K., Vuorinen, A., Wildi, K. S., Wood, E. S., Yerkovich, S., Lee, J., Plotkin, D., Citarella, B. W., Hartley, E., Lubis, B., Ikeyama, T., Bhaskar, B., Jung, J. -S., Mcguinness, S., Eastwood, G., Marta, S. R., Guarracino, F., Gerle, S., Coxon, E., Claro, B., Loverde, D., Patil, N., Parrini, V., Mcbride, A., Negaard, K., Ratsch, A., Abdelaziz, A., Uribe, J. D., Peris, A., Sanders, M., Emerson, D., Kamal, M., Povoa, P., Francis, R., Cherif, A., Joseph, S., Di Nardo, M., Heard, M., Kyle, K., Blackwell, R. A., Biston, P., Jeong, H. W., Smith, R., Prawira, Y., Montrucchio, G., Garcia, A. H., Salterain, N., Meyns, B., Moreno, M., Walia, R., Mehta, A., Schweda, A., Supriatna, M., Kirakli, C., Williams, M., Kim, K. H., Assad, A., Giraldo, E., Karolak, W., Balik, M., Pocock, E., Gajkowski, E., Masafumi, K., Barrett, N., Takeyama, Y., Park, S., Amin, F., Andriyani, F. M., Sudakevych, S., Vera, M., Cornejo, R., Schwarz, P., Mardini, A. C., de Paula, T., Neto, A. S., Villoldo, A., Colafranceschi, A. S., Iglesias, A. U., Granjean, J., Melro, L. M. G., Romualdo, G. F., Gaia, D., Souza, H., Galas, F., Mendiluce, R. M., Sosa, A., Martinez, I., Kurosawa, H., Salgado, J., Hugi-MayrCharbonneau, B. E., Barzilai, V. S., Monteiro, V., de Souza, R. R., Harper, M., Suzuki, H., Adams, C., Brieva, J., Nyale, G., Eltatar, F. S., Fatani, J., Baeissa, H., Masri, A. A., Rabie, A., Hui, M. Y., Yamane, M., Jung, H., Margaret, A. M., Nacpil, N., Ruck, K., Bakken, R., Jara, C., Felton, T., Berra, L., Shah, B., Chakraborty, A., Cardona, M., Capatos, G., Akkanti, B., Orija, A., Jain, H., Ito, A., Housni, B., Low, S., Iihara, K., Chavez, J., Ramanathan, K., Zabert, G., Naidoo, K., Seppelt, I., Vandyk, M., Macdonald, S., Mcgregor, R., Siebenaler, T., Flynn, H., Lofton, K., Aokage, T., Shigemitsu, K., Moscatelli, A., Fiorentino, G., Baumgaertel, M., Mba, S. E., Assy, J., Hutahaean, A., Roush, H., Sichting, K. A., Alessandri, F., Burns, D., Salt, G., Garabedian, C. P., Millar, J., Sim, M., Mattke, A., Mcauley, D., Tadili, J., Frenzel, T., Bar-Lavie, Y., Ortiz, A. B., Stone, J., Attokaran, A., Farquharson, M., Patel, B., Gunning, D., Baillie, K., Watson, P., Tamai, K., Sajinadiyasa, G. K., Kanyawati, D., Salgado, M., Sassine, A., Yudo, B., Mccaul, S., Lee, B., Lee, S. M., Afek, A., Iwashita, Y., Semedi, B. P., Metiva, J., Van Belle, N., Martin-Loeches, I., Ivatt, L., Woon, C. Y., Kang, H. M., Smith, T., James, E., Al-Rawas, N., Iwasaki, Y., King-Chung, K. C., Gudzenko, V., Hugi-Mayr, B., Taccone, F., Perdhana, F., Lamarche, Y., Ribeiro, J. M., Bradic, N., Van den Bossche, K., Lansink, O., Singh, G., Debeuckelaere, G., Stelfox, H. T., Yi, C., Elia, J., Tribble, T., Shankar, S., Padmanabhan, R., Hallinan, B., Paoletti, L., Leyva, Y., Fykuda, T., Badulak, J., Koch, J., Hackman, A., Janowaik, L., Hernandez, D., Osofsky, J., Donadello, K., Lawang, A., Fine, J., Davidson, B., Vazquez, A. O. R., COVID-19 Critical Care Consortium, and Consortium, COVID-19 Critical Care

Subjects
Male, Respiratory Distress Syndrome, COVID-19, Intensive care unit, Mechanical ventilation, Neuromuscular blocking agent, SARS-CoV-2, Aged, Female, Humans, Intensive Care Units, Middle Aged, Propensity Score, Respiration, Artificial, Neuromuscular Blocking Agents, Respiration, Other Research Radboud Institute for Health Sciences [Radboudumc 0], Settore MED/41 - Anestesiologia, Critical Care and Intensive Care Medicine, COVID-19 Drug Treatment, Artificial, Human medicine
Abstract

Background The role of neuromuscular blocking agents (NMBAs) in coronavirus disease 2019 (COVID-19) acute respiratory distress syndrome (ARDS) is not fully elucidated. Therefore, we aimed to investigate in COVID-19 patients with moderate-to-severe ARDS the impact of early use of NMBAs on 90-day mortality, through propensity score (PS) matching analysis. Methods We analyzed a convenience sample of patients with COVID-19 and moderate-to-severe ARDS, admitted to 244 intensive care units within the COVID-19 Critical Care Consortium, from February 1, 2020, through October 31, 2021. Patients undergoing at least 2 days and up to 3 consecutive days of NMBAs (NMBA treatment), within 48 h from commencement of IMV were compared with subjects who did not receive NMBAs or only upon commencement of IMV (control). The primary objective in the PS-matched cohort was comparison between groups in 90-day in-hospital mortality, assessed through Cox proportional hazard modeling. Secondary objectives were comparisons in the numbers of ventilator-free days (VFD) between day 1 and day 28 and between day 1 and 90 through competing risk regression. Results Data from 1953 patients were included. After propensity score matching, 210 cases from each group were well matched. In the PS-matched cohort, mean (± SD) age was 60.3 ± 13.2 years and 296 (70.5%) were male and the most common comorbidities were hypertension (56.9%), obesity (41.1%), and diabetes (30.0%). The unadjusted hazard ratio (HR) for death at 90 days in the NMBA treatment vs control group was 1.12 (95% CI 0.79, 1.59, p = 0.534). After adjustment for smoking habit and critical therapeutic covariates, the HR was 1.07 (95% CI 0.72, 1.61, p = 0.729). At 28 days, VFD were 16 (IQR 0–25) and 25 (IQR 7–26) in the NMBA treatment and control groups, respectively (sub-hazard ratio 0.82, 95% CI 0.67, 1.00, p = 0.055). At 90 days, VFD were 77 (IQR 0–87) and 87 (IQR 0–88) (sub-hazard ratio 0.86 (95% CI 0.69, 1.07; p = 0.177). Conclusions In patients with COVID-19 and moderate-to-severe ARDS, short course of NMBA treatment, applied early, did not significantly improve 90-day mortality and VFD. In the absence of definitive data from clinical trials, NMBAs should be indicated cautiously in this setting.

Published
2022
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145. Seven day continuous ambulatory electrocardiographic telemetric study with pocket electrocardiographic recording device for detecting hydroxychloroquin induced arrhythmias

Author

Vijay B K, Nigam A, Walia R, Prabhakaran N, Kodliwadmath A, Pai Vs, Singh Obc, and Sabbarwal

Subjects
medicine.medical_specialty, Accelerated idioventricular rhythm, Coronavirus disease 2019 (COVID-19), business.industry, Atrial fibrillation, Mean age, medicine.disease, Arrhythmic death, QT interval, Ecg monitoring, Internal medicine, Ambulatory, cardiovascular system, medicine, Cardiology, cardiovascular diseases, business
Abstract

BACKGROUND & AIMSThe use of hydroxycholoroquin for COVID 19 treatment and prophylaxis raised issues concerning its cardiac safety owing to possibility of QT prolongation and arrhythmias.1 There was no study on long term electrocardiographic telemetry monitoring of patients taking hydroxychloroquin and we planned a continuous electrocardiographic holter telemetry of these patients for a period of seven days.MethodsHealthcare workers taking hydroxycholoroquin as pre exposure prophylaxis, patients taking hydroxychloroquin were monitored by holter electrocardiographic telemetry with continuous beat to beat analysis for seven days with capacity to report any arrhythmic event or significant QT prolongation instantly to medical faculty.Results25 participants with mean age 42.4 ± 14.1 years, 40% females. 20% patients needed to stop HCQ. Four patients developed QT prolongation > 500 ms and needed to stop HCQ, one patient had accelerated idioventricular rhythm and stopped treatment. one had short episodes of atrial fibrillation. No malignant arrhythmia or ventricular arrhythmia or torsades were noted. No episode of significant conduction disturbance and arrhythmic death noted. Baseline mean QTc was 423.96 ± 32.18 ms, mean QTc corrected at 24 hours 438.93 ± 37.95, mean QTc 451.879 ± 37.99 at 48 hours, change in baseline mean QTc to max QTc was 30.74 ± 21.75 ms at 48 hours. All those develop QTc prolongation > 500 ms were greater than 50 years of age.ConclusionAmbulatory telemetry ECG monitoring seems to detect early QT prolongation and stopping drug timely prevented malignant arrhythmias. HCQ seems to have less risk of QT prolongation in young healthy individuals.

Published
2020
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