Two paths to paralysis: A multicenter comparison of cisatracurium to atracurium in the management of acute respiratory distress syndrome
Recommended Citation
Dobry P, Lane R, Whittaker P, Gwaltney A, Smith S, Hudson B, Carabetta S, Brual R, Sawyer L, Perez M, Truong M, DeVier M, Dalton K, Edwin SB, Giuliano C, Haan BJ, and Daley M. Two paths to paralysis: A multicenter comparison of cisatracurium to atracurium in the management of acute respiratory distress syndrome. J Crit Care 2025;91:155227.
Document Type
Article
Publication Date
8-22-2025
Publication Title
Journal of critical care
Abstract
PURPOSE: Neuromuscular blocking agents (NMBAs) such as cisatracurium and atracurium are used to facilitate lung-protective ventilation in moderate-to-severe acute respiratory distress syndrome (ARDS). Although cisatracurium has been more extensively studied, data comparing these agents directly are limited. This study compares clinical outcomes between atracurium and cisatracurium in patients with moderate-to-severe ARDS.
MATERIALS AND METHODS: This multicenter, retrospective cohort study was conducted between January 2017 and December 2023 across 11 Ascension Health hospitals. Mechanically ventilated adults with a PaO(2)/FiO(2) ratio < 150 who received a continuous infusion of atracurium or cisatracurium for at least 12 h within 48 h of ARDS diagnosis were included. The primary endpoint was ventilator-free days at day 28.
RESULTS: A total of 384 patients were included, with 192 in each group. Median 28-day ventilator-free days did not differ between groups in the unmatched (0 [IQR 0-16.7] vs. 0 [IQR 0-16.4], p = 0.72) or matched (0 [IQR 0-18.3] vs. 0 [IQR 0-14.4], p = 0.09) cohorts. These findings were further confirmed by multivariable analysis. After matching, there were no significant differences in 90-day inpatient mortality, length of stay, or duration of mechanical ventilation. While patients receiving cisatracurium showed greater improvements in PaO(2)/FiO(2) ratio at 72 h (p < 0.01), resolution of ARDS was similar between groups. Safety outcomes were comparable between agents.
CONCLUSIONS: Atracurium and cisatracurium demonstrated similar safety and effectiveness in patients with moderate-to-severe ARDS. These results suggest that atracurium is a viable alternative to cisatracurium for the treatment of ARDS.
Medical Subject Headings
Acute respiratory distress syndrome; Cisatracurium atracurium; Hypoxia; Neuromuscular blocking agents
PubMed ID
40848334
Volume
91
First Page
155227
Last Page
155227
