ACURASYS
Trial question
What is the role of cisatracurium in patients with severe ARDS?
Study design
Multi-center
Double blinded
RCT
Population
340 patients
Inclusion criteria: patients presenting to the ICU with severe ARDS beginning within the previous 48 hours
Key exclusion criteria: age < 18 years, lack of consent, continuous infusion of a neuromuscular blocking agent at enrollment, known pregnancy, increased ICP, severe chronic liver disease, or bone marrow transplantation or chemotherapy-induced neutropenia
Interventions
N=178 early neuromuscular blockade (using cisatracurium besylate for 48 hours)
N=162 placebo (matching placebo for 48 hours)
Primary outcome
Death at 90 days
31.6
40.7
40.7 %
30.5 %
20.4 %
10.2 %
0.0 %
Early neuromuscular blockade
Placebo
Borderline significant decrease ▼
Borderline significant decrease in death at 90 days (31.6% vs. 40.7%; HR 0.68, 95% CI 0.48 to 0.98)
Secondary outcomes
Borderline significant decrease in death at 28 days (23.7% vs. 33.3%; RR 0.71, 95% CI 0.51 to 1)
Significant decrease in pneumothorax (4% vs. 11.7%; RR 0.34, 95% CI 0.15 to 0.78)
Safety outcomes
No significant difference in ICU-acquired paresis.
Conclusion
In patients presenting to the ICU with severe ARDS beginning within the previous 48 hours, early neuromuscular blockade was superior to placebo with respect to death at 90 days.
Reference
Papazian L, Forel JM, Gacouin A et al. Neuromuscular blockers in early acute respiratory distress syndrome. N Engl J Med. 2010 Sep 16;363(12):1107-16.
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