Introduction: Non-depolarizing agents such as rocuronium and vecuronium are frequently used in the emergency department (ED) to facilitate intubation but may lead to delay in neurologic examination and intervention. Sugammadex is used for reversal of neuromuscular blockade by non-depolarizing agents but its role in the reversal of neuromuscular blockade for neurologic examination in the ED is poorly defined.
\nMethods: This was a multicenter cohort study using retrospective chart review. We reviewed all ED encounters from June 21, 2016–February 9, 2024 of the electronic health record of Mass General Brigham, a large multistate health system, and abstracted all ED administrations of sugammadex to facilitate neurologic examination. We calculated descriptive statistics and assessed outcomes.
\nResults: In 3,080,338 ED visits during the study period, 48 patients received sugammadex to facilitate neurologic examination. Of those patients, 23 (47.9%) underwent a procedure within 24 hours. Three (6.3%) had bradycardia, and one (2.1%) had hypotension following sugammadex administration. A total of 23 patients (47.9%) ultimately died during their admission, and 24 (50%) died within 30 days.
\nConclusion: Patients who received sugammadex in the ED to facilitate neurologic examination during the study period had rare associated adverse effects, high rates of procedures within 24 hours of administration, and significant in-hospital mortality. Prospective data is needed to assess the impact of sugammadex on decision-making.
","language":"eng","license":{"name":"Creative Commons Attribution 4.0","short_name":"CC BY 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.","url":"https://creativecommons.org/licenses/by/4.0"},"keywords":[{"word":"Sugammadex"},{"word":"Neuromuscular blockade"},{"word":"Rocuronium"},{"word":"Vecuronium"},{"word":"Neurological Examination"},{"word":"emergency department"}],"section":"Neurology","is_remote":true,"remote_url":"https://escholarship.org/uc/item/30k5d2qq","frozenauthors":[{"first_name":"Stephen","middle_name":"D.","last_name":"Hallisey","name_suffix":"","institution":"Brigham and Women’s Hospital, Department of Emergency Medicine, Division of Emergency Critical Care Medicine, Boston, Massachusetts; Harvard Medical School, Department of Emergency Medicine, Boston, Massachusetts","department":""},{"first_name":"Christiana","middle_name":"K.","last_name":"Prucnal","name_suffix":"","institution":"Harvard Medical School, Department of Emergency Medicine, Boston, Massachusetts; Brigham and Women’s Hospital, Department of Emergency Medicine, Boston, Massachusetts; Massachusetts General Hospital, Department of Emergency Medicine, Boston, Massachusetts","department":""},{"first_name":"Annette","middle_name":"M.","last_name":"Ilg","name_suffix":"","institution":"Brigham and Women’s Hospital, Department of Emergency Medicine, Division of Emergency Critical Care Medicine, Boston, Massachusetts; Harvard Medical School, Department of Emergency Medicine, Boston, Massachusetts","department":""},{"first_name":"Raghu","middle_name":"R.","last_name":"Seethala","name_suffix":"","institution":"Brigham and Women’s Hospital, Department of Emergency Medicine, Division of Emergency Critical Care Medicine, Boston, Massachusetts; Harvard Medical School, Department of Emergency Medicine, Boston, Massachusetts","department":""},{"first_name":"Paul","middle_name":"S.","last_name":"Jansson","name_suffix":"","institution":"Brigham and Women’s Hospital, Department of Emergency Medicine, Division of Emergency Critical Care Medicine, Boston, Massachusetts; Harvard Medical School, Department of Emergency Medicine, Boston, Massachusetts","department":""}],"date_submitted":"2024-07-13T02:20:52.112000Z","date_accepted":"2024-10-17T14:44:15.479000Z","date_published":"2025-01-30T14:00:00Z","render_galley":{"label":"Final Article","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/29328/galley/31571/download/"},"galleys":[{"label":"Layout","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/29328/galley/31091/download/"},{"label":"Final Article","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/29328/galley/31571/download/"}]}