A multi-center retrospective cohort study of SUGAmmadex for neuromuscular blockade reversal in the emergency department: SUGARED study - on behalf of EMPHARM-NET Investigators

Abstract

Study objective: The objective of this study was to describe the proportion of emergency department (ED) patients with traumatic brain injury (TBI) or spontaneous intracranial hemorrhage (sICH) who demonstrated a positive neurologic response to sugammadex-mediated reversal of rocuronium, and to compare outcomes between responders and non-responders. Methods: This was a multicenter, retrospective, observational cohort study of 11 US Emergency Departments. Adult patients, aged ≥18 years, who were intubated using rocuronium and subsequently received sugammadex and had a primary diagnosis of TBI or sICH between December 15, 2015, to June 30, 2024 were screened for inclusion. The primary outcome of this study was the proportion of patients who had a positive response (defined as an increase in GCS of ≥1 point) within 30 min of sugammadex administration. The secondary outcomes included change in analgosedation requirements during the first 30 min post-sugammadex administration, and the rate of neurosurgical procedures. Results: The primary outcome analysis included 362 patients. An increase in GCS within 30 min post-sugammadex administration occurred in 54% (n = 196), with a median GCS change of 3 (IQR: 2–4, range 1–9). A positive response was associated with the addition of a new analgesic agent (30.6% 13.9%, difference = 16.8%, 95% confidence interval 8.4 to 25.1), sedation agent (33.7% vs. 14.5%, difference = 19.2%, 95% confidence interval 10.7 to 27.7), and a non-significant increase in neurosurgical procedures (43.4 vs. 33.7%, difference = 9.6%, 95% confidence interval −0.4 to 19.7). Conclusion: Sugammadex administration to reverse rocuronium in the ED was associated with a significant change in GCS and analgosedation requirements.