For citation purposes: Woodhouse T, Jonas A, Szakmany T. Cisatracurium for acute respiratory distress syndrome: review of current evidence. OA Critical Care 2013 Mar 01;1(1):1.

Systematic Review

Anaesthesiology, Perioperative & Critical Care Medicine

Cisatracurium for acute respiratory distress syndrome: review of current evidence

T Woodhouse, A Jonas, T Szakmany,

Authors affiliations

(1) Department of Anaesthetics, Intensive Care and Pain Medicine, School of Medicine, Cardiff University, Cardiff, UK

(2) ACT Directorate, Royal Glamorgan Hospital, Cwm Taf LHB, Llantrisant, UK

* Corresponding author Email:



Our aim was to review the latest available evidence about whether the use of a continuous infusion of cisatracurium, a neuromuscular blocking agent (NMBA), in patients with acute respiratory distress syndrome (ARDS) had a beneficial effect on clinical outcomes.

Materials and methods

The following databases were searched: The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 6, 2012), MEDLINE (1950 to June 2012) and EMBASE (1980 to June 2012); the references of relevant trials and review articles identified were also searched. Only randomized controlled trials were included in the meta-analysis. In addition, we have reviewed observational studies in our systematic review. Study selection and extraction of data were all performed independently.


We included three fully published randomized controlled trials containing 431 patients. The primary outcome of 28-day all-cause mortality was significantly lower in the NMBA group compared with the placebo group (RR 0.68, 95% CI = 0.51–0.92, I2 0%). NMBAs also had a statistically significant effect on ICU mortality (RR = 0.71, 95% CI = 0.55–0.90, I2 = 0%), overall mortality (RR = 0.73, 95% CI = 0.57–0.92, I2 = 0%), number of cases of new-onset barotrauma (RR = 0.43, 95% CI = 0.2–0.9, I2 = 0%) and number of ventilator-free days (MD = 1.91, 95% CI = 0.28–3.55, I2 = 0%). However, they did not show any significant effect on the duration of mechanical ventilation (RR 1.14, 95% CI = –4.07–6.35, I2 = 0%) or number of cases of new-onset critical illness neuromyopathy (RR 1.13, 95% CI = 0.76–1.67, I2 = 0%).


Our analysis showed that the early, short use of a continuous infusion of cisatracurium led to a statistically significant reduction in mortality in ARDS patients. The potential effects and drawbacks of the intervention were discussed.

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