As it prepares for a possible surge of new COVID-19 patients, San Francisco General Hospital is running short of a critical but little known type of drug needed to treat the most severely ill coronavirus patients, NBC Bay Area’s Investigative Unit has learned.
“It’s another shortage of concern,” said UCSF pulmonologist John Balmes, about the two scarce paralytic drugs, cisatracurium and rocuronium. Both help those patients with acute respiratory distress syndrome, ARDS, efficiently use the flow of oxygen while ventilators are keeping them alive.
Jennifer Esteen, a San Francisco General psychiatric nurse and union organizer, confirms the shortages at SF General, where a dozen patients are in the intensive care unit and nine are currently on ventilators.
“They are not in an emergency today, but given the rate of admissions,” Esteen says, “and need for ventilators increasing, they are expecting to have an increase of these drugs that go with people being on ventilators.”
University of Utah adjunct professor Erin Fox, who tracks drug shortages nationwide, says that rocuronium was short even before the COVID-19 outbreak. Also running short, she says, are sedatives used during the intubation process to put patients on ventilators – with the three most used being midazolam, propofol and fentanyl.
“All those medicines, we need more than we have ever needed before … we need a huge surge of these,” she says. “So just like people are talking about we need more masks, we need more ventilators -- you actually can’t make a ventilator work for a patient unless you have the sedatives and the paralytic agents that you need.”
Dr. Balmes said the paralytic drugs serve to immobilize skeletal muscles so patients with ARDS need less oxygen to survive, given the syndrome deprives them of oxygen as fluid fills their lungs.
“It makes it harder to treat severe COVID-19 ARDS” without the drugs, he said. “It’s already hard enough because these patients are very sick.”
Balmes said the only option doctors may be left with is placing patients prone on their stomach, which helps to restrict their natural breathing while they are sedated.
But that process is labor intensive, requires specially designed beds, and is difficult to perform when hospitals are trying to care for so many patients at once, authorities say. Several patients at SF General have been treated by being placed in the prone position.