ASHP Survey: Mechanical Ventilation Rx Shortages Remain a Challenge

Author: Bruce Buckley

Anesthesiology News

Five medications used to sedate or immobilize intubated COVID-19 patients on mechanical ventilation were cited most often by U.S. hospital pharmacy leaders as being in critically short supply, according to ASHP’s latest survey on the status of hospital and health-system pharmacy resources during the pandemic.

The five IV drugs—cisatracurium, fentanyl, ketamine, vecuronium and midazolam—were part of a list of ICU medications that respondents were asked to rate by current inventory status and availability from suppliers.

Eric Maroyka, PharmD, BCPS, the senior director of ASHP’s Center on Pharmacy Practice Advancement, said the ICU medication list was drawn from “what we were hearing from our members in the areas hardest hit by the coronavirus. We had ASHP staff doing almost daily calls with pharmacy leaders in those areas to get a feel for the meds that were keeping them up at night.”

The drugs that respondents deemed to be in critically short shelf supply were cisatracurium, fentanyl, ketamine and vecuronium. Those rated as extremely difficult to obtain from suppliers were cisatracurium, fentanyl and midazolam.

Round 3 of the biweekly survey also found that the shortage of surgical-type masks and N95 respirators may have eased somewhat since the last questionnaire was fielded from March 23 to 26.

“A little over a third, or 36%, of respondents categorized the disruption in supplies of medical masks as either major or moderate,” Dr. Maroyka said, “indicating that they’re either going without masks or using alternatives with mixed or poor results. That’s a slight improvement from the 42% that cited a major or moderate disruption in the previous survey.”

The new survey, deployed April 6 to 9, was based on a total of 340 respondents representing small (21.5%), medium (29.8%) and large hospitals (43.3%).
Round 4 of the biweekly series went out this week, Dr. Maroyka said. It covers questions on additional medications that may be in shortage, including dialysate products used for the growing number of COVID-19 patients requiring dialysis.

“We’re also asking about staffing,” Dr. Maroyka said, “and specifically, have you increased or decreased staff, and have you used temporary staff or repurposed staff from other practice settings?”

On the drug shortage questions, he said a main reason for asking was to determine “what ASHP can do to incite change through our private- and public-sector partners.” A second motivation, he added, was “to devise tools and resources for our members to help them identify second-, third-, fourth- and even fifth-tier drugs that many practitioners aren’t used to using.”

He noted that a drug that was part of the standard of care 15 years ago “might be something that you now have to dip into your toolbox for, just because of these intermittent runs of shortages.”

Identifying drugs in short supply, Dr. Maroyka said, also may help hospitals in some states “as they grapple with whether to assume some level of normalcy and start to perform elective surgical procedures that are going to compete for the sedatives and injectable analgesics needed for critical COVID-19 patients.”