Hospitals Reporting Short Supplies of Neuromuscular Blockers

Patients with the coronavirus disease 2019 (COVID-19) are filling more than half of the ICU beds in 40% of the hospitals represented in the survey.

A new survey by the American Society of Health-System Pharmacists (ASHP) indicates that critical care drug shortages are improving, but neuromuscular blockers are frequently in short supply at many hospitals.1,2

The survey—round 4 of a biweekly assessment of pharmacy resources—collected answers from 258 ASHP members at hospitals of various sizes from around the country. The survey was conducted April 21 to April 24, 2020.1

Survey results found that patients with the coronavirus disease 2019 (COVID-19) are filling more than half of the ICU beds in 40% of the hospitals represented in the survey.2

Cisatracurium, a drug used with patients on ventilators,2 had the most critical current inventory status among hospitals with an ICU at least half full of patients with COVID-19. Their answers indicated that 19% had less than a 1-day supply of cisatracurium and 44% had less than a 7-day supply.1,2

Atracurium and vecuronium also showed inventories in short supply among ICU drugs, according to the survey. Respondents with an ICU at least half full of patients with COVID-19 showed that 14% had less than a 1-day supply and 20% had less than a 7-day supply of atracurium; whereas, 7% had less than a 1-day supply and less than a 7-day supply of vecuronium.1

“In general, hospitals with more COVID-19 ICU patients have lower inventory on hand of neuromuscular blockers and sedatives compared to hospitals who have fewer COVID-19 ICU patients,” said Michael Ganio, PharmD, MS, BCPS, FASHP, senior director, Pharmacy Practice and Quality, ASHP, in an email to Pharmacy Times®.

According to Ganio, vecuronium has been listed in the ASHP Drug Shortages database since September 2015. However, cisatracurium was added to the database in April 2020 as hospitals increased use or increased inventories in preparation of an anticipated surge in patients with COVID-19.

Fentanyl, dialysis replacement solutions, and midazolam were also in short supply among survey respondents with an ICU at least half full of patients with COVID-19, to lesser degrees than neuromuscular blockers, according to the round 4 results.1

According to ASHP, inventory supplies for all of these drugs, as well as others that were included in both rounds 3 and 4 of the biweekly survey, have shown improvement.1 Ganio said that although the survey did not provide insight into why inventories are improving, there are likely specific reasons.

“Manufacturers have announced increased production of critical drugs. Some hospitals may have decreased demand as they get past their surge in COVID-19 patients. Distribution of drug supplies has been more responsive to hospital need based on COVID-19 cases,” Ganio said in an email.

The ASHP survey also found that the availability of surgical-type masks has improved since earlier rounds of the organization’s survey. The round 4 survey showed fewer respondents reporting major and moderate disruptions in the availability of masks, and more respondents reporting minor or no disruption in availability; however, shortages remain high in hospitals.2

In addition, the use of telehealth services has increased. Eighty percent of survey respondents indicated they are using technology to facilitate remote patient care.1,2


  • American Society of Health-System Pharmacists. COVID-19 Bi-Weekly Pharmacy Resources Survey Results. ASHP website. Accessed May 8, 2020.
  • Pharmacist: Ventilator Drugs Remain in Short Supply [news release]. [email] Sent May 8, 2020. Accessed May 8, 2020.

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