Patient safety incident review: malignant hyperthermia in the non-hospital setting
The following information and recommendations are being shared to assist facilities in their continuous quality improvement.
The Non-Hospital Medical and Surgical Facilities Patient Safety Incident Review Panel has recently reviewed an incident involving suspected malignant hyperthermia (MH). The case was very well managed, and the rapid use of dantrolene may have prevented the further harm that is often seen with a fulminant MH crisis. This case highlights the need for dantrolene as part of a non-hospital facility’s emergency supplies.
The following recommendations provided to the facility involved are important when dealing with this critical situation:
- It is suggested that MH cases with modern volatiles and less severe presentations be reviewed by the most responsible physician with MH experts in Toronto and/or the Malignant Hyperthermia Association of the United States.
- Modern volatiles seem to result in less severe MH cases especially when no succinylcholine is used as a co-agent.1 Temporal delay from onset of use of volatiles seems typical with sevoflurane/desflurane versus halothane. Perhaps with modern volatiles the single dose of dantrolene 2.5 mg/kg is all that is needed to break the cycle.
- Facilities must ensure that documentation of the event is as detailed as possible.
- The Non-hospital Medical and Surgical Facilities Accreditation Program standards state periodic MH drills must be conducted to ensure that the facility is physically prepared, and staff are ready to act in the event of a MH crisis. All personnel must receive training, and simulated MH drills must be performed annually at a minimum.
Read the Malignant Hyperthermia accreditation standard for more detailed information.
Medical directors and clinical leads are encouraged to share this information with their clinical team and to review protocols to prepare for this life-threatening situation.
- Schuster F, Johannsen S, Schneiderbanger D, Roewer N. Evaluation of suspected malignant hyperthermia events during anesthesia. BMC Anesthesiol. 2013;13(1):24. Published 2013 Sep 23.