Comparing Clinical Outcomes in Cardiac Surgical Patients Who Receive Sugammadex Versus Placebo: A Prospective...

To compare the difference in the number of cardiopulmonary bypass surgical patients who receive sugammadex vs. placebo and who meet the Society of Thoracic Surgery early extubation quality benchmark.

Single-center, randomized, double-blind, placebo-controlled trial.

Participants were enrolled at a single U.S. hospital between August 2023 and July 2025.

Seventy-four eligible cardiac surgery patients undergoing cardiopulmonary bypass with anticipated institutional fast-track extubation were enrolled; 64 were included in the analysis.

Administration of either sugammadex or placebo 15 minutes after arrival to the ICU following cardiac surgery.

The primary outcome was the number of patients meeting the Society of Thoracic Surgery quality benchmark of early extubation in the sugammadex vs. placebo groups. Secondary outcomes encompassed specifics related to clinical outcomes, medication requirements, and nursing perception.

Surgery duration (p = 0.0004), bypass duration (p = 0.0177), and intraoperative blood products (p = 0.0003) were all increased in the sugammadex group. No difference was observed in the primary outcome and 96.9% of patients in both groups were extubated within 6 hours after surgery. However, all patients in the sugammadex group achieved a train of four greater than or equal to 0.9 before extubation compared with only 37.5% of the placebo group (p < 0.0001). The intraoperative dose of rocuronium (mean p = 0.0119; median p = 0.0047) was significantly increased in the sugammadex group. All additional demographics and secondary outcomes were comparable between groups.

This trial found no difference in the number of patients who achieved the early extubation benchmark in the sugammadex vs. placebo groups; however, a significant number of patients in the placebo group had residual neuromuscular weakness as defined by quantitative neuromuscular monitoring. Further studies are required to investigate the implications of the high incidence of quantitative monitoring related weakness in this population without the use of sugammadex.