JMIR Publications

ABSTRACT

Background:

Malignant hyperthermia (MH) seriously threatens perioperative safety. Historically, limited awareness of MH among anesthesiologists and the unavailability of dantrolene have caused a high mortality rate of MH events in China. Although domestic dantrolene has been available in China since 2020, Chinese anesthesiologists continue to face significant challenges in managing MH crises. A WeChat applet–based National Remote Emergency System for MH (MH-NRES) was developed to assist anesthesiologists in making rapid diagnosis, initiating dantrolene mobilization, implementing effective treatment, and subsequently constructing an MH database. However, the efficacy of MH-NRES in real-world patients experiencing MH in China remains uncertain.

Objective:

This study aimed to assess the efficacy of a mobile-based national MH remote emergency system in enhancing outcomes for MH patients.

Methods:

This non-randomized, historically controlled study compared 14 suspected MH patients managed with the assistant of the MH-NRES applet (December 2022 to November 2024, MH-NRES treated group) to 34 retrospectively collected MH patients (January 2018 to November 2022, control group). The primary outcome was the mortality of MH patients. The use of dantrolene and the time interval from MH episode to administration of dantrolene were considered secondary outcomes. The user activity metrics of MH-NRES was also reported.

Results:

After the MH-NRES launched for public use in May 2022, the cumulative number of users reached 21,835, with a maximum daily user growth of 689 (median 15, IQR: 9-25). The cumulative page views amounted to 245740 and the average daily page views were 262.8.The module that users visit most often was the MH treatment (13768 of 49465, 27.8%), followed by the dantrolene mobilization (13547 of 49465, 27.4%), then the instruction on dantrolene use (7029 of 49467, 14.2%). The mortality of MH patients in the MH-NRES treated group was significantly lower than that in the control group (1/14, 7.1% vs. 19/34, 55.9%; P=0.022). There were no significant differences in the early clinical manifestations of MH between the two groups. The rate of dantrolene use in the MH-NRES treated group was significantly higher than that in the control group (11/14, 78.6% vs. 15/34, 44.1%; P=0.029). The dantrolene available time in the MH-NRES treated group was 126.5 minutes earlier than that in the control group, but the difference did not reach statistical significance (113.5 [54.5-244.3] vs. 240 [105-324] minutes, P=0.076).

Conclusions:

The MH-NRES aids in improving the timely administration of dantrolene and decreasing mortality rates among MH patients. This system constitutes a specialized perioperative management approach for rare diseases. Clinical Trial: Chinese Clinical Trial Registry (ChiCTR2200066497)