Improving Dantrolene Mobilization in Regions with Limited Availability

This depicts the user interface of the National Remote Emergency System for Malignant Hyperthermia for dantrolene mobilization in China (fig. 1). In National Remote Emergency System for Malignant Hyperthermia, dantrolene can be mobilized in three steps: (1) calculating the minimum dantrolene vials needed; (2) identifying the dantrolene suppliers based on availability, quantity of stock, and displaying them intelligently; (3) contacting suppliers to start dantrolene mobilization.From 2015 to 2020, a total of 58 suspected malignant hyperthermia (MH) cases were reported in mainland China with a mortality rate as high as 53.4%,1 which was similar to the range reported in the predantrolene era in the United States.2 Due to the low incidence of MH and the high cost of dantrolene, the stocking of the drug could constitute a significant economic challenge for hospitals. Although dantrolene is now authorized for sale, access to dantrolene is still limited in China, as well as in some developing countries worldwide.3 Dantrolene mobilization using the real-time emergency system (i.e., the National Remote Emergency System for Malignant Hyperthermia) may be a realistic solution. Dantrolene could be stored in a portion of the major hospitals within a reasonable distance and mobilized immediately when an MH emergency occurs. This system’s applicability can extend to other pharmaceuticals or equipment within a similar context. After the National Remote Emergency System for Malignant Hyperthermia was launched for public use in July 2022, a total of eight suspected MH cases were collected nationwide, with a mortality rate of 12.5%, including one death without the use of dantrolene. Among four patients who were treated with dantrolene, three acquired the drugs mobilized by the National Remote Emergency System for Malignant Hyperthermia. A survey in the United Kingdom showed that 79.8% of hospitals had a recommended stock of dantrolene, enabling 98.9% of hospitals to obtain dantrolene within 1 h.4 Currently, 63 hospitals stocking dantrolene can be searched in National Remote Emergency System for Malignant Hyperthermia and the number is gradually increasing. However, the stock levels of dantrolene are quite insufficient to make dantrolene available to most hospitals in China within 1 h. Hence, it is imperative to establish formal stocking arrangements for dantrolene in China, with a particular focus on Western China where shortages are prevalent. These arrangements are necessary to ensure equitable access to this medication across the entire country.The authors sincerely thank Tao Zhu, M.D. (Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China) and Alen Sam Saji, M.B.B.S. (Department of Anesthesiology, West China Hospital, West China Medical School, Sichuan University, Chengdu, China) for their language editing and valuable suggestions.This research was funded by the National Natural Science Foundation of China (Beijing, China) (72074162).The authors declare no competing interests.