MHAUS – Four Decades of Excellence and a Legacy of Patient Safety

Malignant hyperthermia (MH) is a rare, life-threatening pharmacogenetic disorder triggered in susceptible individuals by exposure to volatile anesthetic gases or depolarizing muscle relaxants. Though uncommon – occurring in approximately one in 100,000 surgical patients – an MH crisis can be rapid, progressive, and catastrophic. When a crisis occurs, every minute counts. Timely recognition and intervention are essential to prevent morbidity and mortality.Excerpt from the MH Operating Room Protocol Poster. Photo courtesy of MHAUS. ©2025 Malignant Hyperthermia Association of the United States.Despite its rarity, MH remains a critical concern for anesthesiologists and perioperative teams due to its unpredictable presentation. Patients often appear healthy until exposed to triggering agents, underscoring the need for vigilance and preparedness across all procedural settings. History and mission Founded in 1981 by Suellen Long Gallamore, Owen Davison, Robert Luckritz, and George Massik – with crucial support from Henry Rosenberg, MD – MHAUS has become a cornerstone of MH research, education, and advocacy. From its grassroots beginnings, MHAUS has grown into a nationally recognized resource for clinicians, patients, and families. The mission of MHAUS is to promote optimal care and safety for MH-susceptible individuals through education, advocacy, support, and dissemination of evidence-based clinical guidelines. Among its most visible tools is the MH Emergency Management Poster, widely displayed in ORs to guide crisis response. Thanks to MHAUS-led initiatives – including clinician education, hotline support, registry development, and the availability of dantrolene, the only known antidote – mortality from MH crises has fallen dramatically, from over 70% to less than 5% today (Can Anaesth Soc J 1966;13:437-43; Anesthesiology 2009;110:89-94). MH Hotline: 24/7 physician expert support One of the most impactful MHAUS services is the MH Hotline, a toll-free consultation line providing 24/7, year-round access to board-certified anesthesiologists with specialized MH expertise. Since its establishment in 1981, it has remained the only service of its kind, offering real-time guidance to clinicians managing MH crises. Early hotline operations were modest, even relying on cofounder Suellen Gallamore's basement and MedicAlert to connect callers with consultants. Today, the hotline manages 400-800 calls annually with 29 trained consultants. New volunteers undergo structured mentorship before handling calls independently. In recognition of decades of extraordinary service, Drs. Kumar G. Belani, Cynthia Wong, and Charles B. Watson were recently honored for more than 30 years of volunteer service to the Hotline. North American MH Registry Launched in 1987 by Drs. David and Marilyn Larach, the North American MH Registry (NAMHR) was designed to streamline data collection from MH cases using standardized reporting tools while maintaining confidentiality. Initially based at Penn State College of Medicine, the registry later moved to the University of Pittsburgh Medical Center (2000). In 2017, it moved to the University of Florida, where it is currently directed by Nikolaus Gravenstein, MD. Merged with MHAUS in 1995, NAMHR now integrates data from hotline calls and has supported numerous research initiatives. Its first landmark study validated the Caffeine Halothane Contracture Test (CHCT) protocol. To date, NAMHR has contributed to more than 25 peer-reviewed publications and over 1,800 citations, covering diagnosis, presentation (including “awake MH”), treatment, genetics, complications, and outcomes. CHCT The CHCT remains the gold-standard diagnostic test for MH susceptibility. Introduced by F.R. Ellis et al. at the first international MH symposium in 1971, this test laid the foundation for modern MH diagnosis and management (Br J Anaesth 1971;43:721-2; Naunyn Schmiedebergs Arch Pharmacol 1972;274:107-9; Br J Anaesth 1975;47:62-5; Anesthesiology 1993;79:1-4). Currently, CHCT is available at limited North American centers, including: University of Minnesota Uniformed Services University of the Health Sciences (Bethesda, Maryland; military personnel only) Toronto General Hospital (Canada). While highly sensitive and specific, CHCT requires a surgical biopsy and specialized laboratory facilities, limiting its availability (Anesthesiology 1998;88:579-88). Genetic testing In contrast, genetic testing has become increasingly accessible and affordable. Techniques including targeted gene panels, whole-exome, or whole-genome sequencing can identify pathogenic mutations, most commonly in the RYR1 and CACNA1S genes. Although genotype-phenotype correlation is incomplete, genetic testing is now often recommended as the first-line diagnostic tool for MH susceptibility. Widespread adoption of genetic testing has also broadened understanding of MH's relationship with other systemic disorders. Evidence suggests that up to 1 in 800 individuals carry pathogenic variants conferring MH risk, which may also predispose them to conditions such as exertional heat stroke, statin myopathy, and other myopathies. Neuroleptic Malignant Syndrome Information Service In 1997, MHAUS collaborated with psychiatry leaders to establish the Neuroleptic Malignant Syndrome Information Service (NMSIS). Neuroleptic malignant syndrome (NMS) is a rare but potentially life-threatening disorder triggered by antipsychotics and other dopamine antagonists, with clinical features – hyperthermia, rigidity, autonomic instability – closely resembling MH. To support clinicians, an NMS Hotline was launched, offering consultation from anesthesiology and psychiatry experts. Although this hotline is no longer in operation, the NMSIS played a key role in increasing awareness, providing timely guidance, and fostering collaboration between anesthesiologists and psychiatrists. Its legacy continues through improved recognition and differentiation of MH and NMS in clinical practice. MHAUS remains steadfast in its mission: to save lives through education, expert guidance, and advancing knowledge of MH and related disorders. Through initiatives such as the MH Hotline, NAMHR, CHCT, and genetic testing, MHAUS continues to lead in patient advocacy, professional support, and scientific discovery. For more information, or to access MH resources, visit mhaus.org.Stacey Watt, MD, MBA, MHPE, FASA, President, MHAUS, Clinical Professor of Anesthesiology, University at Buffalo, and Chief of Service, Department of Anesthesiology, Kaleida Health, Buffalo, New York. @StaceyWattMDDarlene Mashman, MD, Vice President, MHAUS, and Associate Professor, Department of Anesthesiology and Pediatrics, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia.Teeda Pinyavat, MD, MHAUS MH Hotline Medical Director, MHAUS Executive Board, and Associate Professor of Anesthesiology, Division of Pediatric Anesthesiology, Columbia University, New York, New York.

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