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Emergency Department Intubation Success With Succinylcholine Versus Rocuronium: A National Emergency Airway Registry Study.
Ann Emerg Med 2018; 72(6):645-653AE

Abstract

STUDY OBJECTIVE

Although both succinylcholine and rocuronium are used to facilitate emergency department (ED) rapid sequence intubation, the difference in intubation success rate between them is unknown. We compare first-pass intubation success between ED rapid sequence intubation facilitated by succinylcholine versus rocuronium.

METHODS

We analyzed prospectively collected data from the National Emergency Airway Registry, a multicenter registry collecting data on all intubations performed in 22 EDs. We included intubations of patients older than 14 years who received succinylcholine or rocuronium during 2016. We compared the first-pass intubation success between patients receiving succinylcholine and those receiving rocuronium. We also compared the incidence of adverse events (cardiac arrest, dental trauma, direct airway injury, dysrhythmias, epistaxis, esophageal intubation, hypotension, hypoxia, iatrogenic bleeding, laryngoscope failure, laryngospasm, lip laceration, main-stem bronchus intubation, malignant hyperthermia, medication error, pharyngeal laceration, pneumothorax, endotracheal tube cuff failure, and vomiting). We conducted subgroup analyses stratified by paralytic weight-based dose.

RESULTS

There were 2,275 rapid sequence intubations facilitated by succinylcholine and 1,800 by rocuronium. Patients receiving succinylcholine were younger and more likely to undergo intubation with video laryngoscopy and by more experienced providers. First-pass intubation success rate was 87.0% with succinylcholine versus 87.5% with rocuronium (adjusted odds ratio 0.9; 95% confidence interval 0.6 to 1.3). The incidence of any adverse event was also comparable between these agents: 14.7% for succinylcholine versus 14.8% for rocuronium (adjusted odds ratio 1.1; 95% confidence interval 0.9 to 1.3). We observed similar results when they were stratified by paralytic weight-based dose.

CONCLUSION

In this large observational series, we did not detect an association between paralytic choice and first-pass rapid sequence intubation success or peri-intubation adverse events.

Authors+Show Affiliations

Department of Emergency Medicine, San Antonio Uniformed Services Health Education Consortium, San Antonio, TX. Electronic address: Michael.D.April@post.harvard.edu.United States Army Institute of Surgical Research, San Antonio, TX.Brigham and Women's Hospital and Harvard Medical School Departments of Emergency Medicine, Boston, MA.United States Army Institute of Surgical Research, San Antonio, TX.Brigham and Women's Hospital and Harvard Medical School Departments of Emergency Medicine, Boston, MA.United States Army Institute of Surgical Research, San Antonio, TX.United States Army Institute of Surgical Research, San Antonio, TX.Department of Emergency Medicine, San Antonio Uniformed Services Health Education Consortium, San Antonio, TX.Department of Emergency Medicine, San Antonio Uniformed Services Health Education Consortium, San Antonio, TX.Brigham and Women's Hospital and Harvard Medical School Departments of Emergency Medicine, Boston, MA.No affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Multicenter Study
Observational Study
Research Support, U.S. Gov't, Non-P.H.S.

Language

eng

PubMed ID

29747958

Citation

April, Michael D., et al. "Emergency Department Intubation Success With Succinylcholine Versus Rocuronium: a National Emergency Airway Registry Study." Annals of Emergency Medicine, vol. 72, no. 6, 2018, pp. 645-653.
April MD, Arana A, Pallin DJ, et al. Emergency Department Intubation Success With Succinylcholine Versus Rocuronium: A National Emergency Airway Registry Study. Ann Emerg Med. 2018;72(6):645-653.
April, M. D., Arana, A., Pallin, D. J., Schauer, S. G., Fantegrossi, A., Fernandez, J., ... Brown, C. A. (2018). Emergency Department Intubation Success With Succinylcholine Versus Rocuronium: A National Emergency Airway Registry Study. Annals of Emergency Medicine, 72(6), pp. 645-653. doi:10.1016/j.annemergmed.2018.03.042.
April MD, et al. Emergency Department Intubation Success With Succinylcholine Versus Rocuronium: a National Emergency Airway Registry Study. Ann Emerg Med. 2018;72(6):645-653. PubMed PMID: 29747958.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Emergency Department Intubation Success With Succinylcholine Versus Rocuronium: A National Emergency Airway Registry Study. AU - April,Michael D, AU - Arana,Allyson, AU - Pallin,Daniel J, AU - Schauer,Steven G, AU - Fantegrossi,Andrea, AU - Fernandez,Jessie, AU - Maddry,Joseph K, AU - Summers,Shane M, AU - Antonacci,Mark A, AU - Brown,Calvin A,3rd AU - ,, Y1 - 2018/05/07/ PY - 2017/10/29/received PY - 2018/03/04/revised PY - 2018/03/06/accepted PY - 2018/5/12/pubmed PY - 2019/8/14/medline PY - 2018/5/12/entrez SP - 645 EP - 653 JF - Annals of emergency medicine JO - Ann Emerg Med VL - 72 IS - 6 N2 - STUDY OBJECTIVE: Although both succinylcholine and rocuronium are used to facilitate emergency department (ED) rapid sequence intubation, the difference in intubation success rate between them is unknown. We compare first-pass intubation success between ED rapid sequence intubation facilitated by succinylcholine versus rocuronium. METHODS: We analyzed prospectively collected data from the National Emergency Airway Registry, a multicenter registry collecting data on all intubations performed in 22 EDs. We included intubations of patients older than 14 years who received succinylcholine or rocuronium during 2016. We compared the first-pass intubation success between patients receiving succinylcholine and those receiving rocuronium. We also compared the incidence of adverse events (cardiac arrest, dental trauma, direct airway injury, dysrhythmias, epistaxis, esophageal intubation, hypotension, hypoxia, iatrogenic bleeding, laryngoscope failure, laryngospasm, lip laceration, main-stem bronchus intubation, malignant hyperthermia, medication error, pharyngeal laceration, pneumothorax, endotracheal tube cuff failure, and vomiting). We conducted subgroup analyses stratified by paralytic weight-based dose. RESULTS: There were 2,275 rapid sequence intubations facilitated by succinylcholine and 1,800 by rocuronium. Patients receiving succinylcholine were younger and more likely to undergo intubation with video laryngoscopy and by more experienced providers. First-pass intubation success rate was 87.0% with succinylcholine versus 87.5% with rocuronium (adjusted odds ratio 0.9; 95% confidence interval 0.6 to 1.3). The incidence of any adverse event was also comparable between these agents: 14.7% for succinylcholine versus 14.8% for rocuronium (adjusted odds ratio 1.1; 95% confidence interval 0.9 to 1.3). We observed similar results when they were stratified by paralytic weight-based dose. CONCLUSION: In this large observational series, we did not detect an association between paralytic choice and first-pass rapid sequence intubation success or peri-intubation adverse events. SN - 1097-6760 UR - https://www.unboundmedicine.com/medline/citation/29747958/Emergency_Department_Intubation_Success_With_Succinylcholine_Versus_Rocuronium:_A_National_Emergency_Airway_Registry_Study_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0196-0644(18)30318-4 DB - PRIME DP - Unbound Medicine ER -