Emergency Department Intubation Success With Succinylcholine Versus Rocuronium: A National Emergency Airway Registry Study
April, M.D., et al, Ann Emerg Med 72(6):645, December 2018
Intubating patients and performing RSI are critical components of emergency medicine, and there is continued debate regarding the best paralytic agent to use.
Succinylcholine is quick on and quick off, but causes muscle fasciculation and can increase potassium. It carries some contraindications (known or suspected elevated potassium, burns >24 hours, muscular dystrophy); Rocuronium takes slightly longer to work and lasts longer.
The authors present National Emergency Airway Registry (NEAR) data on 5,244 intubations from 22 centers.
Succinylcholine was used more frequently (about 60% of the time) but first pass intubation success was similar at 87.0% for succinylcholine and 87.5% for rocuronium; this success rate held after adjusting for relevant variables (e.g. airway characteristics).
Adverse events were also the same (14.7% for succinylcholine vs. 14.8% for rocuronium) and all pretty minor - most of it was transient hypoxia.
EDITOR’S COMMENTARY: Although not practice changing, this informative study makes it clear that first pass success and likelihood of favorable intubating conditions are excellent with both succinylcholine and rocuronium and that we are choosing agents correctly as the serious adverse event rate was negligible. However, this is not a trial so we don’t gain any insight into which one is better or worse for all comers.
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